resources - State and National

Assistive Technology       Children       Cultural Competence      Defense and Veterans' issues
   Employment & Vocational Rehabilitation of People with TBI      General brain injury information, advocacy, and support
Housing and residential placement      Management of TBI for clinicians   Medicaid Services    Public agencies in Oregon       Screening and assessment
Social Security Disability          Statistics           Substance Abuse      Veterans

Subtle Brain Injury

Brain Injury Permanency from Concussion

• Does Concussion involve permanent brain damage? It can.
• Does Concussion disable? Often, but usually not for extended periods.
• Will I get better? In all likelihood.
• If I don't have a full recovery, is it because I am nuts? No.
• Why is it that some people continue to have persisting problems? That is what this intro is about.

Far too much of the focus in the study of what the researchers always call "mild" brain injury, is trying to predict how serious a brain injury will become, based upon the way in which the patient interacts with medical professionals in the acute stage. This misses the point. Certainly, if there was no concussion, there isn't likely to be a brain injury. But once there has been a concussion, the focus should not be on categorizing how serious the concussion was, but on what deficits the person is left with, after a healing period, and what we can do to minimize the disruption of those deficits upon this person's life.

Why do some people have apparent full recoveries, while others, are profoundly affected by a similar injury? To begin this discussion, we must summarize our theory of the pathology of subtle brain injury.

• Diffuse Axonal Injury. Concussion results in organic injury to the brain, in most cases, by the mechanism of diffuse axonal injury.
• Process not an Event. This injury is more likely as a result of strain to axons than actual tearing, which over a period of 12-72 hours results in a cascade of events which can disrupt a significant number of neural connections, either because of the death or damage to the axons which connect the neuron bodies.
• Regeneration isn't Total Recovery. Our current research into neuropathology indicates that significant regeneration of these neural connections can occur, but that the extent of such regeneration falls off considerably with age (with over 40 being a meaningful line of demarcation) and that the regenerated neural connections are less efficient than premorbid.
• High Achiever Problems. For this reason, individuals in professions which place a high demand on processing speed, are more likely to experience deficits than others, and that most people who have suffered more than a Grade I concussion, will have some measurable deficits, if sufficient demands are made upon their brains.

There is an overwhelming ignorance in the medical community that there is even the possibility of permanent brain injury in patients who may have suffered a concussion. To this day, a significant proportion of the medical community believes that there can be no permanent brain injury without a loss of consciousness or without a blow to the head. Perhaps more important, there is a poor understanding that brain injury symptoms may escalate after the first couple of hours. Likewise, there is far too much confidence put in our ability to rule out brain injury through the use of CT and MRI. This page will focus first on the diagnostic issues and then move on to the subtle symptomatology that underlies these types of brain injuries.

Source: http://www.subtlebraininjury.com/index.php

Following are links to State and National Associations and Agencies to help in understanding, living with, and treating brain injury.

• Assistive technology
  • Agency/organization websites
    • TBI Technical Assistance Center (TBI TAC)  https://tbitac.norc.org/   Established in 1997 to help States in the planning and development of effective programs that improve access to health and other services for individuals with TBI and their families. TBI TAC supports the federal TBI Program, which is administered by the U. S. Department of Health and Human Services' Health Resources and Services Administration, Maternal and Child Health Bureau.  TBI TAC publications can be downloaded from this site.
    • Northwest ADA Information Center - Disability and Business Technical Assistance Center (DBTAC)
      http://www.dbtacnorthwest.org/
• Children
  • Agency/organization websites
    • National Dissemination Center for Children with Disabilities
      http://www.nichcy.org/
    • Oregon Department of Special Education 
      http://www.ode.state.or.us/search/results/?id=40
    • Family & Commnunity Together (FACT) Oregon Helps connect parents of children with disabilities or complex health care needs with parent mentors who provide emotional support, doctor recommendations and information on local resources. FACT’s Parent Training and Information Center provides information for parents of children and youth with disabilities. Call 1-888-988-3228 for more information about special education. http://factoregon.org/
• Oregon TBI Consulting Team http://tr.wou.edu/tbi/team/
  Consultants for schools and families to help students with brain injury.
• Documents/training materials
  • Students with Traumatic Brain Injury: Identification, Assessment, and Classroom Accommodations docetc/Resources/children/TBIKIDS.pdf
    
