Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

A brain-imaging study conducted at the U.S. Department of Energy's (DOE) Brookhaven National Laboratory provides the first definitive evidence that patients suffering from attention deficit hyperactivity disorder (ADHD) have lower-than-normal levels of certain proteins essential for experiencing reward and motivation.

 The study, published in the September 9, 2009, issue of the Journal of the American Medical Association, also has important implications for treatment. "Finding ways to address the underlying reward-system deficit could improve the direct clinical outcome of ADHD, and potentially reduce the likelihood of other negative consequences of this condition," said study co-author Gene-Jack Wang, chair of Brookhaven's medical department.

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A California jury has awarded a former college student more than $49 million in damages, after finding two truckers and the state liable for a 2007 accident that left him severely brain damaged.

In May 2007, Drew Bianchi was a passenger in a car with three companions headed for a camping trip. Two trucks collided on a perilous two-lane mountain pass about 25 miles south of San Jose, Calif. One of the trucks struck the car Bianchi was riding in, crushing the section of the car where he was seated.

Bianchi, now 23, requires around-the-clock care and lives in a residential facility near his family in Bakersfield, Calif.

Read More here www.highbeam.com/doc/1P2-20818095.html 

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One of the problems associated with TBI is the person's ability to drive and lack of insight as to that ability.  I came across this interesting article on the topic of evaluating driving following a TBI.  Keep in mind that statistics tell us that 10% of TBI's are severe or moderate.  80% are mild.  The following is a summary of the study.

 OBJECTIVE. We conducted a literature review of assessment tools predicting driving performance for people with traumatic brain injury (TBI).

METHOD. Data sources were Web of Science, EBSCOhost, PubMed, and recently published literature from experts and team members not yet catalogued in the databases. We used the American Academy of Neurology's classification criteria to extract data from 13 studies, and we assigned a class (I-IV, with I being the highest level of evidence) to each study. We grouped primary studies into categories of driving assessment (neuropsychological; simulator; off-road; self-report, other report, and postinjury disability status; and comprehensive driving evaluation) and synthesized the predictability of these tools as it relates to driving performance for people with TBI.

CONCLUSIONS. To assist clinicians and researchers in making decisions regarding testing the driving performance of people with TBI, we provide recommendations for neuropsychological tests; off-road tests; self-report, other report, and postinjury disability status; and comprehensive driving evaluation.
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Read the entire article with references here:  C; Charles Levy; Dennis McCarthy; William C Mann; Desiree Lanford; J Kay Waid-Ebbs. "Traumatic Brain Injury and Driving Assessment: An Evidence-Based Literature Review." The American Journal of Occupational Therapy. The American Occupational Therapy Assn, Inc. 2009. HighBeam Research. 29 Sep. 2009 <http://www.highbeam.com>.

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Five years ago, Andrzej Chraca, now 38, was driving south on Wright Boulevard near the intersection of South Frontage Road in the northeast Illinois town of Schaumburg.

At the same time, Steve Miles, a driver for the state's Department of Transportation, was driving eastbound on South Frontage Road, and they collided in the middle of the intersection.

Both drivers claimed that they entered the intersection on a green light and filed lawsuits against each other. The suits were consolidated at trial.
As a result of the collision, Chraca was rendered an incomplete paraplegic. He is unable to walk without leg braces and requires the use of a walker or wheelchair.

Miles suffered a cervical vertebrae fracture and partial paralysis to the right side of his body. He also suffered a mild traumatic brain injury.

In the largest verdict of its kind in the history of Cook County, Ill., Miles was left unable to walk following the 2004 crash has been awarded $24 million.

Plaintiffs' attorney Martin Healy Jr. represented Miles.

Read more J. "Illinois man awarded $24M in car crash suit." Lawyers USA. Dolan Media Company. 2009. HighBeam Research. 29 Sep. 2009 <http://www.highbeam.com>.

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"The American Association for Justice announced today it is launching what it called the first phase of a nationwide ad campaign 'to educate lawmakers about the epidemic of preventable medical errors and how tort law changes won't lower costs or cover the uninsured,'" The Boston Globe reports. "The ads, running in Washington publications and on online news sites, say the estimated 98,000 deaths from preventable medical errors is 'like two 737s crashing every day for a whole year.' But the ad concludes: 'Would we blame the passengers or the airlines?'" (Rhee, 9/22).

