Hormone may help dieters keep weight off: U.S. study

Julie Steenhuysen for Reuters reports Falling levels of a hormone called leptin that helps the brain resist tempting foods may explain why people who lose weight often have a hard time keeping it off, U.S. researchers said on Friday.

Restoring leptin to pre-diet levels may reverse this problem, they said, offering a way for weary dieters to finally win the weight battle.

"When you lose weight you've created about the perfect storm for regaining weight," said Michael Rosenbaum of Columbia University Medical Center in New York, whose research appears in the Journal of Clinical Investigation.

After weight loss Rosenbaum said the metabolism not only becomes more efficient, so the body needs fewer calories, but the brain becomes more vulnerable to tasty-looking treats.

"Areas of your brain involved in telling you not to eat seem to be less active. You are more responsive to food and you are less in control of it," he said in a telephone interview.

Leptin is a natural appetite suppressant secreted by fat cells in the body. Its discovery created a stir in the 1990s when researchers found leptin caused mice to eat less and lose weight. This rarely happens in humans.

Since then researchers have been looking the best way to use the hormone to help treat obesity.

In earlier studies, researchers found that when people lose weight, leptin levels fall as the body tries to protect its energy stores.

Rosenbaum investigated the impact of this loss of leptin on the brains of people who had lost weight, and whether replacing the hormone might help them keep off the weight.

He used an imaging technique known as functional magnetic resonance imaging that shows activity in the brain. The researchers studied six obese patients before and after going on a hospital-supervised diet that reduced their body weight by 10 percent.

People were shown pictures of food and non-food items, such as an apple or a yo-yo. The researchers found that after weight loss, areas in the brain responsible for regulating food intake were less active when people were shown food images. Areas in the brain responsible for emotion were more active.

When the researchers restored leptin to the levels before the dieting, these changes were largely reversed.

Similar results have been seen in people with a rare genetic condition in which their bodies do not make leptin.

Rosenbaum believes leptin could be a useful tool in helping people maintain weight loss. "The idea is there should be a whole new class of therapies to help us keep weight off after we have lost it," he said.

BIAA Legislative Update June 2008-3

Laura Shiebelhut asked me to forward this Legislative Update. Brain Injury Association of America
Policy Corner E-Newsletter – June 27, 2008
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
Dear Advocates:


Legislative activity related to traumatic brain injury policy ensued on numerous fronts this week, as Congress made progress on several bills before leaving town for a week-long July 4 recess beginning on Monday.

Progress on appropriations occurred this week on the Senate side, as the full Senate Appropriations Committee marked up and approved its Fiscal 2009 Labor, Health and Human Services (HHS), and Education funding bill.

Meanwhile – on the other side of the Capitol - as marked up on the Subcommittee level last week, the House Labor, Health and Human Services (HHS), and Education Appropriations funding measure contains increased funding for some federal TBI programs. Unfortunately, this bill was not approved by the full House Appropriations Committee on Thursday, as a major breakdown in the Committee’s markup process occurred as a result of partisan disputes. The fate of all House appropriations bills are now uncertain.

Progress on several important bills not related to appropriations also took place this week. On Thursday, the Senate Veterans Affairs Committee approved provisions contained in S. 2921, The Caring for Wounded Warriors Act. BIAA has strongly supported and endorsed this legislation, which was recently introduced by Sen. Clinton (D-NY), and would strengthen supports for family caregivers of returning servicemembers with TBI.

On Wednesday, the House of Representatives passed the ADA Amendments Act of 2008 (H.R. 3195) with strong bipartisan backing by a vote of 402-15. Earlier in the week, BIAA formally endorsed this legislation, which is designed to strengthen protections for individuals with disabilities originally enacted through the Americans with Disabilities Act (ADA) in 1990.
Also this week, the Senate approved a compromise version of the war supplemental funding bill, readying the legislation for president’s expected signature. This legislation contained a moratorium – strongly supported by BIAA - on the implementation of several harmful Medicaid regulations.

Finally, the House and Senate were unable to agree on a final Medicare package, which would have prevented deep cuts beginning on July 1 in Medicare payment rates for physicians. Negotiations on such a package are expected to continue when Congress resumes session on Monday, July 7.

__________________________________________________________________
Labor-HHS-Education Appropriations Bill Advances in Senate; Stalls in House
Progress on appropriations occurred this week on the Senate side, as the full Senate Appropriations Committee marked up and approved its Fiscal 2009 Labor, Health and Human Services (HHS), and Education funding bill.

The Senate’s markup provided the same funding amounts for several TBI programs as last year, including $5.7 million for TBI programming within the Centers for Disease Control and Prevention (CDC) and $8.754 million for the HRSA TBI State Grant Program.

Meanwhile, on the other side of the Capitol, as marked up on the Subcommittee level last week, the House Labor, Health and Human Services (HHS), and Education Appropriations funding measure contains increased funding for some federal TBI programs compared to last year. The House Subcommittee markup includes $11 million for the HRSA TBI State Grant Program (+$2.246 million over last year) and $6.6 million for TBI programming within CDC (+$0.9 million over last year).

Unfortunately, though, this bill was not approved by the full House Appropriations Committee on Thursday, as a major breakdown in the Committee’s markup process occurred as a result of partisan disputes. In fact, partisan vitriol reached such a high level during the attempted House markup of the Labor-HHS-Education funding bill that Rep. Obey (D-WI), Chairman of the House Appropriations Committee, threatened not to allow any further progress to occur this year on House appropriations bills. Stay tuned.

