Alexa and Her Friends Promote Independence

The new technology of smart homes has sparked the interest of all Americans, as they imagine Alexa and other such tools closing the blinds, turning off the stove and other such activities at a specific time.  For those with a brain injury and/or other disabilities, the possibilities are even greater, allowing them to, “independently plan, organize and complete everyday activities.”

Nearly a decade ago, in 2009, the government saw the potential of smart homes for the disabled, when it concluded, “more outcomes-based research and collaboration among stakeholders is essential in order to establish guidance for designing, selecting and implementing individualized smart home solutions for those with neurological disability.”  To identify both the needs of those with brain injuries, as well as their caregivers and their rehabilitation and home healthcare providers in smart homes, the government conducted such studies, as that in 2016.  To condense the findings of this study, it found that “to meet participation needs of people with ABI, the design of smart homes must consider all categories of daily and social activities.”  More so, the VA found that smart homes actually aid in cognitive rehabilitation, as VA smart homes send technological reminders when someone goes “off track”.  The VA has stated smart homes have been described as a ‘cognitive prosthetic‘, telling someone when to take their medication and even such things as notifying someone how long they have been shaving.

Last month, the Gary Sinise Foundation, an organization whose mission is to “serve our nation by honoring our defenders, veterans, first responders, their families, and those in need,” built a smart home in Wildwood, Missouri for a veteran who lost both his legs and suffered a brain injury after stepping on an IED in Afghanistan.  This month, the Gary Sinise Foundation gave a smart home that they built in Richland County, Ohio to a former Army Sergeant who also suffered a traumatic brain injury and leg injuries while serving in Afghanistan.  As smart homes become more available, for both individual residence and community living, further independence can be known to many more with brain injuries.

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Hit by Dementia on the Battlefield

Last year, I reported on the correlation between traumatic brain injury and dementia.  Specifically, I linked to a study that found that those with a TBI had a 4.5 percent greater risk of dementia (in some studies, this percentage is a bit lower).  While terrible, that was not a complete surprise, when one is referring to moderate and severe brain injuries.  (The report that found that mild TBI is not so mild for the elderly is upsetting, but not unbelievable.)  However, since that time, government-funded studies, as well as other studies, have broadened that research and discovered that even a mild brain injury without loss of consciousness (loc) can more than double one’s chance of developing dementia, no matter what age that person is when that mTBI occurs.  A study of more than 350,000 veterans found that those who had a mild TBI, a single jolt to the head, without loc had a 2.36 percent greater risk of developing dementia.  For those in the study who had a mild TBI with loc, there was a 2.51 percent higher risk of developing dementia, not that much higher.

“One working theory is that somehow these injuries either cause an overproduction of normal waste proteins, or make it impossible to clear these proteins,” notes the study.  However, this is just a working theory because no one fully understands how the brain works, or rather why and how it stops working.  Responding to the above studies results, the director of the Army’s traumatic brain injury program questioned, “”Is blast exposure hurting service members or soldiers?  And if it is… how can we modify our equipment or the way we operate to prevent injury?”

Beyond the military, why is the risk of dementia higher after a TBI for working age adults, in general?  Additionally, the NCBI sponsored a nationwide study that found that, “the risk of dementia diagnosis decreased over time after TBI… [but] it was still evident >30 years after the trauma.”  Based on this information, how can we modify our diet, our physical activity, etc., during our TBI recovery and after, to prevent this?  As of now, research on cognitive decline, mild cognitive impairment, and dementia prevention has been “encouraging but inconclusive”.  However, the assumed prevention tactics of cognitive training, blood pressure management (for those with hypertension), and increased physical activity are beneficial regardless.

Trump Gives Credit to Caregivers

Trump donates his presidential paycheck to VA caregivers,” read the headline on The Military Times website yesterday, May 17, 2018.   Specifically, the President’s quarterly paycheck of $100,000 is the first check that the President has donated to the VA (earmarked for the caregivers) and the fifth paycheck that he has donated to various governmental departments.  “President Trump understands the critical role of caregivers,” said Acting VA Secretary Robert Wilkie of this quarter’s donation. Apart from financial support, caregivers support the health and healthcare of dependents and provide much needed social interaction.