  • Teaching Strategies for Students with Brain Injuries docetc/Resources/children/teaching.strategies.for.students.with.brain.injuries.pdf
    
  • Back to School [After a TBI] docetc/Resources/children/back.to.sch.after.tbi.pdf
    
  • ThinkFirst Oregon - part of a national non-profit organization working with teachers, educators and community groups to reduce the risk of brain and spinal cord injury through community education and outreach.
    http://www.ohsu.edu/xd/outreach/programs/thinkfirst//
  • Underachieving Students - This technical brief from the National Center for the Dissemination of Disability Research discusses research conducted at Mount Sinai, that focuses on identification, assessment, and classroom modifications for students who have experienced mild brain injury resulting in underachievement in school.
• Additional Information and websites

  • Routines and Children with Disabilities
    Beneficial Activities for Kids with Special Needs
    The Ultimate Guide to Flying with Autistic Children
    Teaching Students with Special Needs
    Homeschooling and Special Needs Children
    College Assistance Guide for People with ADHD
    Disability.gov’s Guide for Family Caregivers
    How Caregivers Can Take Better Care of Themselves
    Obesity and Children with Special Needs
    A New Savings Plan for the Disabled
    A Guide for Disabled Homebuyers
    A comprehensive guide to home adaptations for disabled people.
    Financial Assistance for Accessibility Home Repairs and Modifications
    Home Accessibility Costs

• Cultural Competence
  • Agency/organization websites
    • National Center for Cultural Competence
      http://nccc.georgetown.edu/
    • National Library of Medicine – Asian American Health
      http://asianamericanhealth.nlm.nih.gov/
    • National Library of Medicine – American Indian Health
      http://americanindianhealth.nlm.nih.gov/
  • Documents/training materials
    • Minnesota Department of Human Services – Guidelines for Culturally Competent Organizations
      http://www.leg.state.mn.us/docs/2005/other/050050.pdf

• Defense and Veterans' issues
  • Agency/organization websites
    • Defense and Veterans Brain Injury Center
      http://www.dvbic.org/
    • Fort Oregon
      http://fort-oregon.org/
    • BrainLine.org  national multimedia project offering information and resources about preventing, treating, and living with TBI; includes a series of webcasts  www.brainline.org
    • Military HOMEFRONT is the central source for Service members and families to obtain information about all Quality of Life programs and services
      http://www.militaryhomefront.dod.mil/
    • Military Severely Injured Joint Support Operations Center (MSIJSOC)
      http://www.military.com/support
  • Documents/training materials
    • “Veterans Health Benefits 101 for TBI Advocates,” Archived webcast, Maternal and Child Health Bureau (MCHB) of the Department of the US Department of Health and Human Services, Health Resources and Services Administration
      http://128.248.232.90/archives/mchb/dcafh/tbi/
      july2005/mchbtbijuly2005transcript.htm

• Employment and Vocational Rehabilitation of People with TBI
  • Agency/organization websites
    • Oregon Vocational Rehabilitation Services
      Provides rehabilitation services to persons with disabilities and makes eligibility decisions for disability benefits  http://www.oregon.gov/DHS/vr/
    • Work Incentive Network
      www.win-oregon.com//
  • Documents/training materials
    • Job Accommodation Network – Work-site Accommodation Ideas for Persons with Brain Injury
      http://www.jan.wvu.edu/media/BrainInjury.html
    • Traumatic Brain Injury Facts: Vocational Rehabilitation and Employment Services
      http://www.tbitac.nashia.org/tbics/download/nashvoc.pdf
    • Guide to State Government Brain Injury Policies, Funding and Services: Vocational Rehabilitation, National Association of State Head Injury Administrators 2003
      http://www.tbitac.nashia.org/tbics/download/fullnashiaguide.pdf
  • Additional Information and website

