A recent study by Mount Sinai faculty suggests that a gene associated with onset of type-2 diabetes also decreases in Alzheimer's disease dementia cases. The research, led by Dr. Giulio Maria Pasinetti, MD, Ph.D., The Aidekman Family Professor in Neurology, and Professor of Psychiatry and Geriatrics and Adult Development at Mount Sinai School of Medicine, was published this week in the scientific journal, Archives of Neurology.
Read the full article by clicking here.
The BIAA is having its annual conference in Las Vegas at the end of the month. One of the featured speakers is Nathan Zasler. Dr. Zasler just finished and book entitled The Neurology of Consciousness: Cognitive Neuroscience and Neuropathology.
This is a very welcome addition to the field of neuroscience literature and should be read by anyone involved in the care of persons with disorders of consciousness. The book starts with a thoughtful Preface by the editors, Dr. Laureys and Dr. Tononi, which is followed by yet another introspective commentary by Dr. Allan Hobson of Harvard Medical School in the form of a Prologue. The contributors to this text include some quickly recognizable names, including Drs. James Bernat, Antonio Damasio, Joseph Fins, Michael Gazzaniga, Adrian Owen, Joseph Giacino, Nicholas Schiff and Adam Zeman, among others.
Read the full review here.
This policy news and udate just in from the BIAA..bmp)
Brain Injury Association of America
Policy Corner E-Newsletter -- April 24, 2009
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
In This Issue:
Healthcare Reform
Appropriations Update
HHS Nomination
DRRC Testimony to ICDR
_____________________________________________________________________
The Policy Corner is made possible by the Centre for Neuro Skills, James F. Humphreys and Associates, and Lakeview Healthcare Systems, Inc. Brain Injury Association of America gratefully acknowledges their support for legislative action.
___________________________________________________________________
Following a two week recess, Congress was back in the swing of things this week moving forward on preliminary meetings regarding healthcare reform as well as negotiations on the pending 2010 budget resolution.
Healthcare Reform
Next week, BIAA will engage in a series of meetings in the House, Senate, and the White House to discuss healthcare reform principles that would benefit the brain injury community. Please be sure to check back in next week's Policy Corner for action instructions. We need everyone's support to make sure that people with brain injury are heard in this debate!
Appropriations Update
This week, the House and Senate have agreed on a tentative deal on major elements of the fiscal year 2010 budget resolution which includes fast-track procedures for healthcare reform, but would cut $10 billion from the President's discretionary spending request.
The negotiators plan to hold a formal conference committee meeting next week. In the mean time, behind-the-scenes negotiations will continue today and through the weekend. According to CQ, democratic leaders would like to have the final budget adopted next week as President Obama marks his first 100 days in office.
BIAA will continue to monitor the situation as the Appropriations process moves forward.
Senate Approves HHS Nomination
On Tuesday, a Senate panel approved the nomination of Kansas Gov. Kathleen Sebelius to be Health and Human Services secretary, clearing the way for her expected confirmation, although the timing of a vote is unclear.
BIAA will watch this process closely as Healthcare Reform continues to take shape.
Interagency Committee on Disability Research Recommendations
Last week, as part of the Disability and Rehabilitation Research Coalition, BIAA answered the call for research topic recommendations by the Interagency Committee on Disability Research (ICDR).
The their testimony, DRRC focused on how well the existing federal research programs are responding to the changing needs of individuals with disabilities and suggested specific ways to improve future disability and rehabilitation research such as:
* Develop a comprehensive government-wide strategic plan for disability and rehabilitation research.
* Develop government-wide methods for identifying disability and rehabilitation research as well as subtopics (e.g., studies of body structure/function deficits, activities, participation, capacity building activities, treatment and service effectiveness research) so that the magnitude and trends in disability and rehabilitation research across various agencies can be tracked.
* Develop guiding principles for conducting disability and rehabilitation research.
* Support a research agenda-setting summit bringing together policymakers, representatives from federal agencies, non-governmental funders of rehabilitation research, and organizations representing researchers, providers, and individuals with disabilities. The agenda should include but not be limited to consideration of the recommendations by IOM in the 1991, 1997 and 2007 reports on disability; what about the President's New Freedom Commission in Mental Health Recommendations ( 2003) and the recommendations of the Rehabilitation Medicine Summit: Building Research Capacity (April 2005), as well as a review of the progress the nation has made in implementing these recommendations.