The New York Times also reports on medical malpractice. Economic Scene columnist David Leonhardt notes that while there is a great partisan divide on the issue, there is also "a lot of research by economists and others with no vested interest," who have drawn factual conclusions. "The direct costs of malpractice lawsuits - jury awards, settlements and the like - are such a minuscule part of health spending that they barely merit discussion, economists say. But that doesn't mean the malpractice system is working." In addition, "[t]he fear of lawsuits among doctors does seem to lead to a noticeable amount of wasteful treatment," estimated to be about "$60 billion a year or about 3 percent of overall medical spending." But researchers have also estimated that few errors lead to action: "only 2 to 3 percent of cases of medical negligence lead to a malpractice claim." The malpractice system may therefore be "expensive in all the wrong ways" (Leonhardt, 9/22).

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An article in this week's Surgery Special Issue of The Lancet reports that surgery for carpal tunnel syndrome in patients (without an indication of severe nerve damage known as denervation) provides better outcomes than non-surgical treatment. However, the clinical relevance of this difference is modest. The article is the work of Professor Jeffrey Jarvik, of the Harborview Medical Center, University of Washington, Seattle, USA, and colleagues. 
Read more here. 

 "Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial"
Jeffrey G Jarvik, Bryan A Comstock, Michel Kliot, Judith A Turner, Leighton Chan, Patrick J Heagerty, William Hollingworth, Carolyn L Kerrigan,Richard A Deyo
Lancet 2009; 374: 1074-81
The Lancet
 

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Senator Reid announces funds are on their way to Nevada. Read the whole article here.

WASHINGTON, D.C. — Following efforts by Nevada Sen. Harry Reid,Senator Max Baucus revealed his updated health insurance reform proposal with major improvements for Nevada.  The state will receive a full 100 percent match for those added pursuant to the Medicaid expansions for five years.  Furthermore, federal funding for Medicaid increases by 30 percent while Nevada will only have to increase funding 1.6 by percent.

“I thank Chairman Baucus for recognizing the unique challenges that we face in Nevada and working with me to address them,” Reid said. “I promised the people of Nevada that I wouldn’t support any health insurance reform proposal that wasn’t good for our state and I meant it. This latest proposal is a major improvement to the chairman’s original proposal.”

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Traumatic Brain Injury many times produces feelings of fatigue.  The theory is that since the brain needs to work harder after trauma to compensate for interrupted neural pathways, a feeling of tiredness results.  To make matter worse, that tiredness is also accompanied, many times by insomnia.  TBI sufferers are usually tired due to the hyper activity required to maintain previous function in addition to insomnia.

The American Academy of Sleep Medicine defines insomnia as unsatisfactory sleep that impacts daytime functioning. More than one third of adults report some degree of insomnia within any given year, and 2 to 6 percent use medications to aid sleep. Insomnia is associated with increased morbidity and mortality caused by cardiovascular disease and psychiatric disorders and has other major public health and social consequences, such as accidents and absenteeism.

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I recently posted the article entitled "10 Brainiest Cities."  To follow up the other end of the scale I now post an article by the same reporter revealing the 10 Lowest Cities.

Zach Miners, U.S. News & World Report

Find more:

Not every state in the union can be full of geniuses, right? At least that's what, at first glance, one might conclude after seeing the results of the "life'sDHA Index of Brain Health," an assessment that ranks all 50 states and the District of Columbia according to what its creators consider to be factors supporting brain health.

Washington, D.C., and nine brain-healthy states made the top 10 list. Here are the 10 lowest-ranking states: Indiana, North Dakota, South Carolina, Arkansas, Kentucky, Tennessee, Mississippi, Alabama, Oklahoma and, dead last, Louisiana.

The brain health evaluations, performed by researchers at Martek Biosciences Corp., were determined through an analysis of third-party data on the diet, physical health, mental health and social well being of the residents of each state.

Read the whole article here.

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I came across the ADDA website , www.add.org,and thought I would share it.  Many of us have or know kids or relatives with ADD.  Here is the latest newletter.

The kids are back in school and things are settling into a routine on the home front so it's time to catch up at work.  Everyone I talk to says they have too much to do and not enough hours in a day. Linda Walker's productivity tips in this month's article will come in especially handy.
 
ADDA is working hard to change public opinion and public policy concerning adults with ADHD. ADHD Awareness Day, which happened last Wednesday, September 16, is one such initiative. I hope you all had a happy ADHD Awareness Day!
 