Earlier this year, the “Trump tax cut”, H.R. 1, that passed in March, states that, “The [tax] credit [for caregivers]… shall be increased by $500 for each dependent of the taxpayer.”  A dependent is a relative who lives with the caregiver, earns less than $4,050 annually and that the caregiver financially supports.  This is a description that applies to many brain-injured individuals.

AVs: Salvation or Hazard

Getting an extra 30 minutes of sleep while you’re on the road… finishing yesterday’s homework while you’re on your way to your senior year of high school… caring for your baby while you’re breezing through the highway.  All of these scenarios seemed too good to be true a few years ago, but now America is on the cusp of the age of autonomous vehicles (AVs).  As it is, in 2016, 87.5 percent of people ages 16+ had their driver’s license and spent, on average, a total of 17,600 minutes on the road a year.  The idea of a car that could do the tedious and time-consuming duties of driving is a dream that is quickly becoming a reality.

For the disabled, the benefits of autonomous cars are even greater – if nothing else, it allows for increased independence.  It means the legally blind, for example, will finally be able to safely operate a car by themselves.  A 2012 video of a legally blind man stopping at the Taco Bell drive-thru prompted much positive excitement.  The means with which to allow the blind to safely drive is still in actuality in development, but spokesmen do say, “At Waymo, Google’s self-driving car company that was launched nearly a decade ago, officials say visually impaired employees contribute to design and research. While no specific system for blind riders has been completed, the company says it’s developing a mobile app, Braille labels and audio cues.”  As Americans gets older, a self-driving car could help those who have a, “loss [of] flexibility, vision and hearing,” and delayed reaction time.  Of course, these are some of the same impairments suffered by those with brain injuries.

However, this may seem too good to be true because it is just that.  Car fatalities have been on an almost steady decline, from a high of more than 50,000 in the 1970s to the low to medium 30,000s this decade.  (“An additional 2.35 million are injured or disabled.”)  Though this is still an extremely high number, how will fully autonomous or semi-autonomous cars affect this?  Beyond testing, no one knows if or by how much this will decrease with the use of self-driving cars.

Cars don’t have the same “sense” that people do.  Only a month ago, on March 20, 2018, in Arizona, a homeless woman became the first pedestrian fatality to be attributed to this new technology. “If there is any real-world scenario where it would be seemingly safe to operate in an automated mode, this should have been it. Something went seriously wrong,” said an urban planning professor after the incident.  (The car that caused the fatality was a self-driving Uber.  Uber has since suspended it’s self-driving car tests.)  In Mountain View, CA, headquarters to self-driving car company Waymo, Walter Huang was killed after the sun glare got into his eyes when his Tesla noted that it needed him to take the wheel, resulting in his vehicle driving straight into a highway median.  Two years ago, in Florida, a man was killed when he failed to take the wheel after numerous notifications from a self-driving car.  (The National Transportation Safety Board released a report of findings about the incident.)

In a horrifying test, reported by Psychology Today this month, “some recent demonstrations have shown that a few black stickers on a stop sign can fool the algorithm into thinking that the stop sign is a 60 mph sign.”  As far as accidents go, in Pittsburgh, PA in late February, a “Woman claim[ed a] self-driving Uber struck her car, left the scene.”  Did that driver choose not to stop or did the car leave on its own?

The above are just a few examples of accidents or possible accidents resulting from problems with autonomous cars.  (I am not sure how many more examples there are, if any.)  Tesla said in 2016, “Autopilot is by far the most advanced such system on the road, but it does not… allow the driver to abdicate responsibility.”  Presumably the technology has gotten much safer in the past 2 years because California just legalized testing of fully-autonomous vehicles on public roads.  Nationally, H.R. 3388 passed the House unanimously.  The bill’s subtext says that its intent is, “to provide for information on highly automated driving systems to be made available to prospective buyers.”  Further reading though, one finds that the goal of the bill is, “encouraging the testing and deployment of such vehicles.”  (Read also: California proposes new rules for self-driving cars to pick up passengers.)

