Brain and Spine Injury Law Blog

Brain and Spine Injury Law Blog

Water Polo Sport and Brain Injury

Posted in The Human Brain, Traumatic Brain Injury (TBI)

A first-of-its-kind survey has confirmed what some water polo players — especially goalies — have long suspected: Concussions seem to be prevalent in the sport.

More than a third of water polo participants reported sustaining a concussion either during games or in practice, according to a poll conducted by University of California, Irvine researchers.

Study leaders said the findings represent a necessary and important initial step toward understanding the prevalence of concussions in water polo and point to the need for increased player safety. While the sport features a high degree of physicality and aggressive play, epidemiological data on the incidence of head trauma have not been gathered or made public until now. Results appear online in Frontiers in Neurology.

In recent years, there has been growing awareness of the risks of head injury in athletics, and understanding the nature and prevalence of sports-related concussion is a major focus of both clinical and basic research. In 2012, the NCAA began tracking water polo concussions, but only a handful of teams supply data, and the results haven’t been made public.

To read more of the study go to Robert S. Blumenfeld, Jessica C. Winsell, James W. Hicks, Steven L. Small. The Epidemiology of Sports-Related Head Injury and Concussion in Water Polo. Frontiers in Neurology, 2016; 7 DOI: 10.3389/fneur.2016.00098

Delivery of Drugs For Brain Injuries

Posted in Books, Articles, and Literature, Publications, The Human Brain, Traumatic Brain Injury (TBI)
Brain Lipids

A new study led by scientists at the Sanford Burnham Prebys Medical Discovery Institute (SBP) describes a technology that could lead to new therapeutics for traumatic brain injuries. The discovery, published in Nature Communications, provides a means of homing drugs or nanoparticles to injured areas of the brain.

About 2.5 million people in the US sustain traumatic brain injuries each year, usually resulting from car crashes, falls, and violence. While the initial injury cannot be repaired, the damaging effects of breaking open brain cells and blood vessels that ensue over the following hours and days can be minimized.

More than one hundred compounds are currently in preclinical tests to lessen brain damage following injury. These candidate drugs block the events that cause secondary damage, including inflammation, high levels of free radicals, over-excitation of neurons, and signaling that leads to cell death.

To read the online paper, click here.

Erasing Unpleasant Memories After Traumatic Brain Injury

Posted in Age & Alzheimer's Issues, Books, Articles, and Literature, Brain Injury News and Event Update, Personal Injury, Psychiatric & Psychological Issues, The Human Brain, Traumatic Brain Injury (TBI)

Dementia, accidents, or traumatic events can make us lose the memories formed before the injury or the onset of the disease. Researchers from KU Leuven and the Leibniz Institute for Neurobiology have now shown that some memories can also be erased when one particular gene is switched off.

The team trained mice that had been genetically modified in one single gene: neuroplastin. This gene, which is investigated by only a few groups in the world, is very important for brain plasticity. In humans, changes in the regulation of the neuroplastin gene have recently been linked to decreased intellectual abilities and schizophrenia.

In the reported study, the mice were trained to move from one side of a box to the other as soon as a lamp lights up, thus avoiding a foot stimulus. This learning process is called associative learning. Its most famous example is Pavlov’s dog: conditioned to associate the sound of a bell with getting food, the dog starts salivating whenever it hears a bell.

When the scientists switched off the neuroplastin gene after conditioning, the mice were no longer able to perform the task properly. In other words, they showed learning and memory deficits that were specifically related to associative learning. The control mice with the neuroplastin gene switched on, by contrast, could still do the task perfectly.

Medivisual Guest Blog – Medical Inconsistencies in Brain Injury

Posted in Las Vegas Injury Attorney, Psychiatric & Psychological Issues, The Human Brain, Traumatic Brain Injury (TBI), Uncategorized


Medical Legal Educational Blog


By: Robert L. Shepherd, MS, Certified Medical Illustrator, President & CEO, MediVisuals Inc. and Reid Shepherd, BA

When developing demonstrative aids regarding plaintiffs that may have suffered a traumatic brain injury (TBI), the absence of a reference to a traumatic brain injury or references to “mild” traumatic brain injuries in general medical records should not be considered authoritative.  The development and persistence of neuropsychological symptoms through a neuropsychological evaluation is necessary to make such determinations.  Even with a diagnosis of a “mild” TBI following a neuropsychological evaluation, the adjective “mild” should be avoided in demonstrative aids because, as any victim of a “mild” TBI will likely agree, the only “mild” TBI is one that occurs to someone else.  In addition to being misleading, the term “mild TBI” does not have a consistent definition or agreed upon clinical method of detection.1 As the Department of Veteran Affairs reports, “the particular classification used to designate a patient as having mild, moderate or severe (traumatic brain) injury is somewhat arbitrary.”2 For these reasons, and for those discussed later on in this blog, “mild traumatic brain injuries” should be referred to instead as “traumatic brain injuries”.