* Increase federal funding significantly in various agencies performing rehabilitation and disability research.
* Elevate the status of NCMRR within the National Institutes of Health.
* Clarify NIDRR's role to include health and function research as integrally related to employment and community participation research, or Congress may want to consider moving the health and function responsibilities to another agency.
* Create an Office of Disability and Health in the CDC.
* Examine the role of the VA/DoD research programs and enhance the interaction between these programs and civilian disability and rehabilitation research capacity.
* Expand support for efficacy studies documenting the benefit (including cost-benefit) of rehabilitation services, supports, treatments, and devices, including support for large scale randomized clinical trials (where appropriate).
* Support efforts to enhance knowledge translation so that research is more efficiently translated to practice and practice to research in the rehabilitation and disability fields.
* Expand and improve the authority of ICDR to coordinate disability and rehabilitation research among the federal agencies.
This policy news and udate just in from the BIAA.
Brain Injury Association of America
Policy Corner E-Newsletter -- April 24, 2009
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________
In This Issue:
Healthcare Reform
Appropriations Update
HHS Nomination
DRRC Testimony to ICDR
_____________________________________________________________________
The Policy Corner is made possible by the Centre for Neuro Skills, James F. Humphreys and Associates, and Lakeview Healthcare Systems, Inc. Brain Injury Association of America gratefully acknowledges their support for legislative action.
___________________________________________________________________
Following a two week recess, Congress was back in the swing of things this week moving forward on preliminary meetings regarding healthcare reform as well as negotiations on the pending 2010 budget resolution.
Healthcare Reform
Next week, BIAA will engage in a series of meetings in the House, Senate, and the White House to discuss healthcare reform principles that would benefit the brain injury community. Please be sure to check back in next week's Policy Corner for action instructions. We need everyone's support to make sure that people with brain injury are heard in this debate!
Appropriations Update
This week, the House and Senate have agreed on a tentative deal on major elements of the fiscal year 2010 budget resolution which includes fast-track procedures for healthcare reform, but would cut $10 billion from the President's discretionary spending request.
The negotiators plan to hold a formal conference committee meeting next week. In the mean time, behind-the-scenes negotiations will continue today and through the weekend. According to CQ, democratic leaders would like to have the final budget adopted next week as President Obama marks his first 100 days in office.
BIAA will continue to monitor the situation as the Appropriations process moves forward.
Senate Approves HHS Nomination
On Tuesday, a Senate panel approved the nomination of Kansas Gov. Kathleen Sebelius to be Health and Human Services secretary, clearing the way for her expected confirmation, although the timing of a vote is unclear.
BIAA will watch this process closely as Healthcare Reform continues to take shape.
Interagency Committee on Disability Research Recommendations
Last week, as part of the Disability and Rehabilitation Research Coalition, BIAA answered the call for research topic recommendations by the Interagency Committee on Disability Research (ICDR).
The their testimony, DRRC focused on how well the existing federal research programs are responding to the changing needs of individuals with disabilities and suggested specific ways to improve future disability and rehabilitation research such as:
* Develop a comprehensive government-wide strategic plan for disability and rehabilitation research.
* Develop government-wide methods for identifying disability and rehabilitation research as well as subtopics (e.g., studies of body structure/function deficits, activities, participation, capacity building activities, treatment and service effectiveness research) so that the magnitude and trends in disability and rehabilitation research across various agencies can be tracked.
* Develop guiding principles for conducting disability and rehabilitation research.
* Support a research agenda-setting summit bringing together policymakers, representatives from federal agencies, non-governmental funders of rehabilitation research, and organizations representing researchers, providers, and individuals with disabilities. The agenda should include but not be limited to consideration of the recommendations by IOM in the 1991, 1997 and 2007 reports on disability; what about the President's New Freedom Commission in Mental Health Recommendations ( 2003) and the recommendations of the Rehabilitation Medicine Summit: Building Research Capacity (April 2005), as well as a review of the progress the nation has made in implementing these recommendations.
* Increase federal funding significantly in various agencies performing rehabilitation and disability research.
* Elevate the status of NCMRR within the National Institutes of Health.
* Clarify NIDRR's role to include health and function research as integrally related to employment and community participation research, or Congress may want to consider moving the health and function responsibilities to another agency.
* Create an Office of Disability and Health in the CDC.
* Examine the role of the VA/DoD research programs and enhance the interaction between these programs and civilian disability and rehabilitation research capacity.
