Brain Injury Lawyer - New York

Professional Football Continues to Ignore Concussion Dangers

It is truly tragic to read the story in today's New York Times, For Jets, Silence on Concussions Signals Unease.

Despite the overwhelming evidence of the long term consequences following a concussion, professional football teams still refuse to acknowledge what is not accepted medical science.  The problem includes team physicians who are being payed by the team and have an obvious conflict of interest when it comes to making return to play decisions, teams themselves which refuse to set strict policies and players who are taught that a ding is no big deal.

But now, outside medical experts are beginning to raise the heat on these teams.  One such expert, Dr. James Kelly who wrote the original standards on concussion management for the American Academy of Neurology is quoted as saying "They arrogantly assume that they are doing the right thing when it's obvious to outsiders that they mismanage the situation, Cherbret being the prime example.  It looks like they have something to hide."

Also criticizing the NFL is noted concussion expert, Steven Guskiewicz, chairman of the department of exercise and sport science at the University of North Carolina.  He along with his colleagues have published several papers on surveys of more than 2,000 former N.F.L players that found a correlation between a player's concussion history and later-in-life clinical depression, cognitive impairment and early on-set dementia.  Gurskiwicz says that the league continues to ignore his findings and recommendations.

Players need protection and if the league is not capable of making sound decisions to protect the safety of it's players, then it's time that Congress step in to act.

New Spanish Language Web Site on Neurological Disorders

Free, accurate information on many neurological disorders is now available on a new Spanish language website from the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health (NIH). The website is available by clicking here .

Health information featured on the new website includes publications on stroke, dementia, Parkinson’s disease, epilepsy, and autism, as well as many other neurological disorders. The publications can be downloaded or ordered free of charge. The website also provides information on clinical studies, links to non-profit organizations that offer information and assistance on neurological disorders, and a contact form where people can submit questions on topics related to health and biomedical research.

Brain Injury Legislative Update

I have been requested to distribute the following update on federal traumatic brain injury funding by the Brain Injury Association of America:

As you will unfortunately read, although there has been a lot of talk in Congress about the need to dramatically increase appropriations for traumatic brain injury, the final bill failed to include the increases requested and advocated by the Brain Injury Association of America and in many cases failed to even maintain funding at last year's level. 

Traumatic brain injury is a national health crisis.  The failure on the part of Congress to make appropriate appropriations for brain injury is unforgivable.  The Brain Injury Association of America should be thanked for all of their efforts.  Although understaffed and underfunded, they have worked long and hard for those with brain injury and their families.  The failure to appropriate necessary funding is certainly not the fault of the association. 

"Last night, Democratic leaders in Congress filed a massive omnibus appropriations bill (H.R. 2764) that largely matches President Bush’s proposed spending limit of $933 billion for all Fiscal Year (FY) 2008 appropriations.  The omnibus spending bill combines the 11 remaining FY2008 appropriations bills not yet enacted into law this year.

Note: Although the Fiscal Year 2008 Labor-HHS-Education spending bill (H.R. 3043) was passed by Congress earlier this fall, it was subsequently vetoed by President Bush, and thus has now been included in the omnibus appropriations bill.

Unfortunately, the Labor-HHS-Education spending included in this week’s omnibus appropriations bill includes $145.1 billion in discretionary spending, which represents about $5.6 billion less discretionary funding than was included in H.R. 3043.   Overall discretionary funding in the Labor-HHS-Education section of the omnibus bill includes about $600 million more than was provided through last year’s Labor-HHS-Education bill.

TBI programs, unfortunately, were among those losing discretionary funding compared to the amounts contained in H.R. 3043.  While H.R. 3043 would have increased funding for the HRSA TBI Program from last year’s total of $8.910 million to $9.455 million, this week’s omnibus bill would instead reduce funding for this program to $8.754 million. 

Despite this inexplicable and unacceptable decrease in funding for the HRSA TBI program, this week’s omnibus bill nevertheless contains a few heartening funding increases for other TBI programs.  CDC TBI-related activities would receive an increase of approximately $500,000 over last year. In addition, the TBI Model Systems of Care program received a boost of approximately $800,000 over last year’s funding amounts, with specific legislative language directing that the funding increase be used to fund two additional TBI research centers.

