A Broader Definition of Day Care

No one wants a life of twiddling their thumbs, with little to occupy their time.  For this reason, the concept of adult day programs was created.*  As the geriatric population becomes larger, the idea of providing appropriate funding to attend these adult day centers has become more popular.  This year, on January 8**, Rep. Barbara Lee (CA) introduced the Adult Day Center Enhancement Act to broaden the idea of who may benefit and should receive funding for adult day center attendance.  The purpose of the Act is to provide funding for, “a program that provides comprehensive and effective services to individuals living with neurological diseases or conditions… that may result in a functional or degenerative disability and to their family caregivers and that may assist participants.”  (This bill funds daytime assistance to the young adults who are disabled, however I can find no information regarding the age limits.)

Related to its assistance to the participant, “adult day programs can offer services, including medical care, rehabilitation therapies, dignified assistance with the activities of daily living, nutrition therapy, health monitoring, social interaction, stimulating activities, and transportation.”  First introduced in 2013, and re-introduced every other year thereafter, H.R. 320 seeks to maintain the quality of life of the disabled population.  As with inflation, the allowed funding will increase every year until 2023.  (The Veterans Home Adult Day Health Care Improvement Act, to which I assume partially refers to veterans with brain injuries, was signed into law on March 27, 2018.)

On January 8, the Adult Day Center Enhancement Act was referred to the House Committee of Energy and Commerce, of which Rep. Lee is a member.  (Last time the Act was introduced, it was referred to the Subcommittee on Health.)  Due to the shutdown, this bill currently has no co-sponsors nor does it have a summary on congress.gov.  Now that the shutdown is over and before the bill may be enacted, it must be evaluated by the Assistant Secretary of Aging.

* On some sites, I have found it titled “adult day care”.  However, it is generally titled “adult day programs” assumedly because “daycare” has a youth connotation.  If one is to think about it though, that inaccurately marks toddlers as the only segment of the population that needs activity during the day.

** I find it heartening that a bill was introduced in Congress during the partial shutdown, which officially began December 22, 2018.

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Update: Bipartisan Appeal for Reauthorization of TBI Act

On Friday, December 21, 2018, “H.R. 6615, which reauthorizes appropriations for programs and activities relating to the study, prevention, and treatment of traumatic brain injury (TBI),” was signed into law by President Trump.  Officially called the Traumatic Brain Injury Program Reauthorization Act of 2018, the bill previously passed the House with a 353-6 margin and passed the Senate unanimously.  (Reauthorizations were also given to other key health bills, H.R.1222, the Congenital Heart Futures Reauthorization Act of 2017, and H.R. 1318, the Preventing Maternal Deaths Act of 2018.)

Earlier this month, Congressman Pascrell spoke of the bill in House, “Mr. Speaker, I rise to support H.R.6615… I would like to thank Chairman Walden and Ranking Member Pallone for their work to move this important legislation forward.”  Following being signed into law, Chairman Greg Walden (OR) said, “These bipartisan bills… represent a continuation of the hard work [the House Energy and Commerce Committee] has done this Congress to protect and improve the health of all Americans.  From reauthorizing programs so we can better treat and understand congenital heart defects to increasing our understanding of traumatic brain injury, to improving maternal health outcomes… these bipartisan bills will have a profound effect of the lives of children, families, and communities all across the country.”

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See also: Bipartisan Appeal for Reauthorization of TBI Act

 

Bipartisan Appeal for Reauthorization of TBI Act

The federal Traumatic Brain Injury Act provides many benefits to survivors.  For example, much of the research that I reference on this website is done by organizations funded through the Act.  When it was originally signed into law in 1996, the TBI Act defined its goals as to “identify methods of preventing traumatic brain injury; expand biomedical research efforts to prevent or minimize the severity of dysfunction as a result of such an injury; and to improve the delivery and quality of services through state demonstration projects.”  More than 20 years later, the basic goals of the bill remain the same.  However, every few years reauthorization is required, and new amendments are added.

