Category: Traumatic Brain Injury

Quick Quiz: When Medicare Says You’ve Been Overpaid

There you are, hard at work. Your patients are making progress, you’re feeling good, things seem to be going along just fine, and then—boom—you get a letter from the Centers for Medicare and Medicaid Services (CMS) saying they think they’ve overpaid you on a claim. It’s enough to ruin anyone’s day.

Think you know your way around the overpayment process? Take this quick quiz, and then check out this CMS fact sheet for more details on the options available to you if CMS says you’ve been overpaid on a claim. (Quick tip: When it comes to the overpayment process, deadlines matter and are taken seriously. The CMS fact sheet also lays out timelines clearly—you may want to keep a copy handy.)

Ready? Here we go.

To take the full quiz, visit APTA

Light-Intensity Short Walks Can Prevent LE Vascular Damage Caused by Sitting

Long bouts of sitting can have serious effects on blood flow that could increase risk of cardiovascular disease, but a new study proposes that lower extremity vascular damage can be prevented by walking as few as 5 minutes every hour—and not even at a particularly fast pace.

In a study e-published ahead of print in Medicine and Science in Sports and Exercise, researchers from Indiana University monitored the ways in which the superficial femoral artery reacted to 3 hours of sitting without leg movement, and compared those results with study participants who took 5-minute walks at 2 miles per hour every hour. What they found was that prolonged sitting does lead to a “significant impairment” in endothelial function, but that the short walks prevented the damage from taking place altogether.

Full story of vascular damage and sitting at APTA

FDA: Beware of Dietary Supplements That Claim to Speed Concussion Recovery

Think those claims that dietary supplements can help speed concussion recovery sound too good to be true? You’re right. And the US Food and Drug Administration (FDA) agrees.

This week, the FDA released a consumer update on companies that market dietary supplements that purport to heal—and in some cases prevent—concussions. The advertising has received more attention with the start of fall school sports, and the agency is stepping up its enforcement actions to warn companies when their claims are false.

Full story of dietary supplements for concussion recovery at APTA

PT’s Movie Review on ESPN Also Educates on Consecutive TBI

An APTA member’s review of a new documentary on traumatic brain injury (TBI) has been featured on ESPN. Stephania Bell, PT, CSCS, OCS, senior writer for ESPN, gave a strong, positive review for the new documentary “The Crash Reel,” but perhaps just as important, seized the opportunity to provide readers with valuable education on consecutive TBI and its impact on developing brains.

“The Crash Reel” follows the rise, devastating injury, and recovery of elite snowboarder Kevin Pearce, who at age 22 suffered a head injury during training for the 2010 Vancouver Olympics. Pearce’s recovery continues, and he is now a motivational speaker and sports equipment consultant. Earlier this month he carried the torch at the opening ceremonies of the Winter Olympics in Sochi.

Full story on the movie review and TBI at APTA

New Report on Blast Injuries Cites Research Gaps

Despite the prevalence of blast-related injuries among returning war veterans there are still big gaps in research into long-term effects, according to a newly released study by the National Academy of Science’s Institutes of Medicine (IOM). These gaps exist not only in research into specific injury types, but also in understanding the ways in which blast injuries can involve multiple systems and create “cross system interactions” such as mild traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).

The new publication, Long Term Effects of Blast Exposure, is the ninth volume in a series of congressionally mandated studies focusing on the health effects of military service. The newest report focuses on blast injury effects present after 6 months, and is based on reviews of nearly 13,000 titles and abstracts and approximately 400 full peer-reviewed journal articles. The report estimates that between 2001and 2011, more than 31,000 soldiers were injured by explosive devices in the Iraq and Afghanistan wars.

Full story of blast injuries at APTA

Returning to work after a brain injury

Concussions in the National Football League (NFL) and military have received a lot of attention lately. But traumatic brain injury is a much larger issue, affecting at least 1.5 million Americans each year.

As the impact of brain injuries becomes clearer, some experts say they are noticing a pattern. Many people with brain injuries are struggling in their efforts to return to work or get the accommodations from their employers to deal with the aftermath.

Carey Gelfand lives in Glencoe, Ill., one of Chicago’s North Shore suburbs. In 2006, she was working at an art consulting company. She traveled with her boss to New York City to attend an art expo. She was wearing a pair of flat-bottom cowboy boots when the temperature dropped and the rain-slicked streets froze over.

“My feet went out from under me and my head just hit the pavement,” said Gelfand.

Gelfand did what many of us do when we get embarrassed after a fall, she stood up and brushed herself off, declaring, “I’m fine, I’m fine…”  She kept walking with her colleagues and then boarded a bus. “And I looked out the window and I was thinking, ‘I’m here, but I’m not,’” said Gelfand.

Full story of working after brain injuries at WBEZ

Painkillers May Worsen Headache After Concussion

Too much pain medication may have been part of the problem for teens reporting chronic headache months after suffering concussions, researchers reported here.