• General brain injury information, advocacy, and support
  • Agency/organization websites
    • ADRC of Oregon
      Consumer web site, resource database, and integrated call module for consumers and for the Information and Referral/Assistance staff www.adrcoforegon.org
    • Brain Injury Alliance of Oregon (BIAOR)
      Meetings by appointment only: PO Box 549, Molalla OR 97038 (800) 544-5243 (503) 740-3155 fax: 503-961-8730 e-mail: [email protected] http://www.biaoregon.org
    • Brain Injury Alliance Washington (BIAWA)
       Mailing Address: P.O. Box 3044 Seattle, WA 98114 Toll Free: 877-982-4292 Office: 206.467.4800; Toll-Free 877.98BIAWA (877.982.4292) Fax: 206.467.4808 Visit www.biawa.org or email [email protected]
    • Brain Injury Association of Colorado
      1385 South Colorado Boulevard, Suite 606, Building A, Denver, CO 80222 (303) 355-9969 Toll-Free: (800) 955-2443 www.biacolorado.org
    • Brain Injury Association of Idaho
      1055 North Curtis Road, Boise, ID 83706 Ph:(208) 367-2747 Family Helpline: (800) 444-6443 email: [email protected]  www.biaid.org
    • Alaska Brain Injury Network
      3745 Community Park Loop #140, Anchorage, Alaska 99508 office: 907 274-2824 fax: 907 274-2826 www.alaskabraininjury.net
    • United States Brain Injury Alliance (USBIA) www.usbia.org
    • Brain Injury Association of America (BIAA)   www.biausa.org
    • BrainLine.org   www.brainline.org
    • Center for Neuro Skills(CNS)  www.neuroskills.com/resources.shtml
    • Commission on Accreditation of Rehabilitation Facilities (CARF)  www.carf.org
    • Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (HRSA-MCHB) - Traumatic Brain Injury Program
      http://www.mchb.hrsa.gov/programs/tbi.htm
    • Disability Rights Oregon -  Protection and Advocacy Service (DRO)
      This site is a non-profit organization that provides legal advocacy to people in Oregon with disabilities. It is not a part of the state or federal government, but is designated as the protection and advocacy system for Oregon. www.disabilityrightsoregon.org/
    • Head Injury Prevention - A rundown on risks and prevention of head injury in youth sports. http://www.publichealthdegree.com/resources/head-injury-prevention-in-youth-sports-an-online-guide/
    • National Resource Center for Traumatic Brain Injury
      http://www.neuro.pmr.vcu.edu/
    • National Association of State Head Injury Administrators (NASHIA)
      www.nashia.org
    • Neuroscience for Kids
      http://faculty.washington.edu/chudler/neurok.html
    • NINDS  National Institute of Neurological Disorders and Stroke  http://www.ninds.nih.gov/health_and_medical/disorders/epilepsy.htm
    • National Family Caregivers Association
      NFCA is a grass roots organization created to educate, support, empower and speak up for the millions of Americans who care for chronically ill, aged or disabled loved ones.
• National Information Rehabilitation Center (NARIC)
  www.naric.com
• The University of Washington Traumatic Brain Injury System (TBIMS)
  http://depts.washington.edu/uwtbi/
• Traumatic Brain Injury Central
  http://www.mssm.edu/research/centers/traumatic-brain-injury-central
• TBI Resources - http://tbiresources.com/
• Vestibular Disorders Association
  VEDA is a nonprofit organization that provides information to the public and health professionals about inner-ear balance disorders such as Meniere's disease, BPPV, and labyrinthitis. Symptoms of vestibular impairment may include dizziness, imbalance, vertigo, nausea, and fuzzy vision and may be accompanied by hearing problems, fatigue and changes in cognitive functioning.  www.vestibular.org/
• Waiting during Coma
  This site Is made possible through the contributions of those whose lives have been touched and changed by brain injury. We thank them for sharing their stories.
• Documents/training materials
  • Archived webcasts of the HRSA-MCHB
    http://www.mchcom.com (click on ‘Archived webcasts’, then ‘TBI’)
  • TBI Consumer Reports: A published series that summarizes research conducted at Mount Sinai School of Medicine, appropriate for consumers, family members, and service providers
    http://www.mssm.edu/tbicentral/resources/publications/tbi_consumer_reports.shtml
  • TBI Chat Room
    A place to chat online with others affected by brain injury or their caregivers.
  • TBI Media Resources on Idaho Virtual TBI Program Center
    http://www.idahotbi.org/AGModules/LearnAbout/LearnAboutDrilldown.aspx?mid=2970&tabid;=372&categoryid;=802&categoryrelationid;=6837