* Expand support for efficacy studies documenting the benefit (including cost-benefit) of rehabilitation services, supports, treatments, and devices, including support for large scale randomized clinical trials (where appropriate).
* Support efforts to enhance knowledge translation so that research is more efficiently translated to practice and practice to research in the rehabilitation and disability fields.
* Expand and improve the authority of ICDR to coordinate disability and rehabilitation research among the federal agencies.
Dear Senator:
I am in support of AB495, a bill which will no longer protect health care providers when they injure patients. The measure voters approved was designed to limit frivolous lawsuits. It was not intended to protect doctors like Dr. Desai, who has placed the health of patients at risk. Unfortunately, when you give people special legal protections, there is always someone who will try to take advantage.
I am representing a woman whose bile duct remained shut after receiving a pyloric stenosis (stomach thickening condition most often found in infants) surgery. The surgical clips were left in her bile duct. She has three bags of fluid accumulation outside her body which she has to dump and reload several times a day. Additionally her body is unable to absorb food so she is administered nutrition intravenously at night. This has been going on since January 2009. She was referred after the botched surgery to UCLA where she is scheduled to return for corrective surgery. Limiting this woman’s recovery to alleviate this physician’s insurance responsibilities and his insurance company’s profit is unconscionable.
Please right the injustice created when the medical malpractice initiative was passed. Please vote for AB495.
Tim Titolo
Dr. Robert Melillo is an internationally known lecturer, author, researcher and clinician in the areas of neurology, rehabilitation, neuropsychology and neurobehavioral disorders in children. Dr. Melillo's Hemispheric Integration Therapy (H.I.T.) forms the foundation of The BrainBalance Program(R), a multi-modal approach to the remediation of ADHD, Dyslexia, Autism, Asperger's, Tourette's, learning disabilities and processing disorders along with other neurobehavioral disabilities found in children. Brain Balance(TM) Centers do not rely on drugs, medical procedures or psychotherapy.
The new book, Disconnected Kids: The Groundbreaking Brain Balance Program(TM) for Children with Autism, AD/HD, Dyslexia and Other Neurological Disorders, (Amazon.com: Disconnected Kids: The Groundbreaking Brain Balance ...) shows parents how to use this drug-free approach at home, with customizable exercises for physical, sensory, and academic performance, behavior modification strategies, information on foods to avoid, and a follow up program for lasting results.
The negligent performance of lumbar surgery may also give rise to litigation. Negligence in the actual performance of lumbar surgery, however, is infrequently documented in the medical
records and may be difficult to prove. On the other hand, such actions as performing a diskectomy or laminectomy at the incorrect level almost always falls below the applicable standard of care and can be independently proven.
Other examples of negligence during surgery include certain aspects of lumbar fusion surgery, iliac vein or aortic perforation, and the failure to repair a dural tear or leak when recognized.
Examples of intraoperative mishaps that rarely rise to the level of medical negligence include dural tears, cerebrospinal fluid leaks, excessive bleeding and inadvertent nerve root injury.
Overall, mishaps during the technical performance of lumbar surgery constitute the fewest instances of medical negligence.Finally, the failure to diagnose and treat a postoperative
complication may give rise to medical care that breaches the applicable standard of care.
Many post-operative complications following lumbar surgery involve either infection or neurological dysfunction. Infection following lumbar surgery, in and of itself, is usually not medical
negligence; the failure to diagnose and treat such an infection, however, may constitute medical negligence. The failure to diagnose and treat a post-operative disk space infection can
also constitute medical negligence. The presence of a postoperative neurological deficit, in and of itself, may not constitute medical negligence, but the failure to evaluate and treat such a
deficit may be medical negligence.
The failure to provide adequate post-operative follow-up care may constitute medical negligence. In
general, close followup of a patient following lumbar surgery is indicated, and the threshold for performing post-operative imaging including MRI scanning must be low for evaluating neurological dysfunction or infectious processes.
In summary, back pain and lumbar surgery are common medical entities and may be associated with medical negligence giving rise to litigation.
The actual performance of the surgical procedure may give rise to negligence but only in specific instances that may be independently proven.
More commonly, litigation arises from a failure to diagnose the disease entity prior to surgery or a failure to evaluate properly, diagnose and timely treat the patient in the post-operative
period. For these very reasons, an experienced expert witness is necessary to evaluate cases involving lumbar disease and surgical procedures.