Janet Kramer's story of Rose, a 23 year old mother who spent 18 months in prison for self-medicating her ADHD due to mandatory sentencing laws, touched many people.  Janet, an ADDA Board Member and Co-Chair of the ADDA Work Group on ADHD and Corrections, is leading the charge to prevent exactly this type of situation.
 
I'm proud to announce that along with other significant national organizations, ADDA became a signatory on a letter supporting S. 714, the National Criminal Justice Commission Act of 2009, which positively addresses issues very relevant to our members. Congratulations, Janet, the ADDA board and to you, our members. Without your support, we couldn't continue to do what we do for you.

ADDA works hard to bring you valuable services, so I'm sure you're aware of our Webinars program.  Well, there are more exciting Webinars coming up! For ADDA members only, next Wednesday, September 23, Marjorie Johnson will help us manage anger and conflict and the following Wednesday, September 30, Dr. Theresa Cerulli will explain medication management for ADHD.  On October 7, Ari Tuckman will hold a Q & A session that's open to everyone. If you've got questions, Ari's got answers!

This just in! Last Friday (September 18, 2009), Global TV in Canada aired an excellent documentary called "ADD and Loving It!" I watched it and thoroughly enjoyed it. It provided a balanced take on adult ADHD, and (politely) shot down all the usual arguments against it (bad parenting, food additives, etc.). I don't know if Global TV has any plans to air it again, or if it'll be available in the US, but it will be available for the next few days (until September 25, 2009 at http://news.globaltv.com/Loving/2009300/story.html. Enjoy!

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The brain injury toll on troops continues to manifest and escalate.  This is not new news.  Remember that better protective gear in recent wars means soldiers are staying alive after what would otherwise have been fatal injuries in previous wars.  This, in turn, leads to survival with brain injury.

The Daily News from New York wrote this about the tragedy.

 Afghanistan - It's the signature injury of the war, and the medics at this base just south of Kabul have seen their fair share of it.

It's estimated that 20% of soldiers in Iraq and Afghanistan have been diagnosed with traumatic brain injury, or TBI, caused by the impact of improvised explosive devices.

The medics of the upstate Fort Drum-based 10th Mountain Division, 3rd Brigade Combat Team have seen an increase in TBI cases in the past eight months here.

Read more: http://www.nydailynews.com/news/world/2009/09/20/2009-09-20_brain_injury_from_blasts_take_a_toll.html#ixzz0RqnJwdNu
 

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A new study ranks the 'brain health' of all 50 states, with a heavy emphasis on a healthful omega-3 fat.   Zach Miners, U.S. News & World Report.  Omega-3 is very good for brain behavior and health.

If you sometimes find it difficult to concentrate or experience the occasional "senior moment," don't be too hard on yourself. It might just be the state you live in.

To raise awareness about the state of the nation's "brain health" and to encourage people to take action toward improving their own brain function, researchers released an index that purports to rank the "brain smarts" of all 50 states and the District of Columbia.

 Read the entire article here.

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 Study Finds Paralysis is Far More Common than Previously Documented

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I found this fascinating quote today:

An injectable hydrogel could aid recovery from brain injury by helping stimulate tissue growth at the site of the wound, researchers say. Research on rats suggests the gel, made from synthetic and natural sources, may spur growth of stem cells in the brain (…)stem-cells-news.com, “Latest Stem Cells News”, Sep 2009

You should read the whole article.

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Phil Collins says he will never play drums again due to a back injury.  TOM BRYANT Reports from the London Mirror.

The Genesis star says he can no longer even hold his drum sticks because sitting at a kit is too painful.

Phil, 58, said: "I've got a condition that means I can't play any more. After playing drums for 50 years, I've had to stop.

"Obviously I'm very sad about it. My vertebrae has been crushing my spinal cord because of the position I drum in.

"It comes from years of playing. I can't even hold the sticks properly without it being painful.

"I even used to tape the sticks to my hands to get through.

But don't worry, I can still sing."

The news will be heartbreaking for Phil's millions of fans worldwide.

A friend said: "He is devastated as drumming is everything to him. It's how he made his name and it set him on the road to superstardom.

"But drumming has been getting more and more painful and he decided enough was enough and called it a day. He has to put his health first."

Phil, who has sold more than 150 millions albums, was speaking at a garden party on Tuesday in aid of the Prince's Trust.

He is a celebrity ambassador for the charity and Prince Charles and Camilla invited Phil to the reception at their Highgrove home near Tetbury, Glos.