 Centers for Disease Control and Prevention

Multiple organizations have attempted to produce their own definitions and classification systems for TBI.  The CDC’s, “Report to Congress on Mild Traumatic Brain Injury in the United States,” recommends separate conceptual and operation definitions for both incident cases and prevalent cases of “mild” TBI, which may serve to confuse rather than clarify attempted classifications of TBI.1 While the CDC uses the term “mild,” it acknowledges the fact that “mild” TBIs can cause, “serious, lasting problems,” and reports that 80,000 to 90,000 Americans per year, “experience the onset of long-term disability,” from such injuries.1

 Glasgow Coma Scale (GCS)

In most cases, the diagnosis and classification of TBI is done by emergency responders or nurses who express varied attitudes and a lack of self-confidence in using the most common TBI classification system, the Glasgow Coma Scale (See the Below Chart).3 The GCS has been used to classify TBI on clinical grounds for many years, but the GCS is an old system that overlooks important signs that indicate the presence and severity of TBI.4 The GCS is an extremely basic observational index that, “assesses the level of consciousness after TBI,” and is a, “poor discriminator of the presence or absence of less severe TBI.”5 The scale also fails to account for duration of loss of consciousness, which is an important indicator in determining TBI severity. When this already inadequate scale is used by a medical professional who lacks familiarity with the rating system, the resulting classification should not be considered accurate by any means.                                                                                                                                                                             Department of Veteran Affairs

The Department of Veteran Affairs’ classification scale uses the GCS as one of 4 indices to classify TBI (along with length of coma duration, length of period of altered consciousness or mental status, and length of posttraumatic amnesia), but the Department also acknowledges the limitations of the GCS and of its classification system in general: “While the GCS is recognized as a reliable measurement tool, it is influenced by factors unrelated to the TBI itself…The GCS is not particularly useful in the assessment of mild TBI.”2 Variables such as age, extracranial injury, intoxication, intubation, analgesia, sedation, and many potential comorbidity conditions interfere with the results of these classification scales and can make an accurate diagnosis of neurologic injury on clinical grounds impossible.4, 5

Department of Defense

The Department of Defense uses yet another definition and classification system for TBI severity. In order to determine whether an incident of TBI is mild, moderate, or severe, the DoD created an exhaustive list of over 500 specific injuries and symptoms, each with its own severity classification. A very short sample of the DoD’s classification system is as follows, which gives an idea of just how many factors must be considered when attempting to classify a traumatic brain injury. The extensive, full list of symptoms (found at the link below the chart) can hardly be summarized by a one-word label of “mild,” “moderate,” or “severe.

Several other scales for diagnosing and classifying TBI also exist, including: Abbreviated Injury Scale, Trauma Score, Abbreviated Trauma Score, Brussells Coma Grades, Grady Coma Grades, Innsbruck Coma Scale, and the FOUR Scale, but none of these scales overcome the inherent problems involved in classifying such a varied and complex condition as TBI. In addition to having no accurate way to judge duration of loss of consciousness unless a witness is present at the time of injury, these scales are designed to be used quickly in a clinical setting and do not account for the onset of symptoms which are often delayed. Combine these difficulties with the aforementioned complications from comorbidity conditions and other variables, and it becomes clear that existing attempts at TBI classification systems are often unreliable.



Centers for Disease Control and Prevention:”mild” TBIreport-a.pdf

Glasgow Coma Scale:

Department of Veteran Affairs:

Department of Defense:



1. Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem. Centers for Disease Control and Prevention. September 2003. Accessed June 23, 2016.

2. Traumatic Brain Injury. Department of Veteran Affairs. April 2010. Accessed June 23, 2016.

3. Mattar I, Liaw S, Chan M. Nurses’ self-confidence and attitudes in using the Glasgow Coma Scale: a primary study. Nursing In Critical Care [serial online]. March 2015;20(2):98-107. Available from: Academic Search Alumni Edition, Ipswich, MA. Accessed May 5, 2016.