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In an amazing story, A Jackson County man died and his wife was critically injured Tuesday in what authorities described as an attempted murder and suicide at a home off Tanner Williams Road in the Harelston community.
Jackson County Sheriff Mike Byrd said a witness called for help after she was able to escape the home of the victim, Tammy H. Sexton, 47, who had been shot in the head.
The woman was found lying on the bed talking to authorities. Authorities, cited in the Sun Herald, stated. "“It’s truly a miracle that she survived something like this and was talking and conscious,” Byrd said Wednesday. “She had a gunshot wound that went in over her left eye and exited the back of her skull. Based on everything I’ve seen in my career, she shouldn’t be alive.”
Once again, a story of a severe brain injury where the victim walks and talks afterwards. It is reported Tammy Sexton offered authorities tea even with the penetrating would she sustained.
This is similar to the famous case of Phinneas Gage who suffered a railroad iron through his head and frontal lobe and never lost conciousness in 1848. He survived however lived a forever changed life in that his personality was irreparably compromised.
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California-based College Hospitals has agreed to pay $1.6 million to settle charges that two of its campuses improperly discharged and transported about 150 psychiatric patients to homeless shelters in downtown Los Angeles, City Attorney Rocky Delgadillo's office announced on Wednesday, the AP/Kansas City Star reports (Tayefe Mohajer, AP/Kansas City Star, 4/8). City officials alleged the infractions, by College Hospitals' facilities in Costa Mesa and Cerritos, occurred between 2007 and 2008.
The Los Angeles Times reports that the process was discovered by state officials after Steven Davis -- who was diagnosed with schizophrenia, bipolar disorder and schizoaffective disorder -- was treated at the Costa Mesa campus and then taken in a hospital van more than 
40 miles to downtown Los Angeles and dropped off at a homeless shelter. Officials at the shelter complained to the hospital about its action. The van returned and dropped Davis off at a second shelter, but Davis "wandered away without ever entering," the Times reports. City prosecutors then uncovered what they described as the largest case of "homeless dumping" they have encountered, according to the Times (DiMassa/Winton, Los Angeles Times, 4/9).
Under the settlement, College Hospitals will give $1.2 million to charities that care for the mentally ill and homeless and pay $400,000 in civil penalties (AP/Kansas City Star, 4/8). College Hospitals also will have one year to establish written protocols for releasing patients, including locating resources to care for them and obtaining voluntary consent before patients are transported. The two facilities will be barred from taking patients to any homeless shelter within a "patient safety zone" set up in downtown L.A. Delgadillo said, "Dumping patients who are sick or mentally ill on the streets of Skid Row is an unconscionable act," adding, "It's illegal, it's immoral and it has to stop" (Perkes, Orange County Register, 4/8).
College Hospitals attorney Glenn Solomon said that the hospital denies any wrongdoing and that its actions never amounted to "homeless dumping." He added that the hospital agreed to the settlement to establish a workable policy for dealing with homeless patients in the future. "It's the policy of the hospital ... to discharge each and every patient appropriately," Solomon said (Los Angeles Times, 4/9). He added, "The hospital believes it's a good thing to be at the forefront of developing these protocols" (Orange County Register, 4/8).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
Part of the attorney's job in evaluating a case is to obtain and analyze medical records. This makes communication with the client very important. Getting medical records for the current injury as well as past records play a crucial role in evaluating the case.
Many times clients are reluctant to reveal past injuries or events. This creates problems later in the case since information they are unaware of may exist in other records.
Within medical records lies the hidden detail that could prove negligence or that could absolve the unjustly accused practitioner. Though the records often seem incomprehensible, attorneys can
find crucial information in them if they know where to look. Following is a summary of what information should be included in various types of hospital records.
Progress Notes – A daily narrative of a patient’s medical care. They describe the patient’s progress, symptoms and course of recovery. Often written by a resident or intern, and then signed
or initialed by the treating physician. Each entry should be dated and signed.
Admission Notes – Done on the day of hospitalization by the treating physician. Notes should include a history and physical examination, diagnosis and recommendations for treatment.
Examination Form – The history should include the chief complaint, details of the present illness, relevant past, social and family histories and inventory of the body systems. This should
be completed within 24 hours of admission.The physical examination should reflect a general evaluation and a notation of blood pressure, pulse and respiration; the skin, eyes, ears, nose
and throat; neck; breasts, lungs, and heart, abdomen; genitalia or pelvis; rectum; extremities and lymph nodes. A neurological examination should be recorded and allergies noted. A final
impression should be stated.