• Management of TBI for clinicians
  • Documents/training materials
    • Brain Facts http://web.sfn.org/baw/pdf/brainfacts.pdf
      The Primer of the Brain and Nervous System
      
    • Centers for Disease Control and Prevention - "Heads Up: Brain Injury in Your Practice Tool Kit" (available to order, free of charge)
      http://www.cdc.gov/ncipc/pub-res/tbi_toolkit/toolkit.htm
    • Veterans Health Initiative - Traumatic Brain Injury, Independent Study Course Released: January 2004
      http://www1.va.gov/vhi/docs/TBI.pdf
    • Neurotrauma Registry
      Neurotrauma Registry provides a web-based resource list free of charge for individuals who have acquired brain injury, spinal cord injury, or other complex neurotrauma.
    • Neuroland
      This site provides Neurology information for physicians and health care professionals. It also provides links to resources for patients, families, and people without a medical background.
    • Virtual Hospital ® is a registered trademark of The University of Iowa
      The Virtual Hospital is a digital health sciences library created in 1992 at the University of Iowa to help meet the information needs of health care providers and patients. It's goal is to make the Internet a useful medical reference and health promotion tool for health care providers and patients. The library contains hundreds of books and brochures for health care providers and patients.
      This site contains “Acute Brain Injury - A Guide for Families and Friends” in full text.
    • TBI Media Resources on Idaho Virtual TBI Program Center
      http://www.idahotbi.org/AGModules/LearnAbout/LearnAboutDrilldown.aspx?mid=2970&tabid;=372&categoryid;=802&categoryrelationid;=6837

• Medicaid Services
  • Oregon State Health Resources - www.biaoregon.org/OR_State_Health_Resources_10.11.pdf
  • Medicaid - what is it and what does it cover  http://familiesusa.org/issues/medicaid/

  Medicaid provides health coverage for low-income children and adults, medical and long-term care coverage for people with disabilities, and assistance with health and long-term care expenses for low-income seniors. More than 58 million people rely on Medicaid services.

  • Report on Language Services for Medicaid and CHIP Enrollees

    The National Health Law Program released the report How Can States Get Federal Funds to Help Pay for Language Services for Medicaid and CHIP Enrollees?, a resource to assist States in evaluating best practices for setting up language services reimbursement. The report details Federal funding available to States to pay for language services and describes technical requirements that vary from State to State.

     This report answers a variety of relevant question including:

    ·         What are Medicaid and the State Children's Health Insurance Program (CHIP)?

    ·         How does the Federal government pay its share of Medicaid and CHIP costs to the States?

    ·         Why can States get (draw down) Federal reimbursement for language services?

    ·         Why don’t all States cover language services for Medicaid/ CHIP enrollees?

    ·         How much would my State get from the Federal government for language services?

    ·         How does my State start drawing down Federal reimbursement for language services?

    ·         Which providers can get reimbursed for language services?

    ·         How can my State reimburse providers who receive pre-set rates for service?

    ·         How much should the State pay for interpreters?

    ·         How can States offer reimbursement?

    ·         What about language services for individuals not enrolled in Medicaid/CHIP?

     To read the full report, visit <http://www.familiesusa.org/assets/pdfs/How_Can_States_Get_Medicaid_and_CHIP_for_Language_Services.pdf>

     For specific information on your State, visit <http://www.statehealthfacts.kff.org/>

• Public agencies in Oregon
  • Agency/organization websites
    • Department of Human Services (DHS) - Home
      http://www.oregon.gov/DHS
    • Department of Human Services – County Office Information
      http://www.oregon.gov/DHS/localoffices/index.shtml
    • Oregon Public Health Division
      www.oregon.gov/DHS/ph/
    • Oregon Department of Special Education (ODE)
      http://www.ode.state.or.us/search/results/?id=40
    • Oregon Office of Vocational Rehabilitation Services (OVRS)
      www.oregon.gov/DHS/vr/
    • Oregon OVRS offices - Locations by City
      http://www.oregon.gov/DHS/vr/officelocation.shtml
    • Oregon Community Mental Health Programs
      http://www.oregon.gov/DHS/mentalhealth/cmh-programs.shtml
    • Oregon Community Health Centers
      http://www.orpca.org/learn-about-opca/oregons-community-health-centers

