TBI Support Group – Mint Julip

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Posted on 2nd May 2008 by Gordon Johnson in Uncategorized

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From one of our favorite former clients:

I had a good time at our TBI support group meeting today. It was a small group with only about 6 of us. Drake has changed their rules and does not allow us to serve or bring refreshments. We are only allowed to have them if we order them from Drake directly, which our TBI group can’t do since it does not have any funds.

So, I told our local TBI contact person that I would like to share with the group, the therapeutic value of growing mint. I brought several plastic baggies with mint plants along with the directions on How to Grow Mint in a Container Garden. I also shared with them the therapeutic value of making something with the mint….like Non-Alcoholic Mint Juleps. Pulling out all of the necessary items and the directions, I asked the group to help me figure out what we needed to do.

We worked on a variety of skills at the beginning of our meeting. Cognitive skills like gathering together necessary materials, figuring out what materials we should distribute to everyone first, reading and following directions, sequencing. Physical skills and coordination involved in scooping ice out of a container with a ladle and placing it into a cup, using tongs to grab the mint sprigs and place in their cups. One member new to the group said the mint sprig should be placed in the top of the straw…so we had the added challenge of using very fine motor skills! Social skills like enjoying each other’s company, “clinking” our plastic cups together and sharing our hopes for this year. Another member came in late, so we re-tested our memory as we worked together to make a Mint Julep for her.

Today’s group was a rewarding experience for me. I was able to do a skill I used to do prior to my TBI on a smaller scale. It was fun and I felt great! And now I have to take a nap and recover.

Cindy
And the recipe:

TBI (ALCOHOL-FREE) MINT JULEP
Ingredients
  • 1 cup water
  • 1 cup white sugar
  • _ cup (or more) fresh mint leaves, chopped
  • Crushed ice
  • Prepared lemonade
  • Fresh mint sprigs, for garnish
Directions

To Make Mint Syrup:
  • 1. Combine water, sugar and chopped mint in a pan. Bring to a boil and stir until sugar has dissolved.
  • 2. Turn off burner and set pan aside for about an hour to cool down.
  • 3. Strain out mint leaves by placing strainer over the container you are using for your mint syrup. (If the holes in your strainer are large enough to allow some of the leaves to go through, place a paper towel or coffee filter inside your strainer.)
  • 4. Refrigerate mint syrup.

To Make Drink:
  • 1. Fill cup with ice. (Crushed ice works best)
  • 2. Fill cup about _ full with prepared lemonade.
  • 3. Pour a small amount of the mint syrup into your cup of lemonade. Taste and adjust according to your preference, adding more lemonade or more mint syrup if desired.
  • 4. Garnish with a sprig of mint and a straw. Sip slowly and enjoy. (Especially good on a hot summer’s day.)
  • 5. Optional: Make some sun tea and use in place of lemonade.
–Cindy Schneider

Thanks Cindy.

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Posted on 5th April 2008 by Gordon Johnson in Uncategorized

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EDITORS NOTE: From the Brain Injury Association of America:

Attorney Gordon Johnson
http://subtlebraininjury.com
http://tbilaw.com
https://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447


Brain Injury Association of America
Policy Corner E-Newsletter – April 4, 2008
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________

Dear Advocates:

This week BIAA submitted written testimony to the House Appropriations Subcommittee in charge of funding TBI programs within the Department of Health and Human Services and the Department of Education, urging an increase in Fiscal Year 2009 funding for TBI programs.

On Wednesday, April 2, the House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on TBI Related Vision Issues, which highlighted the high rate of vision disturbances in cases of servicemembers returing from Iraq and Afghanistan with TBI.

Also this week, the House Energy and Commerce Committee held a hearing on H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services. BIAA has endorsed this legislation, and signed a letter of support spearheaded by the Consortium of Citizens with Disabilities (CCD) in favor of the legislation.

Unfortunately, no activity occurred this week on H.R. 1418, the House version of legislation to reauthorize the TBI Act, which was passed by the House Energy and Commerce Act on March 13, 2008. BIAA will continue to advocate strongly for floor consideration of the bill by the entire House of Representatives and full passage by Congress into law as quickly as possible.