Senate Veterans Affairs Committee Approves Caring for Wounded Warrior Act Provisions
On Thursday, the Senate Veterans Affairs Committee approved provisions contained in S. 2921, The Caring for Wounded Warriors Act, S. 2921. BIAA has strongly supported and endorsed this legislation, and several recommendations made by BIAA during the legislative drafting process were incorporated into the bill.

Provisions in the legislation, which was recently introduced by Sen. Clinton (D-NY), would strengthen supports for family caregivers of returning servicemembers with TBI. Specifically, provisions would require two pilot programs to be implemented through the Department of Veterans Affairs, improving the resources available to those caring for returning servicemembers with TBI.

A quote from BIAA President and CEO Susan H. Connors was included in Sen. Clinton’s press release announcing passage of the bill’s provisions:
“Traumatic brain injury not only affects individuals but entire families as well. The Brain Injury Association of America applauds Senator Clinton and Members of the Senate Veterans Affairs Committee for their leadership in passing this legislation, which compassionately and responsibly provides much-needed supports to family caregivers of servicemembers with TBI,” said Susan H. Connors, President and CEO of BIAA.

BIAA will continue to monitor the progress of this important bill, and thanks advocates for urging their Members of Congress to become cosponsors of this legislation.
House Passes ADA Amendments Act of 2008 By Wide Margin

On Wednesday, the House of Representatives passed the ADA Amendments Act of 2008 (H.R. 3195) with strong bipartisan backing by a vote of 402-15. Earlier in the week, BIAA formally endorsed this legislation, which is designed to strengthen protections for individuals with disabilities originally enacted through the Americans with Disabilities Act (ADA) in 1990.

The ADA Amendments Act of 2008 is the product of meaningful negotiations and discussions with experts in the disability community, business and employer groups, Members of Congress, and congressional staff. The measure prohibits consideration of mitigating measures in the determination of whether an individual has a disability, with the exception of ordinary eyeglasses and contact lenses. The bill also affords broad coverage for individuals “regarded as” having a disability under the ADA.

A copy of BIAA’s endorsement letter, which was circulated to all Members of the House of Representatives prior to the vote this week, is available at http://www.biausa.org/policyissues.htm.

New brain map technology set to revolutionise disease diagnoses

Led by A/Prof Gary Egan, the Neuroimaging group at the Howard Florey Institute said that his group was using one of the most powerful Magnetic Resonance Imaging (MRI) scanners in the world - an ultra-high field 7 Tesla - to help develop the new brain mapping technology.

In a ground-breaking move, researchers at the Howard Florey Institute in Melbourne are developing a new technology to create individualised brain maps that will change the way disease is diagnosed, and will also enhance the accuracy of brain surgery.

Right now, researchers and neurosurgeons use coarse maps of the brain's structure that are based on a small number of individuals' brains after death. But these maps fail to show differences that can occur between people's brains.

This new brain mapping technology will be created by developing acquisition and analysis processes and software that will offer microscopic level investigation of individual brains.

In this project, Florey researchers are contributing neuroscience, engineering and mathematical expertise, while collaborators from the Neuroscience Research Institute in South Korea are providing the equipment.

The researchers are hoping that this technology will become widely available in the next two to three years.

Led by A/Prof Gary Egan, the Neuroimaging group at the Howard Florey

Read more click here.

Too Much Alcohol can Cause Permanent Brain Damage

You might not just realize this while downing a mug of chilled beer on a summer afternoon, but a new study has revealed that too much alcohol can cause permanent damage to brain.

The study has shown that too much alcohol can also cause brain injury and degeneration by inhibiting insulin and insulin-like growth factor (IGF)

Insulin is not just for diabetes anymore.  New evidence reveals it is vital to normal brain function and alchohol inhibits it.

With the help of postmortem human brain tissue, researchers showed that chronic alcohol abuse can decrease levels of genes needed for brain cells to respond to insulin/IGF, leading to neurodegeneration similar to that caused by Type 2 diabetes mellitus.

"Insulin is one of the most important hormones in the body," said Suzanne de la Monte, professor of pathology/ neuropathology and clinical neuroscience at Rhode Island Hospital and the Warren Alpert School of Medicine at Brown University.

Brain Expert Sees Progress

I have read many articles and book chapters authored by Dr. Erin Bigler.  Dr. Bigler is a neuropsyhologist in Utah.  Dr. Bigler has assisted me in understanding neuroimaging along with neuropsychological issues of many of my clients.

Dr, Bigler was featured in a recent article in the Honolulu Star:

Technology to diagnose brain injuries has improved tremendously over 30 years, says Dr. Erin Bigler, noted clinical neurophysiologist.

"But the problem is we haven't made tremendous gains in how to treat these people," he added in an interview. "The brain is very complicated."

Bigler is a professor of psychology and neuroscience at Brigham Young University, adjunct professor of psychiatry at the University of Utah School of Medicine and faculty member of the Utah Brain Institute.

He is an author and researcher who is sharing his expertise with Hawaii psychologists and physicians as the Morita Distinguished Fellow for 2008 at the Rehabilitation Hospital of the Pacific.

He is also giving a class for psychology and neuropsychology fellows at Tripler Army Medical Center and a new neuroscience class at Brigham Young-Hawaii.

Bigler was at the Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix in 1975 when it was one of the first places to get computerized tomography.

"The first time I saw a CT scanner, it was like, 'Wow!'" he said. "It was very primitive, but we were now actually looking at brain tissue, not just a silhouette of the internal cavity."