This year, Congressman Bill Pascrell presented H.R. 6615 to the House for this reauthorization on July 26, 2018.  (Rep. Pascrell is the co-chair of the Congressional Brain Injury Task Force.  The bill was co-sponsored by the other co-chair of the Task Force Rep. Thomas Rooney (FL), and by Rep. Brian Fitzpatrick (PA), Rep. Eleanor Holmes (DC), Rep. Steve Cohen (TN) and Rep. Brian Higgins (NY).)  “I am proud to introduce this critical bipartisan, bicameral reauthorization of the Traumatic Brain Injury Act,” Pascrell said.  In particular, the bill is seeking a $186,000 increase in the annual budget of the National Concussion Surveillance System.  (From $6,564,000 each fiscal year from 2015 through 2019 to $6,750,000 each fiscal year from 2019 through 2023, to perform aspects of data collection and evaluation.)  Established in 2016, NCSS seeks to, “determine the prevalence and incidence of concussion,” through such activities as household telephone surveys.  Additionally, the bill aims to increase the budget for state and federal research grants.  (Full information regarding budget increases and activities to be completed can be read fully in bill.)

This week H.R. 6615 passed the House and was sent to the Senate.  Termed S. 3657 in the Senate, the Traumatic Brain Injury Program Reauthorization Act of 2018 is sponsored by Sen. Orrin Hatch (UT).  (The fact that the main sponsor of the bill was Rep. Pascrell, a Democrat, in the House and Sen. Hatch, a Republican, in the Senate is further proof of its bipartisan appeal.)  As Hatch said, “We know TBI is a serious problem, but we fail to grasp its severity and scope. Our bill will change that… our legislation will extend important research, education, and advocacy efforts to help us better understand the nature of brain trauma and reduce the prevalence of these injuries going forward.”

R.I.P. President George H.W. Bush

Today, at 11:00am ET, former Presidents, dignitaries, family members and others pay tribute to the 41st President of the Unites States, George H.W. Bush.  For the purpose of this website, it is a day to remember all that President Bush did for those with brain injuries, and for those with disabilities, at large.

President Bush was America’s last president to serve in the military overseas at war.  (President Clinton, President Obama and President Trump did not serve.  President George W. Bush served stateside as a pilot during the Vietnam War.)  Specifically, as a 20-year-old man, he served as a pilot in the Pacific during World War II.  As detailed in the book Flyboys, on September 2, 1944, while targeting a Japanese radio transmitter on the island of Chichijima, his plane was shot over the Pacific Ocean.  Bush did not abandon his plane, instead continuing to fight until his plane went down.  One source states that his injuries from this combat tragedy, that took the lives of many of his squadron, included “bleeding from a headwound”.

“Why had I been spared and what did God have in store for me?… there’s got to be some kind of destiny and I was being spared for something of Earth,” Bush later said about his trauma in WWII.  For those with disabilities, part of that reason was definitely his signing of the American Disabilities Act on July 26, 1990.  Modeled after the Civil Rights Act of 1964, the ADA aimed for equal opportunity for those with disabilities.  While a list of what impairments constitute a disability is not defined in the Act, a disability is defined as, “a physical or mental impairment that substantially limits one or more major life activities of such individual.”  These limiting impairments include, “functions of the… neurological, brain…”

Following his presidency, President Bush continued to support those with brain injury.  For example, in 1996, President Bush created a PSA for the Pediatric Brain Injury Prevention Campaign.  Prior to the PSA, the Campaign had no association with President Bush.  He agreed to do the PSA simply based on a request submitted through letter.

Recently, President Bush suffered through his own trauma – vascular Parkinsonism.  Thought to be caused by a multitude of mini strokes, vascular Parkinsonism is so named because it shares many of the characteristics of Parkinson’s disease.  (Some dispute this correlation, as Parkinson’s can be helped by medication, but vascular Parkinsonism cannot.)  On Friday, November 30, 2018, President, Vice President, Congressman and CIA Director Bush passed away.  After his funeral, his body will travel to Texas where he will be laid to rest next to his wife of over 70 years, Barbara and his young daughter Robin.  For the disabled, his legacy of the ADA will continue.