Phil first found stardom as the drummer in 70s prog rock favourites Genesis after answering an advert in the music paper Melody Maker He initially only did backing vocals but took over the microphone when lead singer Peter Gabriel left in 1975.

A Trick Of The Tail, the group's first album featuring Collins on lead vocals, entered the charts at No.3.

He subsequently launched a solo career as well and his first album Face Value went to No.1.

It was followed by a string of hit singles such as In The Air Tonight and You Can't Hurry Love.

Phil, who was a child actor, also starred in the 1988 movie Buster. In 1996 he announced was leaving Genesis after 26 years. He recently won a new generation of fans with a Cadbury's advert featuring a gorilla drumming along to In The Air Tonight. It became an instant YouTube classic generating millions of hits and a chart re-release reached No.14.
 

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 The belief that healthy older brains are substantially smaller than younger brains may stem from studies that did not screen out people whose undetected, slowly developing brain disease was killing off cells in key areas, according to new research. As a result, previous findings may have overestimated atrophy and underestimated normal size for the older brain.
 

The seeming age-related atrophy in gray matter more likely reflected pathological changes in the brain that underlie significant cognitive decline than aging itself, the authors wrote. As long as people stay cognitively healthy, the researchers believe that the gray matter of areas supporting cognition might not shrink much at all.

"The Prevalence of Cortical Gray Matter Atrophy May Be Overestimated In the Healthy Aging Brain,"
Saartje Burgmans, PhD student, Martin P. J. van Boxtel, PhD, MD, Eric F. P. M. Vuurman, PhD, Floortje Smeets, PhD student, and Ed H. B. M. Gronenschild, PhD, Maastricht University; Harry B. M. Uylings, PhD, Maastricht University and VU University Medical Center Amsterdam; and Jelle Jolles, PhD, Maastricht University;
Neuropsychology, Vol. 23, No. 5.
 

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This great information is made available by the

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BHR Pharma has recently announced plans for a study to begin in early 2010. The study will be a multi-clinic trial to test the power and effectiveness of BHR-100, an intravenous progesterone infusion product, as an outcome-enhancing treatment option for patients with severe traumatic brain injury.

Currently, there are no FDA approved medications for use in improving the outcome for those suffering with traumatic brain injuries. The BHR Pharma study, if successful, will lead to the production and dissemination of the BHR-100 progesterone product as a neuroprotective substance for treating traumatic brain injury.

The study will span over 100 clinics in the U.S., Europe, Israel, and elsewhere about the globe, and will treat over 1200 traumatic brain injury patients. BHR-100 will be administered for 5 days to randomly selected patients with “severe closed head trauma” type traumatic brain injuries. BHR-100, unlike previous progesterone infusions, has been tailored to meet all U.S. Food and Drug Administration requirements for approval for use in humans.

BHR Pharma is cooperating with the American Brain Injury Consortium (ABIC) and the European Brain Injury Consortium (EBIC) to locate trial clinics and to help with the final design of the study. BHR has hired PRA International as a Contract Research Organization to assist in conducting the massive trial.

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Advance in neuroimaging are always exciting as they assist doctors and clinicians in treating patients with traumatic brain injury. 

Functional magnetic resonance imaging (fMRI) is a technique widely used in studying the human brain. However, it has long been unclear exactly how fMRI signals are generated at brain cell level. This information is crucially important to interpreting these imaging signals. Scientists from the Academy of Finland's Neuroscience Research Programme (NEURO) have discovered that astrocytes, support cells in brain tissue, play a key role in the generation of fMRI signals.

Functional magnetic imaging has become a highly popular method in basic neurobiological research, psychology, medicine as well as in areas of study that interface with the social sciences and economics, such as neuroeconomics. fMRI imaging does not directly measure the activity of nerve cells or neural networks, but local changes in cerebrovascular circulation during the execution of certain functions. Interpretation of the measurement data obtained with this method therefore requires a close knowledge of the cell-level mechanisms that are responsible for these local changes in cerebrovascular circulation.
 

Read morehere.

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The Brain Injury Association of America asks me to pass this update on.

*BIAA would like to take a moment to remember Senator Ted Kennedy and the profound influence he had on the brain injury community, by acting as the sponsor and champion of the TBI Act for many years. He will be missed.

Health Care Reform Update

President Obama made it clear Wednesday evening in a joint session speech that he is demanding health care reform action this year. With the spark given by the President's address, Democrats are enthusiastically working to find a way past their differences over such issues as inclusion of a public insurance option.