4. Chieregato A, Martino C, Simini B, et al. Classification of a traumatic brain injury: the Glasgow Coma scale is not enough. Acta Anaesthesiologica Scandinavica [serial online]. July 2010;54(6):696-702. Available from: Academic Search Alumni Edition, Ipswich, MA. Accessed June 23, 2016.

5. Saatman KE, Duhaime A-C, Bullock R, Maas AIR, Valadka A, Manley GT. Classification of Traumatic Brain Injury for Targeted Therapies. Journal of Neurotrauma. 2008;25(7):719-738. doi:10.1089/neu.2008.0586.

6. Traumatic Brain Injury (TBI): DoD Standard Surveillance Case Definition for TBI Adapted for AFHSB Use. Department of Defense. December 2015. Accessed June 23,2016.

Bob Shepherd, MS, CMI, FAMI 

Bob Shepherd is a Certified Medical Illustrator, having graduated from one of only four accredited medical illustration graduate programs in North America.


President  | CEO

Chief Medical Illustrator

Visual Consultant

Motor Vehicle Crash Deaths

Posted in Brain Injury News and Event Update, Spine Injury, Back Injury, Neck Injury and Bone Injury, Traumatic Brain Injury (TBI), Uncategorized

Reducing motor vehicle crash deaths was one of the great public health achievements of the 20th century for the US. However, more than 32,000 people are killed and 2 million are injured each year from motor vehicle crashes. In 2013, the US crash death rate was more than twice the average of other high-income countries.

Key points include:

  • About 90 people die each day in the US from crashes — resulting in the highest death rate among comparison countries.
  • US crash deaths fell 31% compared to an average 56% in 19 other high income countries from 2000-2013.
  • Over 18,000 lives could be saved each year if US crash deaths equaled the average rate of 19 other high-income countries.

Motor Vehicle Crash Deaths

How is the US doing?

August 2016

Reducing motor vehicle crash deaths was one of the great public health achievements of the 20th century for the US. However, more than 32,000 people are killed and 2 million are injured each year from motor vehicle crashes. In 2013, the US crash death rate was more than twice the average of other high-income countries. In the US, front seat belt use was lower than in most other comparison countries. One in 3 crash deaths

in the US involved drunk driving, and almost 1 in 3 involved speeding. Lower death rates in other high-income countries and a high percentage of risk factors in the US suggest that we can make more progress in reducing crash deaths.

Drivers and passengers can:

■■ Use a seat belt in every seat, on every trip, no matter how short.

■■Make sure children are always properly buckled in the back seat in a car seat, booster seat, or seat belt, whichever is appropriate for their age, height, and weight.

■■ Choose not to drive while impaired by alcohol or drugs, and help others do the same.

■■Obey speed limits.

■■Drive without distractions (such as using a cell phone or texting).

Want to learn more?

*Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Israel, Japan, Netherlands, New Zealand, Norway, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom

There were more than 32,000 crash deaths in the US in 2013. These deaths cost more than $380 million in direct medical costs.

Major risk factors for crash deaths in the US:

■■Not using seat belts, car seats, and booster seats contributed to over 9,500 crash deaths.

■■Drunk driving contributed to more than 10,000 crash deaths.

■■Speeding contributed to more than 9,500 crash deaths. Reducing major risk factors could save thousands of lives and hundreds of millions of dollars in direct medical costs each year.

Seat belts saved over 12,500 lives in the US in 2013, yet:

■■ The US had lower-than-average front and back seat belt use compared with other high-income countries.

■■About half of drivers or passengers who died in crashes in the US weren’t buckled up.

Motor vehicle crash deaths in the US are still too high.

Some proven measures of best performing

high-income countries.

Even when considering population size, miles traveled, and number of registered vehicles, the US consistently ranked poorly relative to other highincome

countries for crash deaths. Some of the best performing countries:

■■Have policies in line with best practices, including those that address:

“Primary enforcement of seat belt laws that cover everyone in every seat.   Police officers can stop a vehicle and write a ticket for anyone not buckled up. “Requirements for car seats and booster seats for child passengers through at least age 8.

