The Importance of PLAY(S)

Children generally have more physical energy than their adult counterparts. As a consequence, many participate in youth sports leagues, which not only provide physical activity, but also teach them to work effectively with their peers.  Last year, Senator Capito (WV) proposed Senate Resolution 227 which marked July 16 – 22 as National Youth Sports Week.  According to the bill, the week is, “a celebration of youth sports participation and all of the benefits youth derive from engagement in sports.”

In 2018, “[this] week… thousands of youth sports coaches, athletic directors, recreation directors, association members, sponsors, young athletes, and parents across the country show their support focusing on P.L.A.Y.S. ~ Physical activity, Living healthy, Access, Youth development, Safety.”  While having access to the physical activity and youth development provided by sports, which is a key part of healthy living, the S (safety) should always be included in the celebration.

***The bones of children are still in development and, therefore, weaker.  Additionally, the coating of myelin, neuron fibers, in the brain of youth is still in development.  Because of this, physical injury, including skull injury, is more common and more severe in children, than in adults.  Particularly this can be found in sports, most notably in youth football, youth hockey and youth soccer, but the risk is present in all sports.  (For example, this month, the CDC published an article that identifies brain infection/injury as a rare, but possible result of fresh water swimming.)  Additionally, beyond physical safety, sports may affect the brain psychologically, but this affect can also be positive.  New Jersey, among other states, has a youth sports concussion law, “to help reduce the risk of student-athletes suffering concussion, and its long-term consequences.”  Included as a possible long-tern consequence is a traumatic brain injury.

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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.

Illegal Immigrants and Brain Injury

A hot topic in the past few decades, illegal immigration has now come to the forefront because of America’s current president and his border wall.  (For the past 10 years, the estimated number of illegal immigrants in America has stayed relatively stable at about 11 million.  During the presidencies of Bill Clinton and George W. Bush, it was steadily rising.)  As for brain injury and undocumented residents, there are many cause-and-effect questions that, when answered, are quite sobering.

To begin, what if the illegal immigrant is the culprit?  What if the illegal immigrant causes someone to have a brain injury, either intentionally or inadvertently?  First, the police or whomever is pursuing the case must find them.  Since illegal immigrants are largely undocumented, this can be a hard task.  For better or worse, depending on your political ideology, a number of states are now allowing an illegal immigrant to legally obtain a driver’s license and register their car.  In January 2015, for example, California signed into law AB60, which, “requires the [DMV] to issue an original driver’s license to an applicant who is unable to submit satisfactory proof of legal presence in the United States.”  New Jersey, with the support of Governor Phil Murphy, is now preparing for a similar bill, Assembly Bill No. 1738, to pass.  If this bill passes, it will make New Jersey the 13th state, plus the District of Columbia, to allow this.  (What the consequences are for an illegal immigrant who inflicts injury on another person, such as through a car accident and even if they are legally licensed, is unclear.  They are subject to criminal charges, but civil action may be more difficult.  As they are illegal, and many do not submit tax returns, which would show their yearly income, monetary consequences to cover such things as rehabilitation costs are not possible.)

More so, the government does not seem to account for the economic costs of brain injury:  For the victim, there will be a lose of future wages as, even if the victim is able to return to work, they will be away for a bit.  Additionally, when returning to work, a brain injured individual may have to pursue a career that is less cognitively and/or physically demanding and often less lucrative than their previous occupation.  For the Internal Revenue Service (IRS), this means less taxable dollars are earned.  Also, the brain injured individual may stay longer or indefinitely on Medicare and/or Medicaid.  The government then is required to help pay for their doctors’ visits, their medication, etc.

But, how about when the illegal immigrant is the victim?  No one wants to see a person, legal or not, suffer or even die due to lack of medical care.  All told, the government is financing about $18.5 billion a year for medical care of unauthorized immigrants.  Of this total, “federal taxpayers provided $11.2 billion in subsidized care to unauthorized immigrants in 2016.”  (“A relatively small number of undocumented immigrants, perhaps in the tens of thousands, obtain health insurance through private employers,” states a 2016 article.)  However, a page on the NIH website, written by an individual who had authored other pages on ethics, as it relates to illegal immigrants, notes that, “the Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries.”

There are local health clinics, hospital emergency rooms and free medical school clinics that must treat everyone, regardless of legality.*  Additionally, some doctors will treat undocumented immigrants, off the record.  Treatment for brain injury though, requires more than a brief trip to the doctor.  As an article from 2009, when illegal immigrants were treated differently by the government than now, is titled, “Struggling to find post-acute care for undocumented and uninsured immigrants.”  Should ethics trump legality, no pun intended?