Self-driving cars have already been tested in multiple states with positive results.  For example, in California, the state with the most drivers in America and the state that is testing AVs the most, Waymo just applied to the state to do what the above law indicates: test self-driving cars without a back-up driver on public roads.  (Besides California, many other states already have laws or proposed laws on the legality of self-driving cars.) Six months ago, GM announced its plan to start testing its Chevy Bolt EV in Manhattan later in 2018.  In Connecticut, Governor Daniel P. Malloy created a pilot program, which will soon launch, to test fully-automated cars.  And this month, the Pentagon announced that it intends to become the next big AV developer, as it soon plans to use self-driving vehicles in combat.  As Michael Griffin, the undersecretary of defense for research and engineering, states, “52 percent of casualties in combat zones can been attributed to military personnel delivering food, fuel and other logistics.”  Removing humans from this equation will save many lives.

Since there has been no final determination of the safety or legality of self-driving cars for the general population or for the disabled, no conclusion can be made on this post.  Some car manufacturers are addressing the public’s worries about fully autonomous cars by making them just not really that.  For example, one company, Phantom Auto, has developed a remote control car system, in which the car is “driven” remotely by an employee miles away.

But perhaps the worry about autonomous cars is similar to that which arose when America changed from horse-and-buggy to modern cars?  The concern and the extreme testing are understandable, but some states realize that the testing must stop at some point.  Is that time now?  In addition, should we allow those who are currently hindered from driving by their age or disability to get a key?

* Another issue that some have with self-driving cars is that, “AVs will record everything that happens in and around them. When a crime is committed, the police will ask nearby cars if they saw anything.”  For car accidents and other such physical and/or vehicular traumas this is a plus.  However, while a person or their family may want to know what vehicle caused their child’s car accident, do they want to give the government the ability to know exactly when they left for work, went to Walmart, refilled their gas tank, etc.?  Will self-driving cars be the means for social control?

Department of Energy: Who Knew?

I think we are all aware that the Department of Energy is not who sends us our monthly power bills to keep our lights turned on.  However, what exactly do they do?  Earlier this month, U.S. Secretary of Energy Rick Perry addressed this during a speech to the Hopkinsville, Kentucky Chamber of Commerce: “People might be surprised to learn that the Department of Energy oversees the country’s nuclear weapon supply, 17 national labs and research into dealing with post-traumatic stress and traumatic brain injuries.”  While the research supported by the Dept of Energy is targeted towards the military, research that develops new knowledge and new innovations for those in the military with a TBI can help all TBI survivors.  In late March, Perry toured a research facility, Brooke Army Medical Center, in his home state of Texas.  “The real recipients of what we’re doing are future warfighters, our veterans, and citizens who have had either PTSD or a traumatic brain injury,” he said during his visit.  As an Air Force veteran who served both in Europe and the Middle East, Perry is, unfortunately, all too familiar with this, through his fellow veterans.

mTBI, Not So Mild for the Older Generation

Last month, Rep. Louise Slaughter (NY) fell, resulting in a trip to the hospital.  “The Congresswoman is tough as nails and she will bring that same spirit to the recovery,” said her Chief of Staff at the time.  A Google search of “Louise Slaughter brain trauma” results in many links, including one entitled “Rep. Slaughter Announces Nearly $13 Million to Address Traumatic …”.  When clicking this link, however, one is directed to a now defunct personal webpage.  (A further search shows that Rep. Slaughter was a member of the Congressional Brain Injury Task Force, with particular attention paid to military weaponry.)

First elected to office in 1986, Slaughter was assuredly “tough as nails”, as she had to be, working in Congress and dealing with publications/broadcasters for so many years.  The first female chair of the House Rules Committee and the dean of the NY congressional delegation, Slaughter was planning on running for her 17th term.  “Louise was a trailblazer,” said Nancy Pelosi.  Unfortunately, the 88-year-old woman couldn’t recover from the intracranial hemorraging that resulted from the fall and passed away in mid-March.

Besides Rep. Slaughter, other politicians and others involved in politics have suffered such negative results from intracranial hemorraging.   Roger Ailes was a media consultant for President Richard Nixon, President Ronald Reagan, and President George H.W. Bush, as well as for Rudy Giuliani’s first mayoral campaign.  Most recently, he was CEO of Fox News until 2016 and served as a media consultant to Donald Trump’s presidential debates, before he passed away from intracranial hemorraging (subdural hematoma) in May 2017.  Additionally, one of the most respected past Presidents, Franklin Delano Roosevelt, died of intracranial hemorraging that was either caused by cancer or by high blood pressure.