Doctor’s Orders – Requests for diagnostic testing and therapeutic treatment. All orders should be dated and signed by the physician. Verbal orders are expected to be signed by the doctor during the next patient visit, or within 24 hours. The treating physician is responsible to check that the patient is receiving what was ordered. The nursing staff should conduct a 24-hour review of the orders. Treating physicians should be notified of impending stop orders.
Surgical Records – Documents the preparation of a patient scheduled for surgery. Generally includes a surgical check list of preparatory steps taken by the nursing staff the night before surgery.
Operative Report – A complete and detailed report made within 24 hours. Contains identification of procedures used, a description of all findings, including anomalies encountered, specimens
removed, postoperative diagnosis, unusual events and name of primary surgeon and assistants. A progress note, written by the physician concerning the operation should appear in the records.
Anesthesia Record – Documents the anesthesiologist’s visit, including conversation with the patient, efforts to obtain information pertinent to the patient’s past surgeries, a physical
examination, and complete review of the patient’s chart. During surgery, the anesthesia record should show:
- The length of time anesthesia was administered;
- Time needed to complete surgery;
- Quantities and types of drugs, blood, and intravenous fluids
administered during surgery;
- Continuous record of pulse, blood pressure and respiration;
- Observation notes to include reaction to anesthesia surgery.
Consent Form – Informed consent is necessary for elective treatment and diagnostic procedures involving invasion or disruption of the integrity of the body. A consent form should
include: The date, identity of the patient, and the name of the procedure or treatment interpreted in laymen’s terminology, as well as the name of the person administering treatment and
authorization for anesthesia. The form should state possible risks or complications that have been explained to the patient; authorization for disposal of tissue or body parts; explanation of
alternative treatment, and signature of the patient and a witness.
Nursing Notes – Written on a per shift basis, should be recorded at the time of or immediately after patient events, depending on hospital policy or patient condition. The notes should detail the
progress of the patient and be made in chronological order. They should be signed by the person performing a procedure or witnessing an event.
Discharge Summary – Should be a recap of relevant diagnosis, operative procedures performed significant findings, treatment rendered, the condition of the patient upon discharge and the
discharge instructions. It should be dictated by the treating physician.
Mild & Minor Traumatic Brain Injury: An Unfortunate Oxymoron (Part 1)
Timothy R. Titolo
Attorney
I have often heard it said “if it’s to the brain, any injury is significant!” Huh? Hello? Is anyone paying attention? I said, " ‘if it’s to the brain, any injury is significant!’ “
Introduction
The literature and research has come a long way in helping to provide answers and guides for the previously disbelieved and improvable "mild brain injury” and "post concussion syndrome.” As a trial lawyer, representing victims and families who have suffered from traumatic brain injury, I have immersed myself in the medical literature in an attempt to better represent and understand my clients and their injuries. The purpose of this article is to provide a legal perspective on the information available and the misconceptions lay people and many lawyers have regarding "mild brain injury.”
As lawyers, medical practitioners, and lay people, we are all probably too familiar with the results of paraplegia, quadriplegia, neurodisease, and varying degrees of dementia. These are all spinal cord injury and traumatic brain injury outcomes. What about those who Ronald Ruff, Ph.D., neuropsychologist, has coined "the miserable minority?”
Defining and Understanding Mild Brain Injury
Trauma comes in as the third leading cause of death in the United States following only cardiovascular disease and cancer. (Trunkie, 1983). With the advent of technologically enhanced mode of transportation, motor vehicle travel, cases of head trauma have proportionally increased. Motor vehicle crashes are responsible for a large majority of head trauma. As emergency medical care improves and becomes more available and developed, individuals in our modern society are surviving the acute phases of their injuries and require continued rehabilitation.
What about those whose outcomes are not visibly evident as with paraplegia? Science and medicine have brought the current state of knowledge to a universal agreement that microscopic sized injury to the neurons and axons of the brain can have devastating effects on a person”s cognitive ability, psychiatric and psychological outcomes. And, as one would expect, these types of microscopic lesions and their outcomes are of greatest controversy between medical practitioners and legal professionals. Judges do not understand the specifics of diagnostic testing and yet are allowed, under Daubert to act as the gate keeper for allowing evidence to be brought into a courtroom to help further the understanding of the fact finder. Many lawyers simply do not have the understanding or education necessary to properly pursue a claim for traumatic brain injury. And finally medical practitioners of varying skill levels will provide opinions about matters for which they have been given, many times for the defense, an inadequate base of information to make a diagnosis. This results in Dr. Ruff”s "miserable minority.”