Now, with improved CTs and magnetic resonance imaging, he said, "What we view today is exactly what you would see if you had an anatomic specimen."

This 3-D image shows a corpus callosum, which connects two halves of the brain. The different colors show the direction of major fiber tracks.


While the new imaging tools allow physicians to better diagnose problems in the brain, he said, "we're still in infancy in how to treat these. That's the focus that is so important right now.

"Brain tissue doesn't regenerate," he explained. "Therefore you have to deal with pathways that survive and how to re-engage those pathways. That is the goal of rehabilitation when the brain is injured."

The brain is well designed to withstand minor problems, Bigler said. "It recovers from a fall and a blow quite well. But it's a new era we're in. The brain isn't designed to withstand high-velocity impact," he said, such as from motor accidents, sports and military combat.

Gladiators were not at risk for traumatic brain injuries as much as National Football League players, he said.

An estimated 40,000 head injuries have occurred in Afghanistan and Iraq, Bigler said, noting former ABC World News co-anchor Bob Woodruff's recovery from traumatic brain injury in Iraq was "unbelievable." He said Woodruff's case shows much more could be done to treat brain injuries "if we had unlimited resources."

"Traumatic brain injury is a huge issue," he said. Many people in the past discounted effects of a mild head injury or concussion, thinking it could not have significant consequences, he said.

Most people do recover from a mild concussion, Bigler said, explaining he was knocked out playing football when he was a high school senior. He spent the night in the hospital but played the game the next weekend and went on to graduate, he said.

But more than 1 million to 1.5 million Americans have concussions, and 5 percent to 10 percent "don't have a good outcome," he said.

He said the key to knowing how to treat a brain disorder is to first understand the pathology, which is what he has been focusing on.

"When we started doing three-dimensional work with the brain ... it took us over six years to analyze the data because all of it had to be done by hand," he said. With automation, he said, his lab and others "can do in minutes to hours what would literally take us months to years to do a few years ago."

"We're looking to centers like REHAB to take the information and hopefully use it to guide therapies, to understand the brain better.

"With newer imaging techniques," Bigler said, "we may be able to target specific areas and tell how functional that area is, and there may be ways to engage that brain region" with medications, cell regeneration, cell growth stimulation, reconnections or repairing neurons.

The Morita Distinguished Fellow Program was established in 2003 in memory of SONY founder Akio Morita and his wife, Yoshiko. Morita received treatment at REHAB Hospital and became one of its major supporters.

Credit: By Helen Altonn haltonn@starbulletin.com

BIAA Legislative Update June3

SPECIAL LEGISLATIVE ACTION ALERT: BIAA recently issued a Legislative Action Alert on Fiscal Year 2009 TBI appropriations. BIAA continues to urge advocates to make contact with their representatives in Congress and urge them to increase appropriations for federal TBI programs this year. If you have not already done so, please visit BIAA’s website TODAY to take action: http://capwiz.com/bia/issues/alert/?alertid=11411806.

Progress on appropriations occurred this week in the House of Representatives, as the House Labor, Health and Human Services (HHS), and Education Appropriations Subcommittee marked up, and approved by voice vote, its Fiscal 2009 spending bill on Thursday.

In addition, on Thursday evening, the House approved the latest compromise version of the war supplemental funding bill and the Senate is expected to take the bill up and pass it next week. This compromise bill contains a moratorium, strongly supported by BIAA, to delay the implementation of several harmful Medicaid regulations until at least April 2009.

Congress also made progress on a major disability rights bill, as both the House Education and Labor Committee and the House Judiciary Committee marked up and approved the ADA Amendments Act of 2008 (H.R. 3195).

Finally, BIAA is excited to announce that it has joined a consortium of organizations working to put on a Dual Presidential Town Hall in Killeen, Texas. Killeen is home to Fort Hood, the largest U.S. military installation in the world. Senator McCain and Senator Obama have been invited to participate to discuss issues of mutual importance for our country, before an audience comprised of the men and women whose service and sacrifice ensure that these events continue through their defense of our country and of our Constitution. More information will be forthcoming pending further developments.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org 

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.

Looking Scared!

Dr Joshua M Susskind and colleagues from the Department of Psychology, University of Toronto in Canada carried out this research, supported by a Canada Research Chairs program and a Natural Sciences and Engineering Research Council grant. It was published in the peer-reviewed science journal Nature Neuroscience.

"Fearful faces 'spot threats better'" is the headline on Channel 4 News. The Observer also reported on the same study at the weekend, claiming that a team of Canadian neuroscientists had solved the evolutionary mystery of why our faces contort in a certain way when we are scared.

The researchers found that when a group of students were told to make their eyes bulge or nostrils flare to mimic the facial expressions of fear, their ability to sense danger improved more than when they mimicked the face of disgust. This, the researchers say, supports Darwin's 1872 idea that facial expressions of emotion are often remarkably similar across human cultures, and even the animal kingdom, implying they may have a common evolutionary benefit. The researchers say that their experiment shows how a fearful expression is a protective one rather than a social one because it increases the range of vision, speeds up eye movement and improves airflow through the nose.

It is not clear how the facial expressions of fear or disgust might affect the selection processes that form the basis of evolutionary theory. However, the results of this testing demonstrate a plausible sequence of events for how selection might occur.

Advances in Alzheimer's Cure

Neuroscientist Dr Elizabeth Coulson's research was recently published in the Journal of Neuroscience.