The outlook for final passage of this omnibus appropriations bill by the end of the week has been deemed likely, although not assured.  Republicans are currently reviewing the bill, and it is anticipated that the Senate will add Iraq War supplemental funding when the bill reaches the Senate floor.

Democrat leaders in Congress have asserted that although undesirable, the funding cuts contained in this week’s appropriations omnibus appropriations bill are still preferable to the President’s budget blueprint (which would have eliminated all funding for HRSA TBI Act programs).  Although the funding level for the HRSA TBI program contained in this omnibus bill is extremely disappointing and unacceptable, strong TBI advocacy efforts this year undoubtedly produced a more positive outcome than would have resulted if the voices of TBI advocates were not heard.  We will continue to fight to ensure that these voices are heard, louder than ever, next year.

OMNIBUS APPROPRIATIONS BILL (H.R. 2764) FUNDING NUMBERS IN BOLD

CDC TBI Programs (HHS):  $5.811 million

-H.R. 3043 (Labor-HHS-Education appropriations bill passed earlier this year by Congress but vetoed by President Bush): $5.960 million

-Last Year (Fiscal Year 2007):  approx. $5.3 million

HRSA TBI Programs (HHS) (TBI State Grant Program and Protection and Advocacy Systems):  $8.754 million 
-H.R. 3043:  $9.455 million

-Last Year:  $8.910 million

TBI Model Systems of Care (NIDDR/Department of Education):  $8.3 million, with specific conference report language included in the final bill as follows:“The amended bill specifies $8,300,000 within the National Institute on Disability and Rehabilitation Research to carry out the traumatic brain injury model systems of care program and to fund two additional centers that submitted applications for the last grant competition.” 
-H.R. 3043:  $8.4 million

-Last Year:  $7.5 million

Traumatic Brain Injury (TBI) Reauthorization Act Needs Your Help

On Tuesday night, December 11, 2007, the Senate passed legislation to reauthorize the TBI Act (S. 793)  by voice vote.   The fate of TBI Act reauthorization is now up to the House of Representatives.  Since authority for the TBI Act officially lapsed in 2005, it is essential that advocates encourage the House to take the bill up and pass it as soon as possible.  It is essential that you contact your  Representative to ensure swift House consideration and passage of the TBI Act.

Brain Injury Association of America mourns the passing of Charles W. Haynes, former Board Chairman and long-time advocate

Charles Walter Haynes, former  chairman of the board of the Brain Injury Association of America (then known as the National Head Injury Foundation) sadly has  passed away.

Charles Walter Haynes (1926-2007) started a new chapter in his life as an advocate for persons with brain injury and their families after his daughter, Bonnie, was injured in a car accident in 1979. Mr. Haynes established the Texas Head Injury Foundation and served as its first president.  Later he was elected chair of the Board of the Head Injury Association. 

Mr Haynes played an important leadership role and was a true advocate of the rights of persons with a brain injury and their familes.  He we be missed by all.

SERVICES:

Mr. Haynes is survived by Grace Grainger Haynes, his wife of 52 years, and three children, Sam, Bonnie, and Chas, and three grandchildren.  A memorial service will be held on December 19, 2007 at 4:00pm at Trinity Episcopal Church in Houston, Texas. In lieu of flowers, the family asks friends to please consider a donation to the Brain Injury Association of America, 1608 Spring Hill Road, Suite 110, Vienna, VA 22182.

Legislative Update from Brain Injury Association of America

The following is a legilstaive update provided by the Brain Injury Association of America:
 
SENATE PASSES TBI ACT REAUTHORIZATION BILL

Earlier today (Tuesday, December 11, 2007), the Senate passed by voice vote S. 793, legislation to reauthorize the TBI Act.  The reauthorization includes provisions to continue and hopefully expand TBI Act programs, such as the HRSA State Grant and CDC surveillance programs. 

This is a big victory, as the authorization for TBI Act programs officially lapsed in 2005 and advocacy efforts to renew this authority have been vigorous.  Stay tuned to BIAA for further information and analysis as developments progress.