“Blood Alcohol Concentration (BAC) levels.   US, Canada and the United Kingdom define drunk driving as BAC levels at 0.08% or above; all other comparison countries use lower BAC levels (0.02-0.05%).

■■Use advanced engineering and technology, such as:

“Ignition interlocks for all people convicted of

drunk driving.   This device keeps the vehicle from starting unless the driver has a BAC below a pre-set low limit.

“Automated enforcement, for example, speed

and red light cameras.

“Improvements in vehicle safety and transportation


■■ Implement proven measures, such as:

“More use of publicized sobriety checkpoints.

“Maintain and enforce the minimum legal drinking age.

SOURCES: National Highway Traffic Safety Administration 2013 data. WHO Global Status Report on

Road Safety, 2015.


The Federal government is

■■ Tracking the nation’s progress in reducing crash injuries and deaths.

■■ Evaluating and encouraging the use of proven programs and policies.

■■ Collaborating with and providing guidance, resources, and tools for motor vehicle injury prevention to state, local, tribal, and federal partners.

Drivers and passengers can

■■Use a seat belt in every seat, on every trip, no matter how short.

■■Make sure children are always properly buckled in the back seat in a car seat, booster seat, or seat belt, whichever is appropriate for their age, height, and weight.

■■ Choose not to drive while impaired by alcohol or drugs, and help others do the same.

■■Obey speed limits.

■■Drive without distractions (such as using a cell phone or texting).

States can

■■ Increase seat belt use with primary enforcement seat belt laws that cover everyone in the vehicle.

■■ Consider requiring car seats and booster seats for children through at least age 8 or until seat belts fit properly.

■■ Reduce drunk driving by:

“Expanding publicized sobriety checkpoints.

“Enforcing existing 0.08% blood alcohol concentration (BAC) laws and minimum legal drinking age laws.

“Consider ignition interlock requirements for people convicted of drinking and driving, starting with their first offense.

■■ Support traffic safety laws with media campaigns and visible police presence to increase restraint use and decrease impaired driving and speeding.

■■ Consult CDC’s Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS) to find out the cost of implementing up to 14 interventions and the number of injuries prevented and lives saved.

■■ Consider implementing Vision Zero—a road safety approach that deems death and severe injuries on our roads unacceptable and preventable.

Healthcare providers can

■■Give patients resources about motor vehicle safety and remind them how important it is to use a seat belt on every trip.

■■ Counsel parents and caregivers on using age- and size-appropriate car seats, booster seats, and seat belts on every trip.

■■ Talk to patients about the dangers of impaired driving and help identify counseling options as needed.

■■ Provide parents and caregivers of teens with resources on safe teen driving.

Affordable Care Act is Accomplishing Goal of Providing Lower Cost Care to Millions

Posted in Books, Articles, and Literature, Las Vegas Injury Attorney, Publications, Resources, Spine Injury, Back Injury, Neck Injury and Bone Injury, The Human Brain, Traumatic Brain Injury (TBI)

Data From HHS revealing, to the dismay of naysayers, that the Affordable Care Act – ACA – “Obama-Care”) is achieving its goal of keeping medical costs down as more enrollees  subscribe.  This was the intent of the ACA.  Not that of a small % of those individuals with “bad” health insurance who were required to subscribe to the minimum levels mandated by the ACA, who complain about “losing” their insurance of choice (which was better for them anyway).

Here are the FACTS!


Centers for Medicare & Medicaid Services

Center for Consumer Information and Insurance Oversight

200 Independence Avenue SW

Washington, DC 20201

Date: August 11, 2016

Subject: Changes in ACA Individual Market Costs from 2014-2015: Near-Zero Growth Suggests an Improving Risk Pool

Key Findings

• Per-enrollee costs in the ACA individual market were essentially unchanged between 2014 and 2015. Specifically, after making comparability adjustments described below, per-member-per-month (PMPM) paid claims in the ACA individual market fell by 0.1 percent from 2014 to 2015. For comparison, per-enrollee costs in the broader health insurance market grew by at least 3 percent

• Available evidence indicates that the slow ACA individual market cost growth resulted at least in part from a broader, healthier risk pool. In particular, states that saw stronger-than-average enrollment growth in 2015 saw greater-than-average reductions in PMPM costs. For example, in the 10 states with the highest 2015 growth in ACA individual market member months, PMPM claims costs fell by an average of 5 percent.