Queensland Brain Institute (QBI) neuroscientists at UQ have discovered a new way to reduce neuronal loss in the brain of a person with Alzheimer's disease.

Memory loss in people with Alzheimer's disease can be attributed to several factors.
To read more click here.

BIAA Legislative Update June2

Brain Injury Association of America
Policy Corner E-Newsletter – June 13, 2008
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
Dear Advocates:

Now that Congress has successfully passed this year’s budget, next week will feature key activity on appropriations on numerous fronts.

Late this week, Fiscal 2009 302(b) Appropriations Subcommittee Allocations were announced, including an allocation of $153.1 billion for the Labor, Health and Human Services (HHS), and Education Appropriations Subcommittee, which funds several important federal TBI programs.
House and Senate Appropriations markup schedules were also announced this week, with the House tentatively set to mark up its Labor-HHS-Education appropriations bill on June 19, and the Senate scheduled to mark up its version of the bill during the week of June 23.

In addition, it is possible the House may take up the war supplemental appropriations bill (H.R. 2642) next week, as Democratic leaders have made it a priority to pass this funding bill before Congress recesses for the Fourth of July.

In other developments, this past week the House Committee on Veterans Affairs held an important hearing on implementing the Wounded Warrior provisions contained in last year’s defense authorization bill, including several BIAA-supported provisions focused specifically on TBI care for returning servicemembers.

On Wednesday, the House Committee on Veterans Affairs also approved H.R. 2818, legislation endorsed by BIAA which would establish Epilepsy Centers of Excellence within the VA.
SPECIAL LEGISLATIVE ACTION ALERT: BIAA recently issued a Legislative Action Alert on Fiscal Year 2009 TBI appropriations. BIAA continues to urge advocates to make contact with their representatives in Congress and urge them to increase appropriations for federal TBI programs this year. If you have not already done so, please visit BIAA’s website TODAY to take action:

http://capwiz.com/bia/issues/alert/?alertid=11411806.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org
BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.

How doctors can think better

How Doctors Think is striking a chord with doctors.  Doctors' thinking processes, in particular, need attention, according to Jerome Groopman, MD, hematologist and oncologist. Groopman's 2007 book, How Doctors Think (Houghton Mifflin), called "a mix of science and soul" by New York Times reviewer William Grimes, has struck a chord with physicians, insurers, and others concerned about why so many medical errors occur and how to prevent them.

I find the latest advances in legal thinking and the use of heuristics is also cutting edge thinking in medicine. 

The following is an interview printed in Medical Economics by Leslie Kane MACC of Dr. Groopman:

Kane: You described three heuristics that doctors typically use—"the three As," as you call them. What are they?

Groopman: The first is anchoring. We quickly latch onto what we think the diagnosis is, and selectively accept or ignore information that corresponds with what we expect to find. This influences the questions we choose to ask, and how we ask them. That, in turn, tends to focus patients' answers. So we're more likely to find what we've already decided we're looking for.

The second heuristic is availability. That's the tendency to judge the likelihood of a diagnosis based on how readily relevant examples come to mind. During a flu epidemic, for instance, if you see 15 people with the flu, when the 16th person comes in saying he feels clammy and has a bit of fever, you automatically assume it's the flu. But it might be something else entirely.

Or if you've had a very dramatic case—which all doctors do—it imprints on your mind. When you see patients with similar physical findings, you superimpose that prior dramatic case on the one in front of you.

The third heuristic is attribution. We all hold stereotypes in our mind and are very quick to attribute complaints to a larger stereotype. If a patient is slovenly, hasn't shaved, has rum on his breath, and has an enlarged liver, he becomes alcoholic cirrhosis even if he says he doesn't drink much.

Kane: Doesn't everyone use heuristics to get through life? That's how people learn by experience, and make it through the day without having to evaluate every occurrence from scratch. How are doctors supposed to turn off these very human thinking mechanisms?

Groopman: You're correct. These kinds of mental shortcuts are wired in our brains. Physicians in particular invoke heuristics because we're working under conditions of time pressure and uncertainty, with limited data.

Kane: Given that heuristics are hard-wired, how can doctors overcome them?

Groopman: We need to remember that the three heuristics I mentioned are all traps. So you need to do metacognition—think about your thinking. To do that, ask yourself some simple questions when evaluating patients: "What else could it be?" Or "Am I being too quick to lump it all together?" Or "Can two things be going on at once?" Because maybe the person does drink, but that doesn't mean there can't be another problem that accounts for his enlarged liver.

These are the kinds of questions that when we were residents, we asked our attendings or the attending physicians asked us. But now that we're in practice, it becomes harder to ask these questions because we're working within our own heads.

Kane: With today's shorter patient visits, pay for performance, and evidence-based medicine, doctors are encouraged to use algorithms and decision trees to diagnose. The system doesn't encourage doctors to take more time for open-ended thinking. How can doctors find the time to think more and still make a good living?

Groopman: The system has gone headlong into checking off the boxes and following all the outcomes and decision trees. I believe medicine is still something that requires an understanding of the individual.

I've spent years in research for evidence-based medicine, and I'm very aware of the limits and deficiencies of how those data are used. They reflect a very, very cherry-picked group of patients. They use patients who aren't on seven medications, and they come up with statistical averages. How closely does the patient in your office correspond with the data-based medicine? Are you supposed to say to your patient, "Please leave my office, you don't fit the data"?

Kane: It sounds like there isn't really an answer to the situation. Hearing from doctors who are struggling with diminished reimbursements, I get the impression that the public expects doctors to be more altruistic than other human beings and not care about the financial end.

