On Tuesday, February 7, 2012, the Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing on accessible technology. Chairman Harkin (D-IA) spoke about how America is at a critical juncture in technological development related to education. Technology can either be used in the classroom to keep all students, including students who have sustained a TBI, on equal ground or to segregate those with disabilities by not developing accessible technology. Click here to link to the HELP Committee’s website to read testimony from the hearing.

This year, brain injury awareness day on Capitol Hill will be held on Wednesday, March 21, 2012. As in years past, there will be an awareness fair, briefing and reception. The full schedule for the day is as follows:

10:00 AM – 1:00 PM - Brain Injury Awareness Fair, First Floor Foyer of the Rayburn House Office Building

2:30 PM – 4:00 PM - Congressional Briefing, Location to Be Announced

5:30 PM – 7:30 PM - Reception Celebrating Brain Injury Awareness Month, Location to Be Announced

BIAA is committed to helping the Congressional Brain Injury Task Force plan a successful event. Stay tuned for more details including a list of speakers for the briefing.

This week, BIAA submitted comments to the Department of Health and Human Services (HHS) on the essential health benefits bulletin.

BIAA also submitted comments on the report Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury prepared for the Agency on Healthcare Research and Quality (AHRQ).

A copy of BIAA’s comments on both documents can be located on the BIAA website under the Government Affairs section. Click on Legislative Priorities and the comments are listed under Health Care Reform.

Call your Representative Today!

During the week of January 30, the U.S. House of Representatives is expected to vote Wednesday on the Fiscal Responsibility and Retirement Security Act (H.R. 1173) a bill that would repeal the Community Living Assistance Services and Supports (CLASS) Act.

Calling on Congress to Avoid Repeal of the CLASS Act

If you want to help protect the CLASS Act, please call 855-218-2109 to connect with Congress. Here is what you can tell your legislators:

• I strongly support the Community Living Assistance Services and Supports (CLASS) Act. Please oppose H. R. 1173, which would repeal the program.

• The primary public program now covering long-term services and supports is Medicaid.

• The CLASS Act was designed to be a fiscally responsible alternative that will encourage more personal responsibility and give American families a structure for planning for their own long-term care costs.

• Every family needs this protection. No one has proposed a better alternative to CLASS Act for financing long-term services and supports.

• Please allow continued dialogue on the CLASS Act and development of a viable program moving forward.

Background: CLASS addresses the need for long-term care in the United States in a completely voluntary way that honors the need for consumer choice, dignity and independence – without forcing people to impoverish themselves to qualify for Medicaid. If CLASS is repealed without an alternative being put into place, the need for a coordinated long-term care system will only grow, as will the financial strain on Medicaid. The need for the program is reflected in its popularity with the American people. According to a joint Kaiser Family Foundation/Harvard School of Public Health poll, 76 percent of Americans support CLASS – including 69 percent of Republicans, 71 percent of Independents, and 87 percent of Democrats.

• Current attempts to repeal the CLASS Act really have nothing to do with CLASS – they are part of a continuing attempt to bring down health reform. On November 2, 2011, after Senator Thune’s attempt to repeal CLASS without debate or discussion, Senator Sessions stated, “I think this is a death knell for the entire health care concept.”

• Allowing CLASS to be repealed gives health reform opponents a long-sought political victory – without holding them accountable for solutions on long-term care. Opponents have not produced their own viable alternative to CLASS, and are willing to let the millions of Americans in need of long-term services and supports fend for themselves in a broken patchwork of programs.

• Repealing CLASS is no solution at all. Simply allowing CLASS to be repealed does nothing to address the dire need for real long-term care solutions. CLASS is not perfect, but repealing it without replacing it will not solve our growing long-term care crisis. Seniors, people with disabilities, and their caregivers have waited long enough for Congress to focus on this problem.

Preserving CLASS provides a framework for Congress to move forward effectively. This may involve working with some of the fiscally responsible options put forth by the CLASS Act actuary, tweaking or amending the law, and/or developing additional alternatives; but repealing CLASS turns out the light on real efforts to solve the problem.