• Nearly all states saw continued growth in Marketplace enrollment in 2016, suggesting continued risk pool improvement. Moreover, the 2015 claims data also predate important steps CMS has taken over the six months to further strengthen the Marketplace risk pool. These steps include implementing new processes to prevent misuse of Special Enrollment Periods, reducing the number of consumers losing coverage or financial assistance due to data-matching issues, helping consumers who turn 65 move from the Marketplace onto Medicare, and proposing to curb abuses of short-term plans.


On June 30th, the Centers for Medicare & Medicaid Services (CMS) released data on reinsurance payments for 2015.1 Reinsurance payments are based on issuers’ claims paid amounts for the full individual market, excluding grandfathered and transitional plans; the data include all plans sold on the Health Insurance Marketplace, including the federal Marketplace and the individual State-based Marketplaces, as well as off-Marketplace plans that are subject to the same pricing and


Hearing Damage

Posted in Las Vegas Injury Attorney, The Human Brain, Traumatic Brain Injury (TBI), Uncategorized

So you listened to Led Zeppelin and Rock music as a teenager?  You went to concerts?  All very loud stuff!

New research into the ringing-ear condition known as tinnitus indicates an alarming level of early, permanent hearing damage in young people who are exposed to loud music, prompting a warning from a leading Canadian researcher in the field.

When the auditory nerves are damaged, brain cells increase their sensitivity to their remaining inputs, which can make ordinary sounds seem louder. Increased loudness perception is an indication of nerve injury that cannot be detected by the audiogram, the standard clinical test for hearing ability. Neuroscience research indicates that such “hidden hearing loss” caused by exposure to loud sounds in the early years deepens over the life span, worsening one’s hearing ability later in life.

It’s common after listening to loud music to experience a ringing in the ears for the next day or so, Roberts said. More than half the students in the study said it had happened to them. This brief tinnitus is an early warning sign, according to Roberts. Testing showed that 28 per cent of the study participants had already developed persistent tinnitus.

The 28 per cent of participants with persistent tinnitus also showed heightened sensitivity to loud sounds, indicating that the neurons that transmit sounds to the brain may have been damaged, said Roberts. While some other forms of hearing loss can be repaired, such nerve damage cannot be undone. The only solution, he says, is prevention.

Legislative Update July 2016 Congress Goes Home

Posted in Brain Injury News and Event Update, Legislation, Psychiatric & Psychological Issues, Resources, Soldiers, Veterans and Military Issues, The Human Brain, Traumatic Brain Injury (TBI)
July 2016

Here is the legislative update from the Center for Neuroskills and the Brain Injury Association of America.

With Congress adjourned and in their home districts, advocates have an excellent opportunity to speak out about brain injury. Many are campaigning to be re-elected and other candidates are campaigning to take their jobs. They, along with other candidates for statewide and State House offices, will be out and about in county and state fairs, holding public forums and glad handing in public events. It’s a good time to set up meetings with them or visit with them at public events about brain injury issues.

  House E&C Committee Passes Special Needs Trust Bill

Before adjourning for the political conventions and the August recess, the U.S. House Energy and Commerce Committee passed H.R. 670, the Special Needs Trust Fairness Act of 2015, which enables individuals with disabilities to create their own special needs trust accounts in order to be able to have a savings account without losing government benefits. Sponsored by Rep. Glenn Thompson (R-Pa.), the legislation expands legislation previously passed in 2014, Achieving a Better Life Experience Act of 2014 (ABLE Act), which allowed only families and legal guardians to contribute to a savings account created by an individual with a disability. Interest earned is tax free. The Senate has already passed this legislation by unanimous consent. The BIAA has advocated for passage of H.R. 670.

In accordance with the initial legislation, eligibility is limited to individuals with significant disabilities with an age of onset of disability before turning 26 years of age. All states, except for Florida, have a national enrollment, which means individuals with disabilities can open an account regardless of being a resident in that state. Alaska, Illinois, Iowa, Kansas, Minnesota, Missouri, Nevada, Pennsylvania, and Rhode Island have elected to work together in an effort to provide their residents with access to ABLE accounts in a cost-effective manner. For more information on ABLE implementation and state laws, go to the ABLE National Resource Center.

 House Bill Weakens the ADA – Call to Action!