*Another article recounts the story of an illegal man, without insurance, who suffered a stroke.  Though the hospital legally had to treat him, his care would be uncertain the second he stepped out of the hospital grounds.  Would receiving care for his stroke result in a “medical deportation”?  Ultimately, the hospital was able to find the man’s family in Mexico, but the trip to return him to his family cost $50,000 and was paid entirely by the government.

Note: The above post is not a personal comment on illegal immigration.

Investigators Question America’s Football Crisis

People now see football and brain injury as a definite cause-and-effect.  Parents are much more hesitant to allow their school-aged children join the school football team.  In January, for example, laws related to youth football were proposed in Illinois and New York, both named after former NFL players who suffered the effects of CTE (chronic traumatic encephalopathy).  In Illinois, HB4341 was named after Dave Duerson, a former Chicago Bears player who committed suicide in 2011 and whose autopsy showed that he had a brain injury.  Officially known as the CTE Prevention Act (HB4341), the last action on the Duerson Act was on April 27, 2018 when it was referred the Rules Committee.  In New York, A1269A is named after former Baltimore Colts tight-end John Mackey, who showed signs of brain injury prior to his death at age 69.  The John MacKey Youth Football Protection Act is also still in Committee in the State Assembly.  (Notably, the MacKey Act only prevents children 11 years and younger from playing tackle football, not 12 or 13 years as other proposed laws restrict.)

In Maryland, a bill was introduced by Delegate Terri Hill, and failed, that would have changed the rules for youth soccer, lacrosse, hockey and [tackle] football.  (“I really did not expect it to pass, but I think it’s a conversation we have to have and I don’t think the conversation is over,” Hill said.)  In New Jersey, A3760 was introduced by Assemblywoman Valerie Huttle on April 5, 2018 to prohibit children under the age of 12 from participating in tackle football.  After its introduction, it was referred to the Assembly Women and Children Committee, where it sits now.  Last week, AB-2108 failed in the California Assembly, “but before the outrage and the mudslinging and the ‘Save Youth Football’ rallies, [the] resolution pass[ed] unanimously, with 69 co-authors.”

Many proponents of safer/more restrictive youth football cite a recent Boston University study that showed that hits to the head, not concussions, cause CTE.  Hits to the head are thought to be simply a means of defense in football, not just the residual effect of defense, like a concussion.  Therefore, it’s harder to eliminate them while keeping the competitive edge of the sport.  (Getting rid of the tackle part of professional football would be more difficult, but it is still difficult in youth football, without allowing it to become touch football.)

What the safety rules of youth football should be is a good discussion to have, especially now that a Court-appointed Special Investigator has shown that some NFL players who have claimed brain injury did not, if fact, have such neurological problems.  The Investigator found, for example, that a law firm shared by dozens of NFL players purportedly coached the players on how to fail a neurological test.  A review of the post-NFL lives of some players who claimed themselves to be too cognitively impaired to work did, in fact, work – as motivational speakers, coaches, bankers, etc.

However, no one is fully certain about the effects of football on the brain. In April 2018, former 19-year NFL player Brett Favre spoke of whether his forgetfulness was because of he is aging, as he is 48, or, “do I have [the] early stages of CTE?  I don’t know.”  Research and news have made brain injury and football seem to always coincide, so Favre’s personal questioning is understandable.  Just as was noted in this website’s article related to Shaken Baby Syndrome though, the horrific easy answer isn’t always correct.  Whether or not the news about the CTE-football connection affects a state’s or a school district’s decision on whether to continue to offer football, whether schools stricken their football rules, and whether a parent chooses to allow their child to play the sport rests solely on them.

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?

Sit Down and Breathe

The easiest way to heal from a brain injury is simply to replace the injured parts of the brain.  Though this thought may seem both impossible and simply weird, scientists are now learning how to replace, or rather regrow, the brain in the healing of traumatic brain injury.

Specifically, it is well-known that human life depends of the inhalation of oxygen.  Oxygen also helps the body heal, as it is transported through the body in red blood cells.  Leveraging this healing process, hyperbaric oxygen therapy (HBOT) has been developed as a medical treatment in which one is encapsulated in a room or chamber filled with 100% oxygen.  (The air humans typically inhale is only about 20% oxygen.)  Additionally, HBOT has three times more air pressure than is typically experienced.  Increased inhalation of oxygen means that it is not only transported through red blood cells, but also, “into all of the body’s fluids, the plasma, the central nervous system fluids, the lymph, and the bone.”  More oxygen means more opportunities to aid healing, even while appropriate oxygen is still provided to the lungs.