APPROPRIATIONS HANG-UP

Unfortunately, as of press time on Tuesday, December 11, 2007, Congressional leadership had still not made a final decision regarding floor consideration of a “split-the-difference” omnibus appropriations bill, and thus, a conference report for this bill has not been filed.  Stay tuned to BIAA for the latest updates on this situation.

DEFENSE AUTHORIZATION BILL – INCLUDING TBI CARE PROVISIONS  - SET FOR PASSAGE

Congress is expected to pass the National Defense Authorization Act for Fiscal Year 2008 - including key wounded warrior provisions related to TBI care - this week.  The House of Representatives is expected to adopt the conference report tomorrow (Wednesday) or Thursday, followed by predicted swift passage in the Senate.

According to CQ Today (Dec. 11, 2007), “Several dozen House members might vote against the bill because of its war authorization, but they are likely to prove only a bump in an otherwise smooth road to adoption. And despite the conferees’ differences with the White House on a wide range of issues including military pay and overseeing contractors, they have sufficiently modified provisions to avert a veto threatened by the administration, members and aides predict.”

BIAA has lobbied actively this year on many of the TBI care provisions contained in the final version of the bill, and grassroots activity on the part of TBI advocates helped ensure that these TBI provisions were included in the conference report.

Below is a summary of the key TBI provisions included in the bill:

Major TBI Provisions in the National Defense Authorization Act for Fiscal Year 2008 (H.R. 1585)

Overlap of DoD/VA benefits:  Allows severely ill or injured service members and veterans to access their health care - including TBI care - based on their medical condition, rather than on their status as active duty or medically retired.  For example, if implemented, this overlap of benefits would allow medically retired veterans to access TBI care at private/civilian facilities that are eligible TRICARE providers.  Currently, this access is limited to service members who have active duty status. Note: Some civilian TRICARE facilities provide cognitive rehabilitation therapy.  This provisions sunsets in 2012. (Sec. 1631)

DoD Comprehensive Plan To Address TBI: Requires DoD to submit within 180 days of enactment, in consultation with the VA, a comprehensive plan for programs and activities of the Department of Defense to prevent, diagnose, mitigate, treat, research and otherwise respond to TBI and PTSD.  Plans are directed to include provisions for making injured service members aware of options for different treatments. (Sec. 1618)

This plan is required to include a proposal for the development and deployment of evidence-based means of assessing traumatic brain injury, PTSD, and other mental health conditions in members of the Armed Forces, including a system of pre-deployment and post-deployment screenings of cognitive ability in members for the detection of cognitive impairment.  (Sec. 1618)

This plan is also required to include a proposal on the development and deployment of an education and awareness training initiative designed to reduce the negative stigma associated with TBI and PTSD, and a plan for the provisions of education and outreach to families of members of the Armed Forces with TBI, PTSD, or other mental health conditions. (Sec. 1618)

VA Individualized TBI Rehabilitation Plans/Use of Civilian Facilities for TBI Care: Requires the VA Secretary to develop an individualized plan for rehabilitation and reintegration into the community for each veteran or service member who receives inpatient or outpatient care at the VA for TBI (Sec. 1702).

Note:  Unfortunately, the final version of this defense authorization bill/conference report does NOT include the provision in the Senate version of the bill which would have required the Secretary of the VA to provide care in non-VA (civilian) facilities if the Secretary determines that the VA is unable to provide care at the frequency or duration prescribed in the individualized plan, for rehabilitation and reintegration, or if the Secretary determines it is optimal for the veteran to receive care in a non-VA facility. 

Similar – but weaker - language, was included, stating that, in implementing and carrying out the individualized plans, the Secretary of the VA “may provide hospital care and medical services through cooperative agreements with appropriate public or private entities that have established long-term neurobehavioral rehabilitation and recovery programs.” (Sec. 1703)

Procedures for Referrals to VA and Civilian Health Care Services: Requires a comprehensive policy on improvements to care, management, and transition of recovering service members to “provide for uniform policies, procedures, and criteria among the military departments on the referral of recovering service members to the Department of Veterans Affairs and other private and public entities (including universities and rehabilitation hospitals, centers, and clinics) in order to secure the most appropriate care for recovering service members, which policies, procedures, and criteria shall take into account, but not be limited to, the medical needs of recovering service members and the geographic location of available necessary recovery care services.” (Sec. 1611)