The Consortium for Citizens with Disabilities (CCD), of which BIAA is a member, is calling on advocates to oppose H.R. 3765, which weakens the Americans with Disabilities Act (ADA). Specifically, H.R. 3765, the ADA Education and Reform Act of 2015, would eliminate the responsibility of businesses to know their obligations under the ADA and place the burden of ensuring compliance on people with disabilities themselves. The legislation imposes several additional steps on plaintiffs before they can file a civil action for an accessibility violation in a public accommodation case. It would also impose criminal fines if demand letters or other pre-suit notifications alleging violations of ADA public accommodation requirements are not sufficiently specific.

On July 7, 2016, the House Judiciary Committee passed the bill out of committee by a 15-6 vote. Two other bills were also heard by the Committee: H.R. 241, the ACCESS ADA Compliance for Customer Entry to Stores and Services Act of 2015; and H.R. 4719, COMPLI Act. Similar to H.R. 3765, these bills are designed to limit the ability of individuals with disabilities from enforcing their rights to public accommodation in the same manner as all other citizens. Advocates are called upon to contact their House Members in opposition to H.R. 3765, noting that businesses have had 26 years to know the provisions of the ADA and to be compliance.

BIAA Supports a National Trauma System

The BIAA and NASHIA co-signed a letter supporting a national trauma system of care, which was discussed during the hearing held this week by the House Energy and Commerce Committee’s Subcommittee on Health. The letter thanked the Subcommittee for focusing on the need for an organized and coordinated trauma care system. The organizations pointed out that a full spectrum of timely and appropriate care — from the time of injury through transport to an acute care facility and to rehabilitative care — is necessary in order to preserve life and to reduce the debilitating effects of a traumatic brain injury.

House Appropriators Release Spending Recommendations

The U.S. House Committee on Appropriations marked up the spending bill for Labor, Health and Human Services (HHS) and Education. In total, the draft bill includes $161.6 billion in discretionary funding, which is a reduction of $569 million below the fiscal year 2016 enacted level and $2.8 billion below the president’s budget request. To view the Committee’s press release and report, click here.

Congress Adjourns

The House of Representatives adjourned yesterday, a day early, leaving several issues unresolved, including legislation preventing terrorists from purchasing guns, funding for the Zika virus, or spending bills to fund most federal programs starting Oct. 1. Congress did extend funding through September for Federal Aviation Administration (FAA) programs, as funding was set to expire July 15. The House will return Sept. 6. The Senate is formally in recess from July 18 through Sept. 5.



Best Jobs For Those with Post Traumatic Stress Disorder

Posted in Personal Injury, Psychiatric & Psychological Issues, Publications, Resources, Soldiers, Veterans and Military Issues

Occasionally I am privileged to post a guest blog.  Folks contact me interested in my niche of law and medicine and ask me to review a potential post.  This one is from Julia Merrill discussing best jobs for victims of post traumatic stress disorder. I felt this article particularly useful.

My experience with traumatic brain injury and post traumatic stress disorder reveals employment potentiality can be significantly impaired.  Victims find, as they resume their place in their community of life, that work is far more difficult: it uses much more energy to do what one did previous to injury and creates fatigue. However many times this is accompanied by insomnia so sleep deprivation comes into play. Symptoms including, attention impairment, distractibility, irritability, impaired processing speed and accuracy, make the following statement relevant: It is not that an impaired individual cannot GET a job (they often make excellent first impressions in interviews), the problem is typically in RETAINING the job.  Consistency is typically lacking.  This causes future loss in earning capacity, sometimes for life.

Here is Julia’s guest blog post entitled The Best Flexible Jobs For PTSD Sufferers:Keyboard Job

The Best Flexible Jobs For PTSD Sufferers

by Julia Merrill 

Photo by Pixabay

PTSD, or Post Traumatic Stress Disorder, affects many people who have survived stressful, life-impacting situations, including abuse, military combat, and injury accidents. The effects this disorder can have on sufferers vary widely, but for many, the thought of re-joining the workforce can be daunting.

One of the many issues PTSD sufferers face is the need for a flexible schedule; whether it’s because they need a job that offers limited interaction with others or because they don’t sleep well and need an overnight job, there are many factors to take into consideration when looking for employment. Here are some of the best jobs for anyone looking for a schedule that allows some freedom.