This week, the Senate Finance Committee released an outline of their proposal that is set to be made public next week. BIAA has some concerns about the proposal and is contacting members of the committee to ensure comprehensive coverage in the full proposal. The Committee plans to mark up a bill the week of Sept. 21, 2009.

The House may vote on its bill in the coming weeks, though debate continues over what kind of public option it will contain.

Stay tuned for action alerts as legislation progresses!

Brain Injury Survivor Advocacy Program

In August, BIAA launched a pilot program dedicated to encouraging area brain injury survivors to become more effective self-advocates. The program included identifying likely targets, making appointments, participating in a day of meetings in Capitol Hill, and following up and maintaining relationships with Congressional staffters.

Due to the success of the program, BIAA will continue to offer the opportunity on a quarterly basis to survivors who would like to learn more about advocacy. Space is limited, so if you would like to participate and you live in the Washington, DC area, please send me an email so that I can begin assembling the next advocacy group.

Appropriations Update

With energy legislation delayed and the future of a health care overhaul uncertain, Senate appropriators will try to take advantage of a window of opportunity to pass and clear as many spending bills as possible in September. (CQ)

If Congress is unable complete all 12 fiscal 2010 bills before the next fiscal year begins Oct. 1, 2009, lawmakers will have to pass a continuing resolution later this month to keep money flowing to the government.
 

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 New research published this month in the journal Injury finds that while fatal cervical spine injuries to children in motor vehicle crashes are rare, they are more commonly seen in girls, in children who were restrained in passenger restraints, and in children who also suffered traumatic brain injury due to the crash (see also Pediatrics).

Researchers from The Children's Hospital of Philadelphia, The University of Pennsylvania and Ohio State University Medical Center studied 6,065 children younger than 16 years old and found that only 2.9% of the fatalities involved a cervical spine injury.

This study represents the first time a research team has used a linked version of two previously independent data sets from the Centers for Disease Control (CDC) and the National Highway Transportation Safety Administration (NHTSA) to enable in-depth analysis of the relationship between crash characteristics such as speed or vehicle type, and type of injury (including CSI) for fatally injured children. The two large national mortality databases used were the Fatality Analysis Reporting System (FARS) and Multiple Cause-of-Death (MCOD) datasets.

 Read the entire article: "Research Consortium Advances Understanding of Cervical Spine Injuries in Children Involved in Motor Vehicle Crashes.(Report)." Health & Medicine Week. NewsRX. 2009. HighBeam Research. 11 Sep. 2009 <http://www.highbeam.com>.

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The sad fact is that most attorneys, even those holding themselves out as "personal injury" lawyers, do not have the skill or knowledge to appreciate and handle traumatic brain injury cases.

The good news is that as neuroscience and neurolaw advance, many more attorneys are getting education they need to handle these matters.  This is due, in large part, to the work of the Brain Injury Association of America, North American Brain Injury Society, state and other organizations holding continuing education conferences.

I came across an interesting article that had this to say:

An increasing number of Attorneys specializing in Traumatic Brain Injury arising out of motor vehicle accidents, slip and falls, closed head trauma, and blunt head trauma are becoming aware of the concurrent hormonal deficiencies that impede rehabilitation by their affect on psychological, physiological, and physical functioning (see also Heart Attack).

Many are receiving additional training in the area of Interventional Endocrinology to give them the advantage of understanding that head trauma has a two-phase insult on the body. The first: an acute phase, is associated with the gross manifestations of the injury (loss of consciousness, amnesia, cognitive impairment, fatigue, mood changes, and structural damage to the brain) and a second: the delayed phase, leading to progressive loss of one or more hormones within 3 months of the injury. Many times, the first phase is so subtle that the recognition of the second phase is significantly delayed or ignored.

The trauma can be mild, moderate, or severe and still cause the brain's ability to regulate important, life-maintaining, hormones to fail.

Read more here.

So lets keep up the good work!

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Science Daily reports that researchers published in the current issue of the journal Brain Injury, results that demonstrate when boxers are punched in the head repeatedly, harmful processes are set in motion, which continue long after the initial injuries took place. Earlier research by the same team of scientists showed heightened levels of brain injury markers in the spinal fluid of boxers, further demonstrating the potential for serious injury that fighters may not be fully aware of.

Doctors and scientists have expressed concern that boxers and children who aspire to boxing and martial arts may not be fully informed about the serious risk of long-term chronic brain injury from taking multiple traumatic punches and kicks to the head.

Read more here.

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