Based on this evidence, it seems that HBOT would be a logical choice for professionals to treat those with certain injuries.  For example, Lake Regional Wound Healing Center in Missouri has been named a Center of Distinction, largely for its work with HBOT.. In New Mexico, a pickleball benefit  was recently held both to honor deceased veterans and to raise funds for Mission 22, an organization that offers HBOT to those with TBI.

More so, the federal government discovered these benefits a few years ago.  In June 2014, for example, the NIH published a study entitled Red blood cell transfusion in patients with traumatic brain injury: a systematic review protocol.  In 2016, they published the results of a study entitled Hyperbaric oxygen therapy for traumatic brain injury: bench-to-bedside, during which they concluded that, “HBOT has been demonstrated to have neuroprotective effects without increased oxygen toxicity in experimental TBI models when administered at pressures less than 3 ATA [atmospheric pressure].”

In recent days, a law to provide HBOT to veterans suffering from injury, including TBI and PTSD, was presented to the Arizona legislature.  Specifically, Hyperbaric Oxygenation Treatment for Veterans with Traumatic Brain Injury was sponsored by Mark Finchem and passed the State House and Senate unanimously.  On Thursday, March 29, HB 2513 was signed into law by Arizona Governor Doug Ducey.  Reading about Arizona’s action reminds one that many other states have also passed such legislation: Oklahoma, Texas, Indiana and Kentucky.

* Two relevant questions regarding HBOT, with helpful answers:

“How does hyperbaric oxygen help brain injury or stroke? When cells in the brain die, either from trauma or lack of oxygen, blood plasma leaks out into surrounding brain tissue causing swelling and reducing blood flow. These otherwise normal cells go dormant because they can’t function without the appropriate amount of oxygen. HBOT dramatically increases the oxygen carried in the blood plasma, making oxygen available to heal damaged capillary walls, preventing plasma leakage and reducing swelling. As the swelling decreases, blood flow can be restored to the dormant tissue (neovascularization) and these cells then have the potential to function again.”

“How does hyperbaric oxygen help a child with cerebral palsy (CP) or traumatic brain injury (TBI)? In CP and TBI patients, some of the injured brain tissues may be “dormant” and non-functioning. HBOT can stimulate these “dormant” tissues and return them to more normal function. In young children, cognitive function and spasticity can be improved.”

Brain Injury Awareness Month Across the Country: State Recognition

Brain injury has been an ongoing issue in America since its founding.  Though federally honored, BIAM is still finding legislative recognition on the state level.  For example, House Resolution 741 (HR 741), introduced by Pennsylvania’s Tina Pickett, was only introduced earlier this month and adopted (188-0) on March 14.  A similar bill will soon be voted on in the PA Senate.  (Though this marks the official recognition of the Month, the State has honored and provided education on brain injury at least since 2011.)  In 2013, New Jersey officially recognized it as a month-long state observance, whereas legislators in Alaska were relatively early adopters, passing a law to recognize the Month back in the 2007 – 2008 Congressional year.  (Some states still do not officially note Brain Injury Awareness Month.  However, groups in these states, such as the BIAA, do provide events specifically designed for the Month.)

As for events, New York State, in Tonawanda, located near Niagara Falls, lights the City Hall blue for the entire month to show solidarity and the need for public education on brain injury.  (Blue is the official color of Brain Injury Awareness Month, as designated by the Brain Injury Association of America.) On Brian Injury Advocacy Day, March 20, survivors/advocates met with members of the New York State Legislature to thank legislators for what they have done thus far and to teach them about the impact of brain injury, including how they can further help prevent it, as well as support those with brain injury.  While some legislators may have been tempted by the promise of pie, Kansas legislators and lawmakers met at the Topeka State House on March 21 to learn more about brain injury.  The Nebraska Brain Injury Advisory Council, which is sponsored by the Nebraska Department of Education, launched a mobile-responsive website that, “presents resources and reference information for anyone affected to assist in navigating for the best possible outcome.”

The above is just a short representation of activities throughout the country related to Brain Injury Awareness Month.  Please search online to find more past and upcoming local events.

Caring for Man’s Best Friend

The benefits of dog ownership are well-known.  “Owning a dog can lift your mood or help you feel less stressed.”  For veterans and others with disabilities, the benefits of have a dog, specifically service dogs, go beyond this: dogs can serve by helping or even doing certain tasks that the handlers cannot do themselves.