Working with animals can be hugely rewarding for any sufferer of PTSD, especially non-threatening dogs. Many pet owners around the country have a need for a caregiver who can come and let their dog out during the day while they’re at work, and is a great site for owners and potential employees to find one another. You can set up a profile, arrange meet-ups, and work out the financial end of things all in one spot, then work out a flexible schedule that will allow you to spend some time with a loving pet and earn cash at the same time. If you have more time to spend with your four-legged customers, you can also sign up to be a pet sitter.


While freelance writing can be a tricky business, it can also be a lucrative one if you know where to look and what to avoid. Many sites that claim to offer huge sums of money in exchange for blog posts likely aren’t as truthful as they seem, but there is still cash to be found for certain companies. If you have a flair for writing and are capable of working well on your own, there are plenty of news blogs that pay per article and allow you to work on your own time as long as you turn in a target number during a pay week.


Many office buildings, banks, and hotels keep varying hours and require a small cleaning staff — or even just one person — to come in during downtime and take care of the rooms. Often they may only need you one day a week, but depending on the business (and how much you’d like to work), you can get scheduled several hours during the week to accommodate your schedule. Check with local companies to see what their needs are, or you might contact local cleaning services to see if they’re hiring.

Nursing Aide

While different hospitals and nursing homes require varying levels of education, you may be able to find a part-time job as an aide. This is often a quiet position and can be a very flexible one, as well, depending on where you go. There is also the option of home health care, which varies in responsibility. is a great place to look for local needs, which can range from assisting an elderly patient with self-care to sitting with a terminally ill person.


Many companies require an employee with a good driving record who is capable of working well unsupervised to deliver or maintain merchandise in stores. Some, like Hallmark, offer competitive pay and reimburse for gas and mileage. Many of these companies offer flexible schedules, but some require that you be available around holidays, the busiest times for retail stores.


If you’re good with numbers or have an accounting certification, you may have luck finding work with tax firms or with private individuals who need help with their finances. Offering your services as an independent accountant around tax time can lead to quite a bit of income, and you can set your own schedule depending on how big your client load is.

It can be a bit overwhelming at first to begin a job search with personal needs related to PTSD in mind, but there are plenty of places to look when looking for employment that will be open to an unorthodox schedule.

Julia Merrill is a retired board-certified nurse practitioner. Over the course of her 30-year career, she strived to bridge the communication gap between those seeking the best medical care and those working to provide it. She created with the goal of sharing tips and insights into finding the right medical care, dealing with insurance companies, and ways for everyone to better maintain their own health and wellness.

Athletes Report Recovery But Found To have Lasting Brain Injury

Posted in Books, Articles, and Literature, Psychiatric & Psychological Issues, Spine Injury, Back Injury, Neck Injury and Bone Injury, The Human Brain, Uncategorized

New research finds white matter changes in the brains of athletes six months after a concussion. The study will be presented at the Sports Concussion Conference in Chicago, July 2016, hosted by the American Academy of Neurology, the world’s leading authority on the diagnosis and management of sports-related concussion. The conference brings together leading experts in the field to present and discuss the latest scientific advances in diagnosing and treating sports-related concussion.

The study involved high school and college football players who experienced a sports-related concussion. Each underwent MRI brain scans and were assessed for concussion symptoms, balance problems, and cognitive impairment, or memory and thinking problems, at 24 hours, eight days and six months following the concussion. Researchers also assessed carefully matched athletes who had not experienced a concussion.

At all time points, each had advanced brain scans called diffusion tensor imaging and diffusion kurtosis tensor imaging to look for acute and chronic changes to the brain’s white matter. The scans are based on the movement of water molecules in brain tissue and measure microstructural changes in white matter, which connects different brain regions. Those who had concussions had less water movement, or diffusion, in the acute stages following concussion (24 hours, six days) compared to those who did not have concussions. These microstructural changes still persisted six months after the injury. Also, those who had more severe symptoms at the time of the concussion were more likely to have alterations in the brain’s white matter six months later.

Despite those findings, there was no difference between the group of athletes with and without concussion with regard to self-reported concussion symptoms, cognition, or balance at six months post-injury.

“In other words, athletes may still experience long-term brain changes even after they feel they have recovered from the injury. These findings have important implications for managing concussions and determining recovery in athletes who have experienced a sports-related concussion,” said study author Melissa Lancaster, PhD, of the Medical College of Wisconsin in Milwaukee. “Additional research is needed to determine how these changes relate to long-term outcomes.”

To Read more Click here.