A closed head injury occurs when the soft tissue of the brain is forced into contact with the hard, bony, outer covering of the brain, the skull. Along with the head injury, the average patient usually experiences neck and back injuries. Mild closed-head injuries can occur after a severe neck injury without the head actually striking any surface. The severity of the injury can range from mild to more severe. The symptoms are worse when there is a rotational component to the head injury in addition to back and forth movement of the head. In milder injuries with post concussion syndrome, loss of consciousness need not always occur. There is, however, always some alteration of consciousness: some interruption of brain function. Sometimes a patient remains confused or agitated for a period of time following a closed head injury. With milder injuries, loss of consciousness usually lasts less than an hour (Bernad, 1998).
PRACTICAL NOTE - One must be on guard of medical practitioners hired by the defense who justify their diagnosis and conclusions on the assumption that there was no loss of consciousness. Typically a witness to the patient”s loss of consciousness is not available. Usually the first one to the scene might be a bystander coming to provide aid or the ambulance paramedic who arrives some minutes after the event. The defense medical practitioner will look at the Aevidence available” and conclude from the ambulance and emergency room records that, if they do not indicate a loss of consciousness, then it is reasonable to assume there was none. And, very frequently, these medical practitioners are not provided with deposition testimony or other evidence or information from other observers who may have described the injured party as disorientated or passed out, etc.
All too often I have gotten the defense medical examiner to agree that being provided with Aadditional information” could change their diagnosis. Then I hear something to the affect that since we do not live in a Aperfect world” and we are dealing with time as a Acommodity” such Alimitless” information is not obtainable. What this means, is since the reviewing doctor only got paid to spend an hour or whatever with the patient, there was not enough compensation involved to allow for the sincerest evaluation of the patient.
For instance, I rarely see a neurologist or neuropsychologist, hired by the defense, request of the defense lawyer, information to help in the diagnosis and conclusions. This should certainly not be missed and is a great opportunity to discredit that witness. Rarely has the defense medical examiner taken the time to review what people, who have known the patient, have noticed as changes since the trauma. Is this relevant? You bet it is. Did Dr. Ruff do it in the case at hand-absolutely not! Why? Because he did not live in a Aperfect world” and did not have the Afunding” to do a more extensive evaluation. Ironically, the information had already been made available to his hiring lawyer who skipped getting information from these people before hiring their expert neuropsychologist.
In an investigative report yesterday, the New York Times released a story on the strong bias of IME doctor for insurers.
In the report, a New York IME doctors admits, "If you did a truly pure report, you'd be out on your ears and the insurers wouldn't pay for it. You have to give them what they want, or you're in Florida. That's the game, baby."
Carol Houlder, a substance abuse counselor, waited a year for surgery on her injured ankle to be approved. “I was in so much pain and felt so hopeless for so long,” she said.
Read the whole NY Times article by clicking here.
The Senate adopted its fiscal 2010 budget resolution (S Con Res 85) Thursday night, a few hours after the house adopted its version (H Con Res 85).
While neither budget exactly mirrors President Obama's proposal, they do pave the way for implementing his proposals on health care, energy and education. Conference negotiations will focus on whether to include provisions that would, like the House plan, allow health care overhaul legislation move through the filibuster proof reconciliation process and how much in discretionary spending should be provided to the Appropriations panels to write the 12 annual spending bills.
According to Congressional Quarterly, the Senate plan would provide the Appropriations panel with $1.08 trillion, which is $15 billion less than the president requested and about $8 billion less than the House resolution.
A study published at the University of Nevada Department of Psychology and in the Journal Applied Neuropsychology (Structure of attention in children with traumatic brain injury. Applied Neuropsychology, 2009;16(1):1-10) reveals differences in children with traumatic Brain Injury
The researchers concluded:
"These findings support the utility of a multicomponent model of attention to understand attention deficits resulting from TBI, and may be useful in determining those aspects of attention that are differentially impacted by TBI, in order to assist in assessment and rehabilitation planning."
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