However, what happens when the dog is the one with a brain injury?  Yes, dog’s skulls are harder than humans and surrounded by protective fluid, both of which make brain injuries less common in them.  (This is definitely beneficial for animals that play/fight for fun, may bump into coffee tables as they chase after toys, etc.)  Canines though, can get brain injuries in the same ways that humans can: a car accident, a fall, etc.  The possible symptoms are also similar to those of humans:  bleeding from the nose or ears, coma, confusion, death, disorientation, facial weakness, lethargy, loss of consciousness, paralysis, pupil dilation, seizures, and stumbling.

Once these symptoms begin to occur what do you do?  For these members of the family, seeking medical help should be the next step.  Going to the local veterinarian is definitely the appropriate action, but there are also neuro-veterinarian specialists.  While this is a very limited profession, it’s not impossible to find.  It is fortuitous to an injured canine if their owner lives in Arizona, as they have access to this professional expertise.  (For example, Lucky, a dog found shot in the Arizona desert by border control officers earlier this year, was relatively fortunate that such help was available to him.)

One thing not to do is to abandon the dog.  This is what happened earlier this month to one dog in Sacramento, CA .  A woman, assuredly not the owner, found an injured dog on the streets and brought him to the Sacramento County Bradshaw Animal Shelter.  The dog, now named Thomas, has gone through multiple tests, yet the doctors still do not know what happened to him, just that it resulted in a severe brain injury.  “He is such a fighter… Baby Thomas wants everyone to know he is determined to heal, grow up and live a long, mischievous life!”  This and so many other examples show the need for Sacramento Counties non-profit T.E.A.M. – Teaching Everyone Animals Matter.  (As of March 16, the owner of Thomas has still not been found.  T.E.A.M. is now offering a $1,000 reward for information that leads to an arrest.)

(Most states have laws prohibiting animal cruelty.  For example, 3 weeks ago, a 27-year-old man was sentenced to 12 years in prison for abusing his boxer puppy.  Most of these states also have a law prohibiting animal abandonment.)

2018 Brain Injury Awareness Month

This month, March 2018, Americans recognize Brain Injury Awareness Month.  The theme for this year, through 2020, is Change Your Mind.  The significance of this theme is to show the ongoing public awareness campaign to provide, “a platform for educating the general public about the incidence of brain injury and the needs of people with brain injuries and their families.”  Many posters and webpages note the statistics, commonality and horror of brain injury in the United States.  Yes, as the Brain Injury Association of America notes, “Brain injury changes the way you think, act, move and feel.”  However, in some ways, for the better.  In this sense, part of what the BIAA is seeking to do is de-stigmatization.  (The theme for 2015 to 2017, #NotAlone, is still very apropos.) Search on Twitter or use the hangtags #ChangeYourMind, #BrainInjuryAwarenessMonth or simply #braininjury.

Note: From what I can find, Brain Injury Awareness Month is not a federally designated month.  However, “the Department of Defense (DoD) and the Brain Injury Association of America recognize March as Brain Injury Awareness month to increase awareness of Traumatic Brain Injury (TBI).”  Additionally, the month has been legally designated by many states.  New Jersey, for example, signed into law Section 36:2-87, to mark March as Brain Injury Awareness Month, in 2013.

Youth Football “Suits” Up

The Super Bowl may not be until next year, but the drama of football is already surfacing in California, as a “Judge OKs trial for brain-injury suit against Pop Warner.”  Specifically, the mothers claim their sons, who were 22 and 25 years old on their deaths, died as a result of the brain damage caused to them from participation in the Pop Warner Little Scholars, Inc. {PWLS) football league.  (They say that Pop Warner misrepresents its concern for safety when it says, “Pop Warner is the ONLY youth football program (local, regional and national) that sets and enforces a strict AGE & WEIGHT MATRIX that reduces the risk and reality of injuries.”)

In the past few years, the relationship between sports and brain injury has been extensively studied, primarily on the professional level.  However, studies have also been done on youth football players with results that are equally, if not more, troubling considering their still-developing brains.  “In the past 3 years, 47 children have died playing football in the United States.  Others found [that]… 21 out of 66 brains with clear evidence of CTE in males who played contact football when young.”

As terrible as the news about the relationship between youth sports and TBI may be, the solution is not clear.  A Google search shows that many schools are cancelling their football season, both for safety reasons and for fear of lawsuits.  However, a recent article reported parents’ dilemma:  “[We} talked about all of the risks involved with playing football, most notably the risk of concussions and head injuries that carry long-term health concerns. But we also talked about the risks of not letting our son play football. Not only did I not want to be a “dream killer” (no parent does), but I was also hesitant to waiver from a personal parenting philosophy to enthusiastically encourage controlled risk-taking.”