Intracranial hemorraging is an all-encompassing diagnosis for bleeding within the skull that can be further categorized as an epidural hematoma, subdural hematoma, subarachnoid hemorrhage or intracerebral hemorrhage.  It is a form of mild traumatic brain injury (mTBI), that isn’t mild at all.  A concussion, for example, is a mTBI.

In 2012, the CDC reported that, “in the United States, the number of TBIs that occur each year among older adults, ages 65 years and older, is estimated at 237,844.”  Falls, as what happened to Rep. Slaughter, are the primary cause of TBI among the 65+ age range.  Additionally, it’s hard to assess how severe a brain injury is the older generation, because of other age-related issues.  Is a person’s memory loss due to a brain injury or simply a consequence of age?  The number of elderly Americans suffering a mTBI keeps rising, but the reason for this increase is unknown.  Perhaps it is because Americans are living longer?  Perhaps because Americans are living in their homes and generally staying active later in their lives?  Maybe it’s because new research and talk about such issues as sport-related injuries are being more broadly researched and discussed?

Tragedy Yields Action from Senate Sergeant-at-Arms

On September 11, 2001, Frank J. Larkin was working at the Secret Service’s New York City headquarters in the World Trade Center.  “[I was] dodging, unfortunately, folks who were jumping to their deaths, you know, witnessing that, which is something you just never forget,” he recalls.  A Navy SEAL, with nearly a decade in combat, Larkin has also worked for the Maryland State Police, in association with the Department of Defense, and as a Secret Agent for the US Secret Service.  Then, on January 6, 2015, he was nominated and appointed by Mitch McConnell to the position of Senate Sergeant-at-Arms, “its chief law enforcement officer, protocol officer, and executive officer.”

His son, Ryan F. Larkin, also felt this need to serve, following in his father’s footsteps and enlisting in the Navy in 2006.  Once enrolled, Ryan was deployed twice to Iraq, twice to Afghanistan and completed missions in Lebanon and Honduras.  Considered “a renaissance man,” he received many awards.  In March 2016, Ryan received an Honorable Discharge from the Navy.  While he stayed active post-deployment by, for example, attending college, his discharge was assumedly given at least partially because of a recognized brain injury.  On April 23, 2017, Ryan Larkin took his own life.

As someone without children, I cannot imagine what the loss of a child feels like.  However, I have always heard that it is the worst thing that can ever happen to a parent. Specifically related to Sergeant-at-Arms Larkin, it upended his life, including his career.  In March, he sent notice of retirement.  “Now I feel this obligation to help others…. These men and women volunteered to go in harm’s way to protect this nation, and we promised that we’d take care of them.  But we’re not living up to that promise.”  Upon leaving his job, he intends to spend his time advocating for projects related to traumatic brain injury research, particularly research related to military blast exposure, like that experienced by his son.

A VA study, published in September 2017, reported that the suicide rate for veterans is about 20 percent higher than the rate for non-veterans.  (That statistic is debatable.  Some say its lower and others have said its as high as 22 percent.)  “These findings are deeply concerning,” said VA Secretary Dr. David J. Shulkin at that time.  “What’s more, they report that veterans’ suicides account for 18% of the suicide deaths in the country, while they only make up 8.5% of the adult population.”  The National Center for PTSD, part of the VA, knows and notes the relationship between PTSD and suicide.  On January 10, 2017, Rep. Peter King (NY) introduced H.R. 411, the Veteran Suicide Prevention Act.  This bill was referred to the Subcommittee of Health on February 3, 2017 and it seems nothing has been done with it since that time.

[As of April 2018, Larkin is still in office and he has stated that he will not retire until his replacement is found.]