Groopman: I think this is a caring profession; it still attracts people who want to do good and people who are altruistic and dedicated. But that doesn't mean you shouldn't make a living. Being a doctor doesn't mean you're required to be a monk and give up the world. Physicians are being pushed to work ever harder, while at the same time the system is changing in ways that prevent profit from going to the people who do the work.

Kane: Any other wisdom or advice you'd give doctors?

Groopman: Learning how doctors think has helped me give better care, and has prevented me from making the kinds of mistakes I made in the past. I feel it has restored to me some degree of control because I know my mind better. And that control enables me to more effectively buck the system.

Groopman brings up important information about tuning into your own thinking. Doing so takes some attention and practice; and because thinking short-cuts are so human, it may be a challenge. But doctors have never been ones to take the easy path, especially when an activity can sharpen their expertise and enhance their patients' lives.

Groopman holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is Chief of Experimental Medicine at the Beth Israel Deaconess Medical Center. His earlier books include The Measure of Our Days (1997), which explores the spiritual lives of patients with serious illness; Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine (2000); and The Anatomy of Hope: How People Prevail in the Face of Illness (2005). He is also a staff writer at The New Yorker.

Neurogenesis

Italian Scientists in Turin have discovered evidence of neurogenesis, the creation of new neurons, in the cerebellum of rabbits.

These findings  mean stimulating the growth of the new neurons might be of greater value for the repair of injured brain tissue than stem cells.

The researchers said they are also considering the hypothesis that the neurogenesis they discovered in rabbits might well be related to the rabbits' relatively longer lifespan, compared with the lifespan of rodents, their close relatives. This authors say that hypothesis could create new areas of research concerning neurogenesis in the human brain.

Progesterone in Traumatic Brain Injury

Progesterone in traumatic brain injury: time to move on to phase III trials.

Crit Care. 2008 May 29;12(3):153 published an article by  Vandromme M, Melton SM, Kerby JD.  The following is the abstract. 

ABSTRACT: There are several candidate neuroprotective agents that have been shown in preclinical testing to improve outcomes following traumatic brain injury (TBI). Xiao and colleagues have performed an in hospital, double blind, randomized, controlled clinical trial utilizing progesterone in the treatment of patients sustaining TBI evaluating safety and long term clinical outcomes. These data, combined with the results of the previously published ProTECT trial, show progesterone to be safe and potentially efficacious in the treatment of TBI. Larger phase III trials will be necessary to verify results prior to clinical implementation. Clinical trials networks devoted to the study of TBI are vital to the timely clinical testing of these candidate agents and need to be supported.

Brain Damage

Brain damage may occur due to a wide range of conditions, illnesses, injuries, and as a result of iatrogenesis. Possible causes of widespread (diffuse) brain damage include prolonged hypoxia (shortage of oxygen), poisoning by teratogens (including alcohol), infection, and neurological illness. Chemotherapy can cause brain damage to the neural stem cells and oligodendrocyte cells that produce myelin. Common causes of focal or localized brain damage are physical trauma (traumatic brain injury), stroke, aneurysm, surgery, or neurological illness.

The extent and effect of brain injury is often assessed by the use of neurological examination, neuroimaging, and neuropsychological assessment.

Brain injury does not necessarily result in long-term impairment or disability, although the location and extent of damage both have a significant effect on the likely outcome. In serious cases of brain injury, the result can be permanent disability, including neurocognitive deficits, delusions (often specifically monothematic delusions), speech or movement problems, and mental handicap. There may also be personality changes. Severe brain damage may result in persistent vegetative state, coma, or death.

Various professions may be involved in the medical care and rehabilitation of someone who suffers impairment after brain damage. Neurologists, neurosurgeons, and physiatrists are physicians who specialise in treating brain injury. Neuropsychologists (especially clinical neuropsychologists) are psychologists who specialise in understanding the effects of brain injury and may be involved in assessing the extent of brain damage or creating rehabilitation programmes. Occupational therapists may be involved in running rehabilitation programs to help restore lost function or help re-learn essential skills.

It is a common misconception that brain damage sustained during childhood has a better chance of successful recovery than similar injury acquired in adult life. It is contested that in recent studies, severe brain damage inflicted upon children can be alleviated by the interaction of nicotinamide repropagation in nerve cells. In fact, the consequences of childhood injury may simply be more difficult to detect in the short term. This is because different cortical areas mature at different stages, with some major cell populations and their corresponding cognitive faculties remaining unrefined until early adulthood. In the case of a child with frontal brain injury, for example, the impact of the damage may be undetectable until that child fails to develop normal executive functions in his or her late teens and early twenties.

The effects of impairment or disability resulting from brain injury may be treated by a number of methods, including medication, psychotherapy, neuropsychological rehabilitation, snoezelen, surgery, or physical implants such as deep brain stimulation.

BIAA Legislative Update June 2007-1

The Brain Injury Association of America appreciates me passing this latest legislative news on to my readers.

Brain Injury Association of America

Policy Corner E-Newsletter – June 6, 2008
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
Dear Advocates:

Congress returned from a week-long Memorial Day recess this week, and proceeded to successfully pass a fiscal 2009 budget resolution (S. Con Res 70).

Also this week, BIAA joined coalition efforts focused on several important policy issues impacting the disability community, including efforts to protect Medicaid, strengthen the Americans with Disabilities Act, and formally comment on recently proposed rules concerning the Developmental Disabilities Act.