*Distributed by Laura Schiebelhut, BIAA Public Affairs Manager, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org

The Policy Corner is made possible by the Adam Williams Initiative, Centre for Neuro Skills, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.
__________________________________________________________________

BIAA Submits Testimony to House Labor-HHS-Education Appropriations Subcommittee

This week BIAA submitted written testimony to the House Appropriations Subcommittee in charge of funding TBI programs within the Department of Health and Human Services and the Department of Education. BIAA’s testimony urges an increase in Fiscal Year 2009 funding for programs authorized through the TBI Act, as well as for TBI research programs conducted within the National Institute on Disability and Rehabilitation Research (NIDRR).

In the testimony, BIAA’s President and CEO Susan H. Connors states, “BIAA was gravely disappointed that last year, even as Congress had the good judgment to add hundreds of millions dollars to the budgets of the Department of Defense and the Department of Veterans Affairs to help address the problem of TBI among returning servicemembers, funding for the HRSA Federal TBI Program was reduced from $8.91 million to $8.754 million.”

Within the testimony, BIAA requests $30 million in funding for programs authorized through the TBI Act, as well as sufficient funding to sustain and increase medical rehabilitation research within NIDRR. The testimony also urges an allocation of at least $8.3 million to allow NIDRR to continue to fund 16 TBI Model Systems research centers.A copy of the testimony can be obtained by visiting BIAA’s website at the following address: http://www.biausa.org/policyissues.htm.

House VA Subcommittee Holds Hearing on TBI And Vision Problems

On Wednesday, April 2, the House Veterans Affairs Subcommittee on Oversight and Investigations held a hearing on TBI Related Vision Issues.

Testimony highlighted the high rate of vision disturbances in cases of servicemembers returing from Iraq and Afghanistan with TBI, and the need for a seamless system of care within the Department of Defense and Department of Veterans Affairs to address these eye injuries, including greater use of specialized vision screening.

In the hearing, the Blinded Veterans Association (BVA) noted research showing that 75 percent of servicemembers with documented TBI injuries also have complaints about vision problems, and that approximately 60 percent of those injured have associated neurological visual disorders. A study conducted by one of the panelists, Gregory L. Goodrich, who is a research psychologist at the VA Palo Alto Health Care System, found that both Polytrauma Level I and Level II patients had high rates of visual impairment and/or visual dysfunction, and that injuries caused by a blast event were associated with more vision related loss and/or deficits than other causes.

In his testimony, Tom Zampieri, Director of Government Relations at BVA, asserted, “At present the current system of screening, treatment, tracking, and follow-up care for TBI vision dysfunction is inadequate. Adding visual dysfunction to this complex mix, especially if undiagnosed, makes attempts at rehabilitation even more daunting and potentially disastrous unless there are significant improvements soon.”

Mr. Zampieri urged the Subcommittee to request that DoD/VA provide for the full implementation of the “Military Eye Trauma Center of Excellence and Eye Trauma Registry,” which was recently authorized as one of the Wounded Warrior provisions in last year’s defense authorization bill (H.R. 4986). BIAA has officially endorsed legislation (S. 1999) to create such a Center.

BIAA Supports Bill to Enact Moratorium on Harmful Medicaid Regulations

Also this week, the House Energy and Commerce Committee held a hearing on H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services. BIAA has endorsed this legislation, and signed a letter of support spearheaded by the Consortium of Citizens with Disabilities (CCD) in favor of the legislation.

The legislation, which was introduced by Representatives John D. Dingell (D-MI) and Tim Murphy (R-PA) on March 13, 2008, would delay the implementation of seven harmful Medicaid regulations through March 2009, including several rules which would be especially deleterious to individuals with traumatic brain injury.

One of these rules would limit rehabilitation services for Medicaid beneficiaries, severely curtailing the ability of people with disabilities – including TBI – to receive rehabilitation services now covered under Medicaid. Access to these rehabilitative services is essential, as in many cases, these services play a vital role in allowing people with TBI to live independently in the community.

Best Performance Method in Neuropsychological Assessment

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Posted on 3rd April 2008 by Gordon Johnson in Uncategorized

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There are two fundamental premises upon which the statistical application of the science of neuropsychology is based: The first is that a determination can be made of what a given individual’s premorbid abilities were. The second is that an individual is giving consistent best effort throughout the test battery. Neither assumption works perfectly, but the extent to which these two assumptions work well enough, will determine whether legitimate statistical based diagnostic conclusions can be incorporated into the assessment. In today’s blog, we will discuss the Premorbid Ability assumption. In tomorrow’s, the consistent best effort issue.