Update: Camps for a Cure

As reported in May 2017 as one of the West Coast facilities being built, the brain injury treatment center for military personnel near Naval Hospital Camp Pendleton will open its doors April 2 .  Operating as part of the Intrepid Spirit system, this is the first such facility to be opened on the West Coast.  Up until now, those in the military who sustain a brain injury in the call of duty generally must receive treatment at one of the 6 Intrepid Spirit centers, none of which is in the section of the country.  As David Winters, president of the Intrepid Fallen Heroes Fund, which funded this project, says, “We know that being able to be close to home, surrounded by loved ones, is a crucial part of the recovery process… so we are opening centers on the West Coast this spring… in order [so] that service members who need treatment do not have to uproot themselves and their families to get it.”  Currently, brain injured soldiers are treated at the Concussion Care Clinic at Camp Pendleton hospital, which was only opened in 2014.  However, this new facility can care for hundreds, if not thousands, of new patients.  (This new brain injury-specific facility will not only treat more soldiers, but will also teach prevention tactics and conduct brain/brain injury research.)

See also: Camps for a Cure

Brain Injury Awareness Month Across the Country: Capitol Hill

Brain injury affects America as a whole, and its importance should be recognized on Capitol Hill.  As part of this national recognition, on March 5, Press Secretary Sarah Sanders introduced Retired Marine Corps Sergeant John Peck to the press.   Peck’s story is remarkable and therefore must be noted in its entirety: “Sergeant Peck suffered a traumatic brain injury in Iraq during his first tour of duty.  Then, after two years of therapy, he re-enlisted and deployed to Afghanistan.  While there, he stepped on an IED and lost both arms and legs.  He spent two years at Walter Reed, and in 2016 received a double arm transplant.  He is now doing physical and occupational therapy at Walter Reed, and doing incredibly well.”

Earlier this week, our legislators further honored brain injured Americans at Brain Injury Awareness Day, which is always honored on Capitol Hill during Brain Injury Awareness Month.  Generally, from what I can determine, the day is simply associated with Brain Injury Awareness Month and, therefore, in March.  However, Brain Injury Awareness Day is not honored on a specific calendar day.  (For example, in 2017 it was on Wednesday, March 22.  This year it was on March 20.)  The point of the day, though, is unchanging: to increase knowledge and awareness of brain injury with our elected officials.

As noted in an earlier article, the theme of 2018 Brain Injury Awareness Month is Change Your MindScheduled by the Congressional Brain Injury Task Force, co-chaired by Reps. Bill Pascrell, Jr. (NJ) and Thomas J. Rooney (FL), the events this past Tuesday were a Brain Injury Awareness fair, a Congressional briefing and a reception celebrating Brain Injury Awareness Month.

When I can find the audio of the Capitol Hill Congressional briefing, I will post it on this site.  Additionally, as I find state events honoring the month, I will post them.

A Different Perspective: Cold War Tactics in Cuba

The news late last year that the Cuban government might have found a way to produce sonic effects that harmed the brain of over 20 embassy agents was horrifying.  Now, the liberal publication, The Nation, asks if making Americans fearful of travelling to Cuba was the sole purpose: Is it merely a construct of fear developed by the Trump administration?

To reiterate that effects reported on as suffered by those in the embassy, “Some can no longer remember words, while others have hearing loss, speech problems, balance issues, nervous-system damage. Headaches, ringing in the ears, and nausea.”  The Nation states the government’s conclusion of these findings, which may seem obvious to many brain injury survivors and their families: “We think the audible sound was a consequence of the exposure, because audible sound is not known to cause brain injury.”  For example, tinnitus is a known effect of brain injury.

Regardless of this finding, the publication goes on to say that, “the alert reflects an ongoing effort by President Trump’s State Department to frighten US travelers away from Cuba.”  True, no tourist, and only those who worked for the embassy and their families were affected.  However, Americans should not discount the study’s findings, especially simply because of dislike of the President.  The consequence of error could be significant.

(The prevailing liberal reaction to this problem is curious, given the Democratic Party’s stance on guns and other physical weapons that can be used to commit murder or injury, but statistically have a lower percentage of doing so than whatever has occurred in Cuba.  The President’s response is curious too, in that it puts blame on the Cuban government without a full and comprehensive investigation.)

[SEE PREVIOUS ARTICLE FOR FURTHER INFORMATION ON THE AMERICAN TROUBLES IN CUBA]