• Screening and assessment
  • Agency/organization websites
    • The Center for Outcome Measurement in Brain Injury
      http://www.tbims.org/combi/
  • Documents/training materials
    • Ohio Valley Center for Brain Injury Prevention and Rehabilitation – TBI Screening
      http://www.ohiovalley.org/abuse/pdf/tbi.pdf
    • Traumatic Brain Injury (TBI) Central: Brain Injury Screening
      http://www.mssm.edu/tbicentral/resources/technical_screening.shtml

• Social Security Disability Information
  • Agency/organization websites
    • The Social Security and Disability Resource Center website (SSDRC.com) provides a detailed overview of how the federal disability system works (social security disability and SSI) and also provides answers to many questions that applicants typically have, but often have trouble finding answers to. For the most part, the site is based on the author's personal experience as a former disability-medicaid caseworker, and also as a former disability examiner for the social security administration. Hopefully, the information will be helpful to some of your site's visitors.  
      http://www.ssdrc.com/

• Statistics
  • Agency/organization websites
    • Centers for Disease Control and Prevention – Traumatic Brain Injury: Topic Home
      http://www.cdc.gov/TraumaticBrainInjury/index.html

• Substance abuse
  • Agency/organization websites
    • Ohio Valley Center for Brain Injury Prevention and Rehabilitation – Substance Abuse and Brain Injuries
      http://www.ohiovalley.org/abuse/index.html
    • Substance Abuse & Mental Health Services Administration – Substance Abuse Treatment Facility Locator
      http://www.findtreatment.samhsa.gov/
  • Documents/training materials
    • Aug 2010 Oregon Alcohol and Other Drug Services Directory
      http://www.oregon.gov/DHS/addiction/publications/provider-directory.pdf