Nearly half of adolescents with post-concussion headaches lasting 3-12 months showed either complete resolution of symptoms or a reduction to pre-concussion levels after discontinuing their analgesics, according to Geoffrey Heyer, MD, and Syed Idris, MD, both of Nationwide Children’s Hospital in Columbus, Ohio.

Because withdrawal of painkillers alleviated these patients’ headaches, a diagnosis of medication overuse headache may be made under International Classification of Headache Disorders (ICHD) criteria, the researchers indicated in a poster presentation at the Child Neurology Society annual meeting.

The findings emerged from a retrospective chart review of 104 consecutive adolescent patients treated at Nationwide Children’s for concussion. Of these, 77 reported chronic headache after the injury, and 54 of this group were deemed to have “probable” medication overuse headache.

Under the ICHD, medication overuse headache may be diagnosed in patients with frequent headaches (at least 15 days per month) that either developed or worsened while using headache medications such as over-the-counter or prescription analgesics. The diagnosis is considered “probable” if either such medications have not yet been withdrawn or if the headaches continued for up to 2 months after medications were stopped.

Full story of painkillers and concussions at Med Page Today

Inspired by Denise

f the M.R.I. scan that the neurosurgeon was pointing to was, as it appeared to me, a map of South America, the tumor in the brain of my wife, Denise, was the size of Brazil. Enormous, imposing, bulging all its borders, not to be denied.

Amazing Story of Healing the Tumor in the BrainIt was early October. Denise had not been herself for months. A cheerful and enthusiastic woman, dedicated to her family, her friends, her work, she had become distant, lethargic. Often fatigued, her interests and activities had diminished. Her co-workers had called asking if she was all right, her sisters had taken note, her friends could not understand the changes in her. I thought that she was tired, possibly depressed. I thought that maybe she was in a rut, that patience and empathy was needed.

What was needed was surgery. After a fall at home from which she couldn’t rise we went to the emergency room where the questions, the examinations and an M.R.I. turned up what was wrong: Denise had a meningioma growing in the membrane between her brain and her skull. It had probably been growing for years and was now seven centimeters, of a size and weight that was affecting her vision, her functions, her balance, her personality.

Denise was in the hospital for six weeks. She remained valiant and determined through three brain surgeries and intense physical and occupational therapy. She never faltered. She started therapy as soon as she could, from light bedside therapy, to participation from a wheelchair, through working with a walker, to walking with a cane. I observed one afternoon and was mightily impressed with Denise’s determination to get up and down the training steps, to swing in and out of the car door simulation, to work at it until she was too tired to continue. She wanted to give her all, as she has done since I’ve known her. Denise wanted to return to the people, the interests, the very life that she enjoyed and was missing.

Full story of Denise at The New York Times

Photos courtesy of and copyright PhotoPin,

Behavior Changes Show Up Early in Traumatic Brain Injury

Patients with chronic trauma-related brain disease may develop in two distinct ways, one involving mood and behavioral disorders and the other by cognitive impairment, according to a study that combined prospective and postmortem data.

Behavior Changes Show Early in TBIAlmost all of the 36 patients with chronic traumatic encephalopathy (CTE) had a combination of cognitive, mood, and behavioral disorders, and cognitive impairment was almost universal.

However, almost two-thirds of the patients developed mood and behavioral disturbances at a younger age and died at a younger age. The rest of the patients had predominately cognitive impairment, which had later onset and was associated with death at an older age, Robert A. Stern, PhD, of Boston University, and co-authors reported online in Neurology.

“At this point, CTE can be diagnosed only when someone passes away, postmortem,” Stern told MedPage Today. “Because of that we can’t begin to evaluate treatments or potential cures for the disease. What we’re trying to do is establish what someone looks like when someone is alive.”

Full story of behavior change in TBI at MedPageToday

Photos courtesy of and copyright PhotoPin,

The concussed brain at work: fMRI study documents brain activation during concussion recovery

Concussed Brain at Work During RecoveryFor the first time, researchers have documented irregular brain activity within the first 24 hours of a concussive injury, as well as an increased level of brain activity weeks later—suggesting that the brain may compensate for the injury during the recovery time.

The findings are published in the September issue of the Journal of the International Neuropsychological Society.

Thomas Hammeke, PhD, professor of psychiatry and behavioral medicine at the Medical College of Wisconsin, is the lead author. Collaborators at the Cleveland Clinic; St. Mary’s Hospital in Enid, Okl.; the University of North Carolina; Franklin College in Franklin, Ind., and the Marshfield Clinic in Marshfield, Wis., co-authored the paper.

To study the natural recovery from sports concussion, 12 concussed high school football athletes and 12 uninjured teammates were evaluated at 13 hours and again at seven weeks following concussive injury.

Full story of concussed brain at work in recovery at Medical Xpress

Photos courtesy of and copyright PhotoPin,