Examining The Use Of Biomarkers In Establishing The Presence And Severity Of Impairments

As part of the overall disability determination process, the Social Security Administration uses a step-by-step approach to understand how severe an individual's condition is and whether it meets program criteria for disability. The use of various types of biomarkers has been suggested as a way to strengthen the amount and quality of objective evidence available to the review process. At the request of the Social Security Administration, the National Academies of Sciences, Engineering, and Medicine's Board on Health Care Services organized a virtual workshop on July 21, 2020, titled The State of the Science of the Use of Biomarkers to Establish the Presence and Severity of Impairments. Workshop discussions focused on the current and potential uses for biomarkers; explored legal and ethical implications associated with biomarker use in clinical decision making; and considered the possible uses of nongenetic biomarkers as tools for the diagnosis or prognosis of the severity of specific physical and mental impairments. This publication summarizes the presentations and discussion of the workshop.

“This updated textbook was much needed as there has been increased attention in recent years toward brain injuries. The book provides updated guidelines and clinical practice recommendations that support the intended audience of trainees and current practitioners. This update makes it the current standard text for any brain injury specialist." ---Doody's Review Service, 4 stars This revised and greatly expanded Third Edition of Brain Injury Medicine continues its reputation as the key core textbook in the field, bringing together evidence-based medicine and years of collective author clinical experience in a clear and comprehensive guide for brain injury professionals. Universally praised as the gold standard text and go-to clinical reference, the book covers the entire continuum of care from early diagnosis and assessment through acute management, rehabilitation, associated medical and quality of life issues, and functional outcomes. With 12 new chapters and expanded coverage in key areas of pathobiology and neuro-recovery, special populations, sport concussion, disorders of consciousness, neuropharmacology, and more, this "state of the science" resource promotes a multi-disciplinary approach to a complex condition with consideration of emerging topics and the latest clinical advances. Written by over 200 experts from all involved disciplines, the text runs the full gamut of practice of brain injury medicine including principles of public health and research, biomechanics and neural recovery, neuroimaging and neurodiagnostic testing, sport and military, prognosis and outcome, acute care, treatment of special populations, neurologic and other medical complications post-injury, motor and musculoskeletal problems, post-trauma pain disorders, cognitive and behavioral problems, functional mobility, neuropharmacology and alternative treatments, community reentry, and medicolegal and ethical issues. Unique in its scope of topics relevant to professionals working with patients with brain injury, this third edition offers the most complete and contemporary review of clinical practice standards in the field. Key Features: Thoroughly revised and updated Third Edition of the seminal reference on brain injury medicine Evidence-based consideration of emerging topics with new chapters covering pathobiology, biomarkers, neurorehabilitation nursing, neurodegenerative dementias, anoxic/hypoxic ischemic brain injury, infectious causes of acquired brain injury, neuropsychiatric assessment, PTSD, and capacity assessment Multi-disciplinary authorship with leading experts from a wide range of specialties including but not limited to physiatry, neurology, psychiatry, neurosurgery, neuropsychology, physical therapy, occupational therapy speech language pathology, and nursing New online chapters on survivorship, family perspectives, and resources for persons with brain injury and their caregivers Purchase includes digital access for use on most mobile devices or computers

The United States Social Security Administration (SSA) administers two disability programs: Social Security Disability Insurance (SSDI), for disabled individuals, and their dependent family members, who have worked and contributed to the Social Security trust funds, and Supplemental Security Income (SSSI), which is a means-tested program based on income and financial assets for adults aged 65 years or older and disabled adults and children. Both programs require that claimants have a disability and meet specific medical criteria in order to qualify for benefits. SSA establishes the presence of a medically-determined impairment in individuals with mental disorders other than intellectual disability through the use of standard diagnostic criteria, which include symptoms and signs. These impairments are established largely on reports of signs and symptoms of impairment and functional limitation. Psychological Testing in the Service of Disability Determination considers the use of psychological tests in evaluating disability claims submitted to the SSA. This report critically reviews selected psychological tests, including symptom validity tests, that could contribute to SSA disability determinations. The report discusses the possible uses of such tests and their contribution to disability determinations. Psychological Testing in the Service of Disability Determination discusses testing norms, qualifications for administration of tests, administration of tests, and reporting results. The recommendations of this report will help SSA improve the consistency and accuracy of disability determination in certain cases.

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Many people naturally assume that the claims made for foods and nutritional supplements have the same degree of scientific grounding as those for medication, but that is not always the case. The IOM recommends that the FDA adopt a consistent scientific framework for biomarker evaluation in order to achieve a rigorous and transparent process.

Autism spectrum disorders are developmental disorders. Individuals with autism spectrum disorders develop differently. These differences are usually present in social interaction, communication, and sensory processing, and become visible through a wide variety of behavioral responses that differ from individuals without autism spectrum disorders. Despite significant research efforts, the exact causes of autism spectrum disorders remain poorly understood; however, researchers have gained extensive insights into possible pathomechanisms, even at the molecular level of cells. Many diagnostic criteria have been developed, adapted, and improved. The eight chapters in this book highlight the current state-of-the-art in many areas of autism spectrum disorders. Chapter 1 provides an overview of the epidemiology of autism spectrum disorders and the current knowledge of the underlying pathogenic mechanisms. Chapter 2 summarizes the diagnostic criteria and procedures and highlights present and upcoming therapeutic strategies. Chapter 3 reviews the adverse events and trauma in people with autism spectrum disorders. Chapters 4 and 5 focus on atypical sensory processing, and Chapter 6 discusses the genetic overlap of autism spectrum disorders with other neuropsychiatric disorders such as attention deficit hyperactivity disorder (ADHD), depression, and schizophrenia. Chapter 7 focuses on the contribution of abnormalities in mitochondria, and chapter 8 discusses gut-brain interactions and a potential role for microbiota in autism spectrum disorders. This book is aimed primarily at clinicians and scientists, but many areas will also be of interest to the layperson.

The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus immediately qualify for benefits. In this report, the IOM makes several recommendations for improving SSA's capacity to determine disability benefits more quickly and efficiently using the Listings.