In other developments, the Senate passed by voice vote on Tuesday a package of veterans’ mental health bills. This package included legislation endorsed by BIAA which authorizes the establishment of six VA Epilepsy Centers of Excellence (Epilepsy CoEs) across the country to lead the way in epilepsy diagnosis, research, treatment and surgery. The House Veterans Affairs Health Subcommittee passed an amended version of the bill’s companion in the House, H.R. 2818, on Thursday.

SPECIAL LEGISLATIVE ACTION ALERT: BIAA issued a Legislative Action Alert on Fiscal Year 2009 TBI appropriations two weeks ago. Now that Congress has successfully passed a final budget resolution, BIAA continues to urge advocates to make contact with their representatives in Congress and urge them to increase appropriations for federal TBI programs this year. If you have not already done so, please visit BIAA’s website TODAY to take action:

http://www.biausa.org/policyissues.htm

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637;  lschiebelhut@biausa.org

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.
To sign up to receive future BIAA Policy Corner E-Newsletters and Legislative Action Alerts, please go to http://capwiz.com/bia/mlm/signup/
__________________________________________________________________
Congress Passes Fiscal 2009 Budget Resolution


The House of Representatives passed the final fiscal 2009 budget resolution conference report (S. Con Res 70) on Thursday, by a narrow vote of 214-210. The Senate adopted the same resolution on June 4 by a vote of 48-45.

This marks the first year since 2000 that Congress has been able to successfully agree upon a final budget resolution. Congressional budget resolutions do not become law but rather serve as a blueprint, setting the parameters for spending and tax bills throughout the year.

Final passage of this year’s budget resolution facilitates the establishment of official funding (“302b”) allocations for the fiscal 2009 Labor-HHS-Education Appropriations bill, which funds multiple TBI-related programs, including programs authorized through the TBI Act. Once 302b Subcommittee allocations have been determined, the fiscal 2009 appropriations process can officially go forward with committee markups and other official action.

BIAA recently signed on to a coalition letter urging Appropriations Committee Chairs in both chambers to allocate an additional $15 billion over last year’s funding levels for the Labor-HHS-Education Subcommittees.

According to CQ Today, “The Democrats’ budget resolution calls for $24.5 billion more in discretionary spending than the $991.6 billion President Bush requested. Bush has threatened to veto bills that exceed his target, but Democrats may wait for him to leave office before completing work on these bills. The Appropriations committees will begin work this month, with the first House subcommittee markups next week” (David Clarke, CQ Today, 6/5/2008).

SPECIAL LEGISLATIVE ACTION ALERT: BIAA issued a Legislative Action Alert on Fiscal Year 2009 TBI appropriations two weeks ago. Now that Congress has successfully passed a final budget resolution, BIAA continues to urge advocates to make contact with their representatives in Congress and urge them to increase appropriations for federal TBI programs this year. If you have not already done so, please visit BIAA’s website TODAY to take action:

http://capwiz.com/bia/issues/alert/?alertid=11411806.

Also this week, BIAA joined coalition efforts focused on several important policy issues impacting the disability community, including efforts to protect Medicaid, strengthen the Americans with Disabilities Act (ADA), and formally comment on recently proposed rules concerning the Developmental Disabilities Act.

BIAA joined other advocacy organizations in signing on to one more letter urging Senate and House Democratic leadership to ensure that a comprehensive moratorium on seven harmful proposed Medicaid rules remains part of any supplemental war spending bill that is sent to the President. BIAA continues to strongly support the moratorium, as implementation of these proposed Medicaid rules would, among other harmful effects, restrict important access to rehabilitation services for many individuals with brain injury.

BIAA also signed on this week in support of a proposed deal on the ADA Restoration Act (ADARA) which has emerged in recent days. The drafted legislative language of this proposed deal on ADARA is aimed at restoring the intent and protections of the Americans with Disabilities Act of 1990, and is supported by numerous other disability advocacy organizations, including the American Association of People with Disabilities and the National Disability Rights Network. BIAA will continue to monitor developments as this legislation progresses.

In addition, BIAA signed on to joint comments of the Consortium for Citizens with Disabilities in response to proposed rules related to the Developmental Disabilities Act. The Comment Letter expresses several concerns regarding the proposed rules, including concern that these regulations were only recently published on April 10, 2008 – almost seven years after the 2000 Developmental Disabilities reauthorization bill mandated publication of these rules, and right in the middle of ongoing efforts to work on the 2008-2009 reauthorization.

Bill to Create VA Epilepsy Centers Progresses in Both Chambers

In other developments, the Senate passed by voice vote on Tuesday a package of veterans’ mental health bills. This package included legislation endorsed by BIAA which authorizes the establishment of six VA Epilepsy Centers of Excellence (Epilepsy CoEs) across the country to lead the way in epilepsy diagnosis, research, treatment and surgery. The House Veterans Affairs Health Subcommittee passed an amended version of the bill’s companion in the House, H.R. 2818, on Thursday.

The full House Veterans Affairs Committee is expected to approve the bill and report it to the floor of the House of Representatives before the end of the month.
In April, BIAA formally endorsed the legislation in a letter stating, “BIAA continues to advocate for the use of all available resources (including civilian sector resources when appropriate), as well as the development of new resources and system capacity within the VA, in order to ensure that all veterans with TBI receive the right care, right now.”

A copy of BIAA’s letter endorsing H.R. 2818 can be obtained by visiting BIAA’s website at the following address:  http://www.biausa.org/policyissues.htm.