Premorbid ability. By premorbid ability, we mean a given individuals abilities prior to the onset of the accident or disease process. If no assumptions can be made about premorbid ability, no diagnosis about “cause” can be made by a neuropsychologist. All they are capable of saying is that a given individual has certain weaknesses and disabilities, but no definitive diagnosis can be made. Thus, some method of assessing premorbid ability is essential.

Most neuropsychologists don’t look at enough information in determining pre-morbid IQ. They base far too much of their assessment with respect to pre-morbid ability on the test battery itself. In our earlier example of the person with the IQ of 135 post the accident, that is less of a problem. Clearly a person who has a post-morbid IQ of 135, was very superior before the onset. But most cases are not so clear cut. A previously brilliant person may not continue to have a very superior IQ after the accident. If certain deficits bring the person down into an IQ range of 110 or so, we would likely need to look for other evidence to determine IQ.

One way is by looking at the areas where they still have strengths. If their average scores are in the 130 or above area, and there are a few scores in areas we might suspect would be effected by the injury, then it might be easy to say this person was very superior before. But again, that is the easy pattern to spot. Most profiles are not that obvious.

Another method is to look at certain subtest scores, where it is believed that a given ability is unlikely to be substantially effected by the given injury. Reading scores are often thought to be an ability that is rarely changed significantly by a mild or moderate injury. Thus, a neuropsychologist might say that a person with a “very superior” reading score and a much lower current IQ, had pathological deficits, based on the retained ability to read at a high level.

All of these methods work far better with someone with a very high IQ. When you are dealing with people in the average range, IQ’s of 90-110, it becomes much more difficult to make such assumptions about premorbid IQ from subtest scores.

Another method is to assume IQ based on a assessment of that person’s educational level. So a person with a college degree would be assumed to have a higher IQ than someone without. The obvious flaw in such logic, that some brilliant people don’t go to college, isn’t even the most significant problem. The significant problem is that it groups all college graduates together. Ask anyone who went to college. Not all of their classmates were of equal intelligence and ability.

Another method, one I believe to be considerably better than the first two, is called the ‘best performance method.” The best performance method is based upon the assumption that a person’s highest areas of achievement are the best indicators of premorbid ability. If these areas of highest achievement are in contrast to significantly lower subtests scores that may point to pathology.

Of course, there is considerable disagreement as to how to apply the “best performance method.” Many neuropsychologists dismiss it as they interpret this method as applying only to the best performance on individual tests, within the full battery of tests. That would mean if the person got 99% in arithmetic or vocabulary, that would mean that such person is in the 99%. It is easy to poke holes in a restricted use of the “best performance method” because we all have normal variances in what we are good at.

However, another interpretation of the best performance method is that it makes a full assessment – not just of the scores on the given battery of tests – but also the person’s real world performances or achievements. For example, if a person has graduated from medical school, one assumes that they are very near the top of the pre-morbid ability level. Likewise, if they have risen to the top of any profession, they would be assumed to be near the top.

In my opinion, the overall preferred method, which of course is harder to reduce to statistical probabilities, is to use of the real world “best performance method”. Such method considersall factors, school records, work performance records, areas of retained strength on the test. If someone got a math score of 700 and a verbal score of 700 on the SAT when applying to college, they clearly were way above average at that time. If they went on to graduate from a competitive law school or medical school, we must almost assume that they were at the superior or likely very superior level.

If the scores were good, but not great, if they graduated from college with more than a B average and went on to have a successful career, we can’t assume they were only average. Whether they are high average or superior is open to interpretation but that is what professionals are supposed to do: make subjective interpretations of complex multi-faceted variables, to reach conclusions.

Who a person was before injury is far more complex than how well they do now on a reading score. Only if neuropsychologists look at not the basic outline of a person’s premorbid life, but level of achievement within that life, will neuropsychology be able to identify the true areas of acquired deficits and disability.

Tomorrow the concept of “consistent best effort.”
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