Mercury on the Mind – 1 (Retitle: Did the Dentist Alter Your Brain?)

In Thursday’s article related to brain injury and mercury, I see that some may have found the title derogatory towards dentists.  As someone who had braces in middle school and yearly gets regular checkups, I see the benefit of dentistry.  In addition, I understand that doctors and individuals recognize the benefit of treatment and care with mercury on certain conditions.  For these reasons, I have changed the title of this article.


Mercury Can Cause Brain Damage in Kids read the headline in the Huffington Post earlier this year.  Mercury (Hg) is a naturally-occurring, odorless silver metallic trace element that is liquid at room temperature.  It comes in three forms: elemental mercury, which is the form of mercury found on in teeth fillings, inorganic mercury, and methylmercury, also known as organic mercury found in such things as fish.  Its safety has long been disputed.  For example, while many people have amalgam teeth fillings that contain mercury, batteries, which are filled with mercury, are known to be unsafe. In medicine, it has been used as a purgative, disinfectant, astringent and particular as an antisyphilitics treatment.

Mercury is a neurotoxin.  Ingestion, absorption and fume inhalation of mercury can cause mercury poisoning.  The complications of mercury poisoning are numerous and can happen to people of all ages: weakness, fatigue, headaches, lower back pain, ataxia, slurred speech, tremor, somnolence, and mental disturbances, such as hallucinations and psychosis.  In fetuses and young children, Hg exposure, “may delay developmental milestones,” the NIH found 20 years ago.  For these reasons, mercury has been named one of the ten chemicals of major public health concern by the World Health Organization.  Additionally, its application in medical/dental care and in such products as fertilizers and pesticides has been lessening through the years.  One of the concerns scientists and people, in general, have with consumption of tap water is the possible additional consumption of mercury.

This year, the above-mentioned Huffington Post headline continues: Mercury Can Cause Brain Damage in Kids, the EPA Wants to Weaken Rules On Its Emissions.  The article’s title relates specifically to a legal proposal the Environmental Protection Agency sent to the White House that they say would hobble the 2011 Mercury and Air Toxic Standards (MATS) rule.  It specifically refers to the mercury emitted in the production of coal.  (However, the article’s title simplifies the action they are requesting, in a negative manner.  The proposal wants to eliminate co-benefits, in order to save the coal industry billions.)  A win for the coal industry, the article continues, as power plants are the nation’s biggest emitter of mercury.  If the proposal is enacted, there will be additional health costs for the public.  While the financial burden to the public is much less than the current cost of implementation of the rule for the coal industry, is the outcome more important?

I see no legislative follow-up on the proposal.  Additionally, on the EPA webpage dedicated to MATS, it still states that the ruling has prevented thousands of premature deaths a year and has many health benefits, which seems to imply that the basic standards have stayed the same.  However, if the rules regarding mercury are lessened, critics call it a win for the coal industry, as MATS specifically sets limits on the amount of mercury, and other toxins, allowed in coal-fired power plants.

Preventing Pesticides from Killing Bugs and Brain Cells

A pesticide is “any substance used to kill, repel, or control certain forms of plant or animal life that are considered to be pests.”  No one denies the harm in ingestion of a pesticide.  However, the legality of using certain chemicals in pesticides has been long debated – at present, the chemical chlorpyrifos is of particular concern.

An active ingredient in some pesticides since 1965, chlorpyrifos is “used primarily to control foliage and soil-borne insect pests on a variety of food and feed crops.”  A Google search shows that it is sold under a variety of brand names.  In the past few years, chlorpyrifos has been a focus of concern because of a government-supported study conducted by the Columbia Center for Children’s Environmental Health at Columbia University.  One of the findings of this study confirms, “Children with high pesticide exposure cluster together to form a distinct behavioral phenotype… Cognitive and behavioral deficits associated with this phenotype may be mapped to alterations in brain regions and function.”