Landmark Settlement for Brain Injuries

Landmark Settlement for Individuals with Brain Injuries


SPRINGFIELD, Mass.--(BUSINESS WIRE)--Nearly 2000 individuals with brain injuries will be able to move out of nursing facilities and other institutions under a landmark settlement agreement signed today by state officials and attorneys for the plaintiffs.


The settlement resolves a class action lawsuit, Hutchinson v. Patrick, which was filed in US District Court in Springfield last year on behalf of five individuals, the Brain Injury Association of Massachusetts (BIA-MA) and the Stavros Center for Independent Living. The complaint charges that the Commonwealth is violating the Americans with Disabilities Act for failing to provide adequate community services.

“This is a historic moment for persons with brain injuries in Massachusetts, many of whom have been unnecessarily institutionalized in nursing facilities, often for decades,” said Steven J. Schwartz of the Center for Public Representation, lead counsel for the plaintiffs. “As a result of the settlement, close to 2000 persons with brain injuries finally will be able to live in integrated settings, nearer to their families and their home communities.”

Approximately 8000 people with brain injuries currently reside in nursing and rehabilitative facilities in Massachusetts. At least a quarter of them could successfully transition to integrated community settings if services were available, according to plaintiffs’ co-counsel, Richard Johnston, a partner at Wilmer Hale Cutler Pickering Hale and Dorr.

“Today’s agreement is a first in the nation for people with brain injuries and will serve as a model for other states,” said Arlene Korab, Executive Director of BIA-MA.
The Centers for Disease Control report that 5.3 million Americans are living with disabilities as a result of traumatic brain injuries (TBI) – head injuries caused by external events, such as falls or accidents. Acquired brain injuries (ABI) – caused by internal medical events such as stroke, disease or poisoning – also are significantly prevalent: more than 700,000 Americans suffer new apply to Medicaid-eligible residents of nursing and rehabilitation facilities who have either kind of brain injury. It is the first lawsuit in the nation that seeks community services for persons with all forms of brain injuries, regardless of the cause.
Under the settlement agreement, which is still subject to court approval, the Commonwealth will create two new waiver programs designed to transition individuals with brain injuries from nursing facilities and other institutions to community residences. The programs must be approved by the federal government, which will pay half the cost of both programs. The first program, called the ABI waiver, will serve up to 300 individuals with acquired brain injuries who currently are living in nursing and rehabilitation facilities. The second, called the Community First Demonstration Project, will offer transitional services and provide community placements to 1600 persons with brain injuries in nursing facilities. The programs will be implemented over several years, but should result in approximately 200-250 persons a year leaving nursing facilities.
“When I first learned about the issues being resolved, I was so happy, I filled up with tears,” Catherine Hutchinson, 55, the lead named plaintiff, wrote in a recent email. A mute quadriplegic as a result of a brain-stem stroke in 1996, she lived for more than a decade at the Middleboro Skilled Care Center. “I think about the residents [with brain injury] ... and I know what their empty lives are like,” wrote Hutchinson, who recently moved to The Boston Home, a specialized care facility in Dorchester.

The agreement also requires the Commonwealth to create a new system of community services for persons with brain injuries, including new policies and procedures, a new treatment planning process, a new appeal process for individuals and families, and new quality standards for community services. People in nursing facilities will be offered a choice to receive services in the most integrated setting appropriate to their needs, including their own homes and apartments, or shared living arrangements. In addition, the Commonwealth will establish an education and outreach initiative to inform persons with brain injuries and their families about the new waiver programs as well as the benefits of community living.

Korab applauded the courage of the named plaintiffs who “have opened the door for individuals with brain injury to live independently in the community.”

The majority of people with brain injuries spend weeks or months in acute care hospitals and rehabilitative facilities. Once the acute treatment ends, these individuals still need some level of assistance with personal care and activities of daily living rehabilitative care. However, due to the lack of community-based options for continued rehabilitative care, most of them have no choice but to be admitted to nursing and rehabilitative facilities to have their basic needs met.
When the lawsuit was filed May 17, 2007, Hutchinson described her decade-long institutionalization as being “in prison for a crime I didn’t commit.” In a written statement, she added, “We must find a way to allow people like me to live as independently as possible. I should not have to fight the system when each day I must already fight to communicate, to be understood, make choices and express my feelings.”

The settlement agreement will provide transitional and community services to Hutchinson, the other named plaintiffs and all class members. “For them, the promise of the Americans with Disabilities Act will become a reality,” said Schwartz.
In addition to Hutchinson, originally from Attleboro, the other named plaintiffs are Raymond Puchalski, 59, a Millers Falls resident who has lived for three years at the Kindred/Goddard Hospital’s neurobehavioral unit in Stoughton; Glen Jones, 58, of Haverhill, who has resided at the Worcester Skilled Care Center since 1990; and Nathaniel Wilson, 55, of Springfield, who resides at Wingate of Wilbraham. A fifth named plaintiff, Jason Cates of Westfield, died last fall.
A preliminary hearing on the settlement agreement will be scheduled for mid-June before District Court Judge Michael A. Ponsor in Springfield. Judge Ponsor has been asked to set a final fairness hearing on the agreement for July 25, 2008.

Contacts
Brain Injury Assn of Massachusetts
Pam Bush, 508-475-0032, ext. 18
or
Center for Public Representation
Kathryn Rucker, 617-965-0776
or
WilmerHale
Lauren Coppola, 617-526-6998

Brain Injury Justice

Landmark Settlement for Individuals with Brain Injuries

I received this exciting news from the Brain Injury Association of Massachusettes and the Northwest Brain Injury Association.  I am passing it on to my readers.