DoD TBI Center of Excellence: Requires the establishment of a Center of Excellence in the Prevention, Diagnosis, Mitigation, Treatment, and Rehabilitation of Traumatic Brain Injury, including mild, moderate, and severe TBI.  The Secretary of Defense is directed to enter into partnerships, to the maximum extent practicable, with the VA, institutions of higher education, and other appropriate public and private entities, to further the research efforts of the centers.   This DoD TBI Center of Excellence is responsible for implementing the DoD’s comprehensive plan to address TBI - as required by Sec. 1618 – once this plan is developed.  (Sec. 1621)

Collaboration Required in New VA TBI Research Efforts:  Requires new VA TBI research efforts to collaborate with facilities that conduct research on rehabilitation for individuals with TBI and receive grants for such research from the National Institute on Disability and Rehabilitation Research of the Department of Education (for example, the TBI Model Systems of Care program). (Sec. 1704) 

National Academy of Sciences DoD/VA TBI Study: Requires DoD, in consultation with the VA, to contract with the National Academy of Sciences to study the physical and mental health – specifically including the neurological, psychiatric, and psychological effects of TBI – of members and former members of the Armed Forces who are deployed in OEF or OIF, and their families as a result of such deployment.  Specifically, a comprehensive assessment is required - not later than three years after the date of legislative enactment – of “the full scope of the neurological, psychiatric, and psychological effects of traumatic brain injury on members of the Armed Forces, including the effects of such effects on the family members of such members and former members, and an assessment of the efficacy of current treatment approaches for traumatic brain injury in the United States and the efficacy of screenings and treatment approaches for traumatic brain injury within the Department of Defense and the Department of Veterans Affairs.  (Sec. 1661)

Comprehensive Long-Term TBI Rehabilitation Program in VA: Requires the Secretary of the VA to develop and carry out a comprehensive program of long-term care for post-acute traumatic brain injury rehabilitation that includes residential, community, and home-based components utilizing interdisciplinary treatment teams.  This program is to be developed and located in Department of VA polytrauma rehabilitation centers.  Eligibility is restricted to veterans diagnosed as suffering from “moderate to severe” traumatic brain injury (excludes mild) who are unable to manage routine activities of daily living without supervision or assistance, as determined by the Secretary. (Sec. 1702)

Pilot Program on Assisted Living Services for Veterans with TBI:  Requires the Secretary of the VA, in collaboration with the Defense and Veterans Brain Injury Center of the Department of Defense, to carry out a five-year pilot program to assess the effectiveness of providing assisted living services to eligible veterans with traumatic brain injury to enhance the rehabilitation, quality of life, and community integration of such veterans (Sec. 1705)

Report on TBI Classfications:  Requires the Secretary of Defense and the Secretary of Veterans Affairs to jointly submit a report – not later than 90 days after the date of legislative enactment - describing the changes undertaken within the Department of Defense and the Department of Veterans Affairs to ensure that traumatic brain injury victims receive a medical designation concomitant with their injury rather than a medical designation that assigns a generic classification (such as “organic psychiatric disorder.”) (Sec. 1664)

TBI Registry in VA:  Requires the Secretary of the VA to establish and maintain a registry of names of each individual who: 1) served as a member of the Armed Forces in Operation Enduring Freedom or Operation Iraqi Freedom; 2) exhibits symptoms association with TBI; 3) applies for care and services from the Department of Veterans Affairs or files a claim for compensation for disability associated with such service; and 4) grants permission to the Secretary to include such information in the registry. (Sec. 1704)

Brain Injury Association of America: Legislative Alert

Here is the latest legislative alert from the Brain Injury Association of America:

Dear Advocates:

Congress returned this week from Thanksgiving Break, and acted on several bills impacting traumatic brain injury care and programs.

Late last night, the conference report for the National Defense Authorization Act for Fiscal Year 2008 was filed, containing important Wounded Warrior provisions, including several related to TBI care for returning service members.

Also this week, Congress reportedly made progress on year-end spending negotiations, setting up a likely vote next week on an omnibus appropriations bill including reduced spending levels in an attempt to compromise with the White House.

In addition, an expected markup of an important Medicare package by the Senate Finance Committee was scrapped late this week in favor of direct negotiations with the House of Representatives.