Traumatic brain injury (TBI) in children can be difficult to diagnose, and it is even more difficult to predict an outcome. Traditionally, TBI is defined as mild, moderate, or severe by using certain indicators such as the Glasgow Coma Scale or loss of consciousness. Outcomes based on TBI severity can be unpredictable—mild TBI has been known to cause long-term deficits, and more severe TBI can sometimes result in a surprisingly good outcome.

A recent study found that force of impact was a more accurate predictor of outcome than TBI severity. Force of impact was defined as:

• Never sustained an impact with consequences worth considering
• Mild impact (e.g., knocking head against door frame)
• Moderate impact (e.g., knocked by a player’s elbow during sports)
• Strong impact (e.g., intentional punch to the head)
• Very strong impact (e.g., forceful collision with a hard surface, such as in a car
accident)

Children and parents may have a better memory for concrete examples of the injury, and may be too unfamiliar with clinical terms to accurately describe the event.

Halldorsson JG, Flekkoy KM, Arnkelsson GB, et al. The scope of early traumatic brain injury as a long-term health concern in two nationwide samples: Prevalence and prognostic factors. Brain Injury. (January 2012).

Memory and attention problems are common after a traumatic brain injury (TBI). However, both memory and attention are complex, interrelated systems that can be broken into “pieces” of a process. Research has been mixed about specifically what piece of that process is most commonly affected by TBI. One of the problems of this research is how memory and attention is analyzed during the study. In many cases, studies will only look at one piece of the whole process.

Researchers recently examined memory and attention after TBI as both an interrelated process as well as separate pieces. One interesting finding was that people with TBI made significantly more “false alarm” responses in both memory and attention tests. In other words, when having to decide if an item that was correct or incorrect, people with TBI were more likely to mistake an incorrect item as correct.

This is also called the “yes bias”—an instinct to respond “yes, this (incorrect) item is correct” rather than “no, this (correct) item is incorrect.” The yes bias is in part a result of a lack of inhibition, the inability to stop from making an incorrect choice, that is common after a TBI. The researchers suggest that this lack of inhibition may be related to the inability to sustain long periods of attention.

Slovarp L, Azuma T, & Lapointe L. The effect of traumatic brain injury on sustained attention and working memory. Brain Injury. (January 2012).

Post-concussion syndrome (PCS) is defined as a set of common symptoms that occur in the days or months after a mild traumatic brain injury (mTBI). These symptoms include fatigue, depression, headaches, dizziness, and cognitive problems. PCS has been a somewhat controversial topic because clinicians rely on the patient’s report of their symptoms, in absence of objective test results. In addition, research has shown inconsistent results for the prevalence of PCS after mTBI.

In a recent comparison of people with mTBI to people with no injury, researchers found that the rate of PCS was almost identical in both groups. PCS, therefore, describes a set of symptoms that are just as common in the general public as they are to people with mTBI.

However, when PCS symptoms were analyzed individually, the researchers did find differences between the groups. People with mTBI had significantly greater cognitive impairment than the cognitive impairment found in uninjured people. Additionally, people with mTBI reported their symptoms as more intense and disabling than the uninjured group.

The diagnostic criteria for PCS should be more specific than it is now, but further research is needed to define those criteria.

Dean PJA, O-Neill D, & Sterr A. Post-concussion syndrome: Prevalence after mild traumatic brain injury in comparison with a sample without head injury. Brain Injury. (January 2012).

A self-report of symptoms after a traumatic brain injury is an important part of the assessment process. But, how does a clinician interpret inconsistencies between self-reported symptoms and the objective neuropsychological evaluation?

One problem is that the severity of the brain injury can affect the way the patient talks about symptoms. For instance, a person with a more severe brain injury may have problems with awareness and thus deny having any symptoms. Or, they may have more problems with communication and memory that can limit their report. Conversely, a person with a mild brain injury often shows better awareness and communication about their deficits, but may also have problems such as depression, anxiety, or insomnia that can make these deficits more intense.