Legislation related to pesticide control was first introduced in Congress over a century ago in the Federal Insecticide, Fungicide, and Rodenticide Act.  Since its enactment in 1910, this legislation has been amended and new legislation regulating pesticide use has passed, such as the Food Quality Protection Act in 1996.  In November 2015, the EPA, with former head Gina McCarthy, proposed a ban on the use of neurotoxic chemical chlorpyifos on all food crops.  What then happened to this proposal is unclear.

During the tumultuous tenure of former EPA head Scott Pruitt, in 2017 and 2018, chlorpyrifos came to the pesticide forefront.  In 2017, Pruitt refused to sign off on a ban of the use of chlorpyrifos as a pesticide on food crops.  This decision, many say, is a sign of Pruitt siding with the “Pesticide Lobby”.  Groups such as the Environmental Working Group (EWG) have denounced and fought against Pruitt’s action, noting that, “The evidence is overwhelming that even small doses of chlorpyrifos can damage parts of the brain that control language, memory, behavior and emotion.”  Finally, last month, Pruitt’s decision was reversed by the United States Court of Appeals for the Ninth Circuit – the EPA now bans the use of chlorpyrifos on food crops.

While the above decision is a victory for food safety, the results of this legislation are not immediate.  Additionally, fruits and vegetables must still be washed before eaten both to eliminate any residual pesticide and to better the taste.  On the positive note, though, the EWG notes that, “the agency [has] put children’s health, strong science and the letter of the law above corporate interests.”

Mitigation for Morality and Murder

In the modern world, our understanding of science changes rapidly.  Law, at large, does not change so rapidly.  What has changed, in the past 20 years, is that defense lawyers have begun, during the trial and/or sentencing phases of court, to use brain damage/injury as a mitigating factor for criminal acts.

Brain injury was first introduced as a defense in 1966 for Charles Whitman, the so-called Texas Tower Sniper.  (Whitman stabbed his mother and his wife, shot to death 16 people at the University of Texas at Austin and shot and injured 31 others.  An autopsy upon his death found a tumor in his brain.)  Since the start of this century, the exploration into the effects of brain injury on what some may see as moral quandaries for those with neurological deficits has broadened.  Generally, what has been found is that head injury, specifically a brain lesion, can hinder executive functioning, which governs the ability to plan ahead, think things through, manage impulse, etc.  However, this is basic knowledge that applies to all brain injury survivors; tests specifically related to the unique brains of those who commit criminal acts are inconsistent.

In 2015, the NIH published a report, Does TBI Lead to Criminality?.  Their conclusion states, “The results support a modest causal link between traumatic brain injury and criminality.”  Investigations have shown that while brain injury is not a sufficient defense for a criminal act, it may be a mitigating circumstance in the sentencing phase of a trial – treatment versus incarceration.

Since then, brain damage/injury has often been used as a defense, most recently earlier this month: a convicted murderer in Ohio said, during sentencing, “Not everyone is fortunate enough to have a caring family or outside guidance… I am proof [that] a young person – beaten and abused physically, emotionally, and mentally – becomes the abuser.”   Though the defendant now admits to the killing of five women, the testimony of one of two testifying doctors states that because Kirkland MAY have a brain injury, he should not receive the strictest punishment, the death penalty.

Perhaps, though, the “brain injury” defense will relatively soon become a thing of the past.  The above-mentioned NIH report further concludes, “Reducing the rate of TBI… might have benefits in terms of crime reduction.”  (Since this report was released, more defendants have used brain damage as a mitigating factor for criminal acts.)  According to a UK study, approximately 50 to 70% of the incarcerated population has a brain injury.  That percentage is thought to be in the same realm as those imprisoned in America.  Given these astonishing statistics and the continuing government-sponsored and private research on brain injury prevention and recovery, the NIH’s conclusion seems a definite possibility.

(See also Massachusetts General Hospital – Center for Law, Brain & Behavior, “an academic and professional resource for the education, research, and understanding of neuroscience and the law.”)

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, is important, 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.

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?