SPRINGFIELD, Mass.--(BUSINESS WIRE)--Nearly 2000 individuals with brain injuries will be able to move out of nursing facilities and other institutions under a landmark settlement agreement signed today by state officials and attorneys for the plaintiffs.


The settlement resolves a class action lawsuit, Hutchinson v. Patrick, which was filed in US District Court in Springfield last year on behalf of five individuals, the Brain Injury Association of Massachusetts (BIA-MA) and the Stavros Center for Independent Living. The complaint charges that the Commonwealth is violating the Americans with Disabilities Act for failing to provide adequate community services.


“This is a historic moment for persons with brain injuries in Massachusetts, many of whom have been unnecessarily institutionalized in nursing facilities, often for decades,” said Steven J. Schwartz of the Center for Public Representation, lead counsel for the plaintiffs. “As a result of the settlement, close to 2000 persons with brain injuries finally will be able to live in integrated settings, nearer to their families and their home communities.”


Approximately 8000 people with brain injuries currently reside in nursing and rehabilitative facilities in Massachusetts. At least a quarter of them could successfully transition to integrated community settings if services were available, according to plaintiffs’ co-counsel, Richard Johnston, a partner at Wilmer Hale Cutler Pickering Hale and Dorr.


“Today’s agreement is a first in the nation for people with brain injuries and will serve as a model for other states,” said Arlene Korab, Executive Director of BIA-MA.


The Centers for Disease Control report that 5.3 million Americans are living with disabilities as a result of traumatic brain injuries (TBI) – head injuries caused by external events, such as falls or accidents. Acquired brain injuries (ABI) – caused by internal medical events such as stroke, disease or poisoning – also are significantly prevalent: more than 700,000 Americans suffer new or recurrent strokes every year.


This case and the settlement agreement apply to Medicaid-eligible residents of nursing and rehabilitation facilities who have either kind of brain injury. It is the first lawsuit in the nation that seeks community services for persons with all forms of brain injuries, regardless of the cause.
Under the settlement agreement, which is still subject to court approval, the Commonwealth will create two new waiver programs designed to transition individuals with brain injuries from nursing facilities and other institutions to community residences. The programs must be approved by the federal government, which will pay half the cost of both programs. The first program, called the ABI waiver, will serve up to 300 individuals with acquired brain injuries who currently are living in nursing and rehabilitation facilities. The second, called the Community First Demonstration Project, will offer transitional services and provide community placements to 1600 persons with brain injuries in nursing facilities. The programs will be implemented over several years, but should result in approximately 200-250 persons a year leaving nursing facilities.


“When I first learned about the issues being resolved, I was so happy, I filled up with tears,” Catherine Hutchinson, 55, the lead named plaintiff, wrote in a recent email. A mute quadriplegic as a result of a brain-stem stroke in 1996, she lived for more than a decade at the Middleboro Skilled Care Center. “I think about the residents [with brain injury] ... and I know what their empty lives are like,” wrote Hutchinson, who recently moved to The Boston Home, a specialized care facility in Dorchester.


The agreement also requires the Commonwealth to create a new system of community services for persons with brain injuries, including new policies and procedures, a new treatment planning process, a new appeal process for individuals and families, and new quality standards for community services. People in nursing facilities will be offered a choice to receive services in the most integrated setting appropriate to their needs, including their own homes and apartments, or shared living arrangements. In addition, the Commonwealth will establish an education and outreach initiative to inform persons with brain injuries and their families about the new waiver programs as well as the benefits of community living.


Korab applauded the courage of the named plaintiffs who “have opened the door for individuals with brain injury to live independently in the community.”


The majority of people with brain injuries spend weeks or months in acute care hospitals and rehabilitative facilities. Once the acute treatment ends, these individuals still need some level of assistance with personal care and activities of daily living rehabilitative care. However, due to the lack of community-based options for continued rehabilitative care, most of them have no choice but to be admitted to nursing and rehabilitative facilities to have their basic needs met.


When the lawsuit was filed May 17, 2007, Hutchinson described her decade-long institutionalization as being “in prison for a crime I didn’t commit.” In a written statement, she added, “We must find a way to allow people like me to live as independently as possible. I should not have to fight the system when each day I must already fight to communicate, to be understood, make choices and express my feelings.”


The settlement agreement will provide transitional and community services to Hutchinson, the other named plaintiffs and all class members. “For them, the promise of the Americans with Disabilities Act will become a reality,” said Schwartz.


In addition to Hutchinson, originally from Attleboro, the other named plaintiffs are Raymond Puchalski, 59, a Millers Falls resident who has lived for three years at the Kindred/Goddard Hospital’s neurobehavioral unit in Stoughton; Glen Jones, 58, of Haverhill, who has resided at the Worcester Skilled Care Center since 1990; and Nathaniel Wilson, 55, of Springfield, who resides at Wingate of Wilbraham. A fifth named plaintiff, Jason Cates of Westfield, died last fall.
A preliminary hearing on the settlement agreement will be scheduled for mid-June before District Court Judge Michael A. Ponsor in Springfield. Judge Ponsor has been asked to set a final fairness hearing on the agreement for July 25, 2008.


Contacts
Brain Injury Assn of Massachusetts
Pam Bush, 508-475-0032, ext. 18
or
Center for Public Representation
Kathryn Rucker, 617-965-0776
or
WilmerHale
Lauren Coppola, 617-526-6998