A recent study compared neuropsychological test results to self-reported symptoms between groups of people with mild or severe traumatic brain injuries. People with both mild and severe brain injuries reported significant memory problems, however only the severe brain injury group had test scores that showed significant memory impairment. People with both mild and severe brain injuries showed problems with attention during the neuropsychological tests, but only those with mild brain injury group were aware of and reported it.

Jamora CW, Young A, & Ruff RM. Comparison of subjective cognitive complaints with neuropsychological tests in individuals with mild vs. severe traumatic brain injuries. Brain Injury. (January 2012).

On Friday, January 13, 2012, BIAA’s government affairs director along with NASHIA’s lobbyist met with staff representing the National Disability Rights Network to discuss TBI Act reauthorization in 2012. BIAA will continue to work closely with other stakeholders as the reauthorization of the TBI Act moves forward.

AHRQ Reports Open for Public Comment

The Effective Health Care Program, Agency for Healthcare Research and Quality (AHRQ) made available to the public two draft reports that are available for comment. This review is part of a new series of reports on Closing the Quality Gap: Revisiting the State of the Science (hereafter, CQG series).

The report, Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury, is available for public comment until February 9, 2012.

The report, Closing the Quality Gap Series: QI Measurement of Outcomes for People with Disabilities, is available for public comment until February 6, 2012.

I look forward to seeing you all at the Brain Injury Awareness Day on March 21, 2012!

Schedule for March 21, 2012

10:00 AM – 1:00 PM – Brain Injury Awareness Fair, First Floor Foyer of the Rayburn House Office Building

2:30 PM – 4:00 PM – Congressional Briefing, Location to Be Announced

5:30 PM – 7:30 PM – Reception Celebrating Brain Injury Awareness Month, Location to be announced

Other Activities

BIAA

strongly encourages

everyone that plans to attend Brain Injury Awareness Day to make appointments with their Representatives and Senators to advocate for increased funding for the programs authorized through the TBI Act. Please see tips below:

Congressional Appointments

To find House of Representatives information:

www.house.gov, type in zip code to locate your

Representative

. Click on your member’s link for their Web site where you will find their address and phone number.

To find Senate information:

www.senate.gov, select state and view Senators’ individual Web sites for address and phone number.

When calling the main number of the Senator or Representative, ask to meet with the health legislative assistant (House) or the health policy staff (Senate).

• Make sure to let them know that you are a constituent
  • Ask them for a few minutes of their time on March 21, 2012 to discuss the need for increased resources for brain injury programs in their state.

Example:

Hello ______________ my name is ______________________. I am a constituent of yours and will be visiting Capitol Hill on Wednesday, March 21, 2012 as part of Brain Injury Awareness Day. Could I have a few minutes on that day to talk to you about (state’s) brain injury resources and how they affect the brain injury community in your district/state?

Navigating Capitol Hill

If you are coming in from out of town and require a hotel, below you will find a list of accommodations within a few miles of Capitol Hill:

Hyatt Regency, http://washingtonregency.hyatt.com/hyatt/hotels/index.jsp

Courtyard, Marriott, http://www.marriott.com/hotels/travel/wasny-courtyard-washington-capitol-hill-navy-yard

Capitol Hill Suites, http://www.capitolhillsuites.com

Hotel George, http://www.hotelgeorge.com

Marriott, Residence Inn, http://www.marriott.com/hotels/travel/wascp-residence-inn-washington-dc-capitol

A map of the key House and Senate buildings can be found below:

http://www.aoc.gov/cc/cc_map.cfm

BIAA encourages advocates to check with their state brain injury organizations to determine if others from their state will be attending and if so, to coordinate meetings.

BIAA will provide printed maps of the Senate and House buildings as well as easy to follow fact sheets outlining the issues that you will be advocating for in your meetings. Electronic versions will be distributed and posted to BIAA’s website in early March. BIAA will also provide color copies at the Brain Injury Awareness Fair. Please check back for updated information on Brain Injury Awareness Day! If you have any questions or concerns, please contact Amy Colberg at acolberg@biausa.org.