Congress will attempt to resolve all of these issues – and more – before ending this year’s session within the next couple of weeks.

New York State Traumatic Brain Injury Services Coordinating Council: Meeting Annoucement

As the Chair of the State of New York Traumatic Brain Injury Services Coordinating Council, I am pleased to provide information and the agenda for our next meeting scheduled for Wednesday, December 12, 2007 at 10:00 AM at the offices of the New York State Department of Health located at 161 Delaware Avenue, Delmar, New York.

The agenda for this meeting is as follows:

• Report and update on the TBI Waiver Program
• New York State SPARCS Date Discussion regarding traumatic brain injury data collected by the Health Department
• Subcommittee Structure and Future Direction Discussions
• Public Comment Period

The Council was created by the New York State Legislature and is charged with recommending to the department of health long range objectives, goals and priorities concerning traumatic brain injury.  It is also charged with providing advice on the planning, coordination and development of needed traumatic brain injury services to the residents of New York State.

As the new chair of this council, I have carefully examined the past direction of the council and the progress that it has made in fulfilling its legislative mandate.  After discussions at our last meeting, I have created several new committees to be announced at the meeting.  In addition to membership by council members, I have also invited additional participation by individuals with demonstrated knowledge and expertise in traumatic brain injury to assist in evaluating TBI services in New York State.  I am hopeful that the newly formed committees will address the many needs of New York residents who have sustained a traumatic brain injury as well as the needs of their family members.

I welcome your participating at the next scheduled council meeting.

New Study Confirms Even Minor Impacts Can Cause Concussions and Traumatic Brain Injury

An important new study to be published in the December issue of the journal, Neurosurgery confirms that impacts considered to be minor can cause a concussion and a traumatic brain injury.

The study is based upon date obtained from sensors placed in football helmets.  Researchers at the University of North Carolina studied the amount of force that the player received on impact.

Using special accelerometers embedded in helmets, researchers were able to measure in real time the amount of g-force players' heads experienced at impact, where on the head the players were hit and the directional force of the hits -- linear (straight) or rotational (twisted). The system is called HITS, or Head Impact Telemetry System.

"People see massive hits and think, 'that's the one!' and ignore more trivial blows," said Kevin Guskiewicz, Ph.D., senior author on the papers and chair of the department of exercise and sport science in UNC's College of Arts & Sciences. "Now we know that these trivial hits may be just as serious as the harder ones."

Hopefully this information will cause those who believe that minor impacts cause no permanent injury to reevaluate their opinions.  There is no such thing as a minor head injury.  All head injury must be treated seriously.

Psychology Glossary of Terms

Ever heard a psychological term or read a term that you didn't understand? I recently came across a very good list at Psych Central which has published a Psychology Glossary reference, a fast and simple way to look-up a psychology term and see it used in an example or context. A quick and easy way to check on the meaning of something you don’t quite understand, especially for students of psychology and those reading psychological reports. Click psychology glossary of terms to assist you.

Exposure To Lead Can Affect Ability of Brain to Respond to Later Brain Injuries

Exposure to lead can hinder the brain's ability to recover from injury, a recent study in laboratory animals shows.

Researchers at Jefferson Medical College wanted to know if it was possible that lead might alter the potential for plasticity, the ability of the brain to compensate for an injury.  Their finding is reported in the latest issue of the journal, NeuroToxicology.

They studied young rats that were fed a diet supplemented with lead and compared them to others on a diet without lead. They found that even brief exposures to lead affected the ability of the brain to respond to later brain insults.

It is well known that lead exposure had detrimental effects on learning and memory.  This new study implicates lead as a cause of the failure of the brain to properly heal following insults later in life including traumatic brain injury.

Head Injury A Growing Problem in Skiing and Snowboarding

A review published in the journal Injury Prevention concludes that head and spinal injuries are on the rise as a result of skiing and snowboard accidents.  The authors conclude that faster speeds and complicated maneuvers are leading to more head and spine injuries among downhill skiers and snowboarders.

While injuries in general are declining in these two sports, head injury continues to rise.