• Veterans
  Government Resource
  • Real Warriors Campaign
    Find articles and resources on a variety of psychological health issues, as well as video interviews with Service Members, their families and others dealing with mental health issues and traumatic brain injuries.
  • Outreach Center for Psychological Health & Traumatic Brain Injury
    Contact the 24-hour/7 days a week outreach center at 866-966-1020 to reach the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE).
  • Defense Centers of Excellence (DCoE) for Psychological Health & Traumatic Brain Injury
    Access a DoD program that works to improve psychological health and TBI treatment of Service Members and Veterans.
  • Traumatic Brain Injury (TBI)
    Find information on the causes, symptoms, classifications, recommendations and resources from Hooah 4 Health regarding TBI.
  • Helping Soldiers with TBI to Recover & Reintegrate
    Learn about the program, Project Victory, that helps Service Members who have sustained a mild to severe brain injury to regain skills and functions that were lost through their injury.
  • National Council on Disability - Report on the Invisible Wounds of TBI & PTSD
    Describes the less visible psychological and neurological injuries associated with post traumatic stress disorder (PTSD) or traumatic brain injury (TBI). Download a report titled Invisible Wounds: Serving Service Members and Veterans with PTSD and TBI.
  • Traumatic Brain Injury - The Journey Home
    Provides an informative and sensitive exploration of Traumatic Brain Injury (TBI), including information for patients, family members and caregivers. Topics include types and symptoms of brain injury, TBI treatment and recovery, and helpful insights about the potential long-term effects of brain injury.
  • Brain Injury Network
    Provides advocacy, information and referral, peer support, and resources for survivors of acquired brain injury (abi), which includes traumatic brain injury (tbi), stroke, brain illness and brain tumors.
  • Blast Injury FAQs
    Offers answers to frequently asked questions about blast injuries provided by the Defense & Veterans Brain Injury Center (DVBIC).
  • Resources for Veterans & Their Families on Traumatic Brain Injury
    Get information from the National Association of State Head Injury Administrators on TBI, including state, local and federal resources.
  • Bob Woodruff Foundation
    Provides resources and support to injured Service Members, Veterans and their families, especially those who have sustained the hidden injuries of war.
  • Rehabilitation Research & Training Center (RRTC) on Community Integration of Persons with Traumatic Brain Injury (TBI)
    Provides information and resources to help people affected by TBI, their families and professionals who work with and treat them in order to maximize their access to services and their participation in their communities.
  • Traumatic Brain Injury (TBI) & Stroke Rehabilitation (TSR) Program
    Provides easy access to the most current information about NICHD research projects, publications, news releases and other activities related to TBI and TSR and similar disorders.
  • American Veterans with Brain Injuries (AVBI)
    Offers personal stories, resources and announcements of services available to Veterans with traumatic brain injury and their families.
  • Employment after Traumatic Brain Injury (TBI)
    Learn about research and expectations regarding post-TBI vocational outcomes.
  • Healthcare for Headaches
    Provides educational and informational resources supporting headache research and treatment. The website provide articles that link headaches to TBI and PTSD.
  • Betty Clooney Foundation for Persons with Traumatic Brain Injury (TBI)
    Provides resources in finding the right treatment, therapy and rehabilitation for patients with TBI. Includes information on Soldiers & TBI, services available at their facility in Southern California and a listing of Support Groups in California.
  • Answers for Veteran or Active Military with Paralysis or Brain Injury
    Learn about resources available from the Christopher and Dana Reeve Foundation Paralysis Resource Center, the Defense and Veterans Brain Injury Center and the Brain Injury Association of America to enhance the care of people with paralysis and traumatic brain injury.
  • National Institute of Neurological Disorders & Stroke (NINDS) Traumatic Brain Injury (TBI) Information Page
    Find organizations that can help people live with TBI.
  • Improved Treatment for Stuttering
    Provides free online resources, services and support to those who stutter and their families, as well as support for research into the causes of stuttering.
  • Army Behavioral Health
    Learn about post-traumatic stress disorder (PTSD), traumatic brain injury (TBI) and suicide prevention. Includes help for children, couples and extended families.
  • Understanding Traumatic Brain Injury (TBI)
    Watch a video from the Defense & Veterans Brain Injury Center features the recovery journeys of several service personnel and their families.
  • Traumatic Brain Injury Resource Directory (TBIRD)
    Produced by the Rehabilitation Research Center at Santa Clara Valley Medical Center that provides information and resources available on a range of topics related to TBI.
  • The National Center for Telehealth and Technology (T2)
    Researches, develops, evaluates, and deploys new and existing technologies for Psychological Health (PH) and Traumatic Brain Injury (TBI) across the Department of Defense (DoD).
  • Understanding Brain Injury - A Guide for the Family
    Explains the impact that a brain injury in one family member can have on the entire family. Contains information on the structure and function of the human brain; the causes of brain injury; the recovery process; and behavior and communication changes after brain injury.
  • Basic Facts about TBI Video
    Watch a video from the Brain and Spinal Cord Injury Center provides a basic overview of TBI.
  • Facts About Traumatic Brain Injury (TBI)
    BrainLine

    Provides a variety of information and resources on traumatic brain injury (TBI).
  • War Related Illness and Injury Study Center (WRIISC)
    Provides information on Traumatic Brain Injury (TBI) from the Department of Veterans Affairs.

    
     

     

    The Brain Injury News and Information Blog
    www.braininjury.blogs.com is dedicated to providing the latest news on brain injury and is designed to be a valuable resource for professionals, persons who have sustained a brain injury and family members. New developments in medicine, legislation, law, sports,
    events, meetings and injury prevention are reported on a daily basis.
    
    The Neurology Channel
    
    The Perspectives Network
    "The primary focus is positive communication between persons with brain injury, family members/caregivers/friends of persons with brain injury, those many professionals who treat persons with brain injury and community members in order to create positive changes and enhance public awareness and knowledge of acquired/traumatic brain injury."

    Waiting during Coma
    This site Is made possible through the contributions of those whose lives have been touched and changed by brain injury. We thank them for sharing their stories.