Helmet use is associated with a 22 percent to 60 percent reduction in head injury risk, but helmets are not being used by the majority of those on the slopes. The U.S. Consumer Product Safety Commission estimates that half of head injuries on the slopes could be prevented by helmets, but a survey of several United States ski resorts found that helmets were worn by just one in eight skiers and snowboarders. Notably, the most-skilled athletes were most likely to wear a helmet.

Although there has been some speculation that helmets may increase the odds of spinal injury in children, the new review cites three studies showing that helmets do not raise such a risk. It is true that many parents buy helmets too big, so that kids will grow into them; a poorly fitted helmet offers less protection, impeding vision and muffling hearing. Although more study is needed, the review authors conclude that the benefits of helmet use in preventing serious head injury far outweigh any risk.

New York Task Force To Examine Mold Exposure

The first meeting of the New York State Mold Task Force will be held today in Latham, New York.  The task force was created to examine and report to the governor and legislature the magnitude of the mold problem in New York State, current knowledge about this problem, illnesses that it causes and possible future actions by the health department and legislature.

Mold exposure is a growing problem in New York and throughout the country.  In addition to respiratory problems including asthma attacks and other breathing problems, mold exposure is also a cause of cognitive dysfunction and memory loss.

There are currently no state wide standards addressing mold including even a definition of what qualifies as hazardous mold, acceptable exposure limits or the proper manner of mold remediation.  Hopefully the panel will address these issues.

Brain Injury Publication Available on Line

The Journal of Rehabilitation Research and Development (JRRD) has released a single-topic issue on traumatic brain injury (TBI) and polytrauma. Focused on the diagnosis and treatment of TBI, this issue examines the clinical characteristics of military personnel returning from combat and describes several healthcare models that are providing care and support to them and their families. According to the Journal editors,  “The purpose of this special issue is to document lessons learned that will enhance the identification and treatment of veterans with polytrauma across the country.”

Topics in this issue include:

• Treatment of patients with posttraumatic stress disorder and mild TBI
• Military and VA telemedicine systems for patients with TBI
• Operational description of the VA Palo Alto Polytrauma Network Site
• Neuropsychiatric perspective on TBI.

This issue is available for download at no charge by going to the  Brain Injury Rehabilitation Publication Web Site.   The print version is due for release Dec. 14. Printed copies can be requested by sending an e-mail message  Please be sure to include your complete mailing address in your request.

Dan Windheim, TBI Survivor Listen to His Interview

Many years ago, Dan Windheim sustained life threatening brain damage following a car accident.  Since then he has devoted his life to assisting survivors of brain injury.  He has written several books detailing his experiences and his road to recovery.  His positive attitude is an inspiration for all of us.

You can get more information about Dan and his activities by going to his web site Life With TBI where you can also listen to his recent interview which is also available by clicking here.

Department of Defense Establishes Center of Excellence to Address Traumatic Brain Injury

What follows is a press release from the Department of Defense regarding the opening of their Traumatic Brain Injury (TBI) Center of Excellence:

The Defense Center of Excellence (DCoE) for Psychological Health (PH) and Traumatic Brain Injury (TBI) began initial operations today. The DCoE will be fully functional by October 2009.   It is currently operating in temporary office spaces in Rosslyn, Va., as part of its initial phase.

The Department of Defense (DoD), with support from the Department of Veterans Affairs (VA), is leading a national collaborative network to advance and disseminate PH/TBI knowledge, enhance clinical and management approaches, and facilitate other vital services to best serve the urgent and enduring needs of warrior families with PH and/or TBI.

“The center will integrate quality programs and advanced medical technology to give us unprecedented expertise in dealing with psychological health and traumatic brain injuries,” said Assistant Secretary of Defense for Health Affairs Dr. S. Ward Casscells. “In developing the national collaborative network, the DCoE will coordinate existing medical, academic, research, and advocacy assets within the services, with those of the VA and Health and Human Services, other federal, state and local agencies, as well as academic institutions.”
            
The Defense and Veterans Brain Injury Center (DVBIC) is now integrated into the center. DVBIC has DoD’s primary subject matter expertise on TBI and many of its functions are transitioning to the DCoE. The DoD Center for Deployment Psychology, currently at the Uniformed Services University of the Health Sciences, is also integrated into the training and education functions of the DCoE.