Brain and Spine Injury Law Blog : Brain and Spine Injury Lawyer & Attorney : Tim Titolo Law Office : Personal Injury & Wrongful Death : Car, Truck, and Motorcycle Accident: Las Vegas, Nevada

Interesting defense tactics to attribute signs, symptoms and consequences of brain injury to drug or alcohol use and abuse, are often encountered.  Here is one such story.

A jury has awarded $13 million to a New York transit worker who fell 30 feet from a platform while repairing rail on an elevated track.

Although the city tried to argue that the plaintiff should have been hooked to a safety line, he won summary judgment on liability and the trial was on damages only, said Lawrence Biondi of Lawrence P. Biondi Law Firm in White Plains, N.Y., who represented the plaintiff.

At trial, the city also argued that evidence of brain damage was attributed to the plaintiffs' history of drug and alcohol abuse.

But Biondi said this strategy rang hollow with the jury.

"They went heavy on that. Every witness got on the stand and the whole trial was drugs and alcohol, but I think it backfired," said Biondi.

The defense attorney, Joseph F. Sullivan of Sullivan & Brill in New York, N.Y., did not return a call to his office seeking comment.
 

Read the full article at Sylvia Hsieh. "Supreme Court of New York awards transit worker $13M for fall from platform." Lawyers USA. Dolan Media Company MN. 2009.

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The Brain Injury Assocation has posted the folllowing Legislative Update:

Brain Injury Association of America
Policy Corner E-Newsletter -- June 26, 2009
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________

In This Issue:
Health Care Reform Update
SLI Announces Military Brain Donor Registry
_____________________________________________________________________

The Policy Corner is made possible by the Centre for Neuro Skills, James F. Humphreys and Associates, and Lakeview Healthcare Systems, Inc.  Brain Injury Association of America gratefully acknowledges their support for legislative action.
_____________________________________________________________________

Health Care Reform Update

This week Congress leaves for the July 4th recess in the midst of the Heath Care Reform debate.  At this time, both the Senate and the House of Representatives is engaging in talks over draft proposals with the hopes of bringing one collective measure to a final vote this fall.  BIAA will continue to monitor the situation closely and advocate for the provisions essential to the brain injury community.

Senate Finance Committee

The Senate Finance Committee, whose members have been negotiating a bipartisan proposal behind the scenes this week left Thursday for the July Fourth recess without a deal, although Senate Finance Chairman Max Baucus said he has developed policy to pay for legislation that would cost less than $1 trillion over 10 years.

According to Congressional Quarterly, Baucus said the bill's cost would be offset, in part, by taxing some employer-sponsored health benefits, something that makes the White House and many lawmakers in both parties uneasy. Nonetheless, limiting the bill's spending to $1 trillion is a significant step for the Finance Committee, which has been seen as the main arena for those hoping to get a bipartisan health care bill.

Senate Health, Education, Labor and Pensions Committee (HELP)

This week, the Senate HELP committee continued to mark up a draft health care overhaul bill drafted by its chairman, Sen. Edward Kennedy.

On Wednesday, the HELP committee adopted 20 amendments to the bill that were considered noncontroversial. The amendments were adopted by voice vote.

Sen. Christopher Dodd, who is leading the markup while Kennedy is being treated for brain cancer at home in Massachusetts, said the committee has adopted 240 amendments to the bill thus far.

House Tri-Committee Proposal (Committee on Energy and Commerce, Committee on Education and Labor, Ways and Means Committee)

This week, the House began debating their draft Health Care Reform bill that was developed by the chairmen of the three committees of jurisdiction.

Both the Energy and Commerce and Education and Labor committees held public hearings on the measure Tuesday. The hearings covered the gamut of health policy issues under debate in Congress at the moment, including the merits of creating a government-run insurance plan to compete with private insurers, how to finance an overhaul and how to protect doctor-patient relationships.

Importantly, the draft bill includes Rehabilitative services as part of the minimum benefits package and does not impose annual or lifetime limits on coverage. 


BIAA Supports the Sports Legacy Institute's Brain Donor Registry for Military Veterans

Leading medical experts at the Sports Legacy Institute (SLI), a nonprofit educational and research organization dedicated to advancing understanding of the long-term effects of brain trauma, announced Tuesday, June 23, 2009, that they have launched the SLI Military Living Donor Registry, a brain and spinal cord donation registry for active and veteran members of the United States military.

In conjunction with The Boston University Center, the Sports Legacy Institute will compare findings from the brains of military personnel with those from their athlete program, which has signed up more than 120 donors in less than a year, and other brain banks around the world.

Col. Michael S. Jaffee, national director of the Defense and Veterans Brain Injury Center, said the Defense Department supported the spirit of the research and could assist in approaching active and retired soldiers to register for brain donation.

BIAA enthusiastically supports this initiative and will continue to advocate on its behalf.  For further reading, click on the link below to view the New York Times article:  (The official press release will be available shortly on BIAA's web site:  www.biausa.org )

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Signs honoring a state trooper who was seriously injured by a drunken driver has been dedicated at a highway interchange on Cape Cod where she directed rush hour traffic for years.

Ellen Engelhardt sustained a severe brain injury in 2003 when a car driven by an 18-year-old Wayland man slammed into the back of her cruiser in the breakdown lane of Route 25. She remains confined to a special care facility in Middleborough.

The plaques bearing Engelhardt's name were unveiled Tuesday at Exit 7 off the mid-Cape highway in Yarmouth, where the trooper was a fixture directing morning traffic. The honor is a rare one for living police officers.
 

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While I have seen the uses and acceptance of PET in traumatic brain injury cases in the court room, this is something worth sharing on other uses of PET:

PET scans are commonly used to investigate the following conditions:
Epilepsy - it can reveal which part of the patient's brain is being affected by epilepsy. This helps doctors decide on the most suitable treatments.MRI and/or CT scans are recommended for people after a first seizure, this study explains.

Alzheimer's disease - it is very useful in helping the doctor diagnose Alzheimer's disease. A PET scan that measures uptake of sugar in the brain significantly improves the accuracy of diagnosing a type of dementia often mistaken for Alzheimer's disease, a study revealed.

Interesting related articles:

What is MRI? How does MRI work?

What is a CT scan? What is a CAT scan?
Cancer - PET scans can show up a cancer, reveal the stage of the cancer, show whether the cancer has spread, help doctors decide on the most appropriate cancer treatment, and give doctors an indication on the effectiveness of ongoing chemotherapy. A PET scan several weeks after starting radiation treatment for lung cancer can indicate whether the tumor will respond to the treatment, a study showed. This article looks at whether PET scans are beneficial during cancer diagnosis, staging and monitoring.

Heart disease - a PET scan helps detect which specific parts of the heart have been damaged or scarred. Any faults in the working of the heart are more likely to be revealed with the help of a PET scan. A study revealed how comprehensive diagnosis of heart disease based on a single CT scan is possible.

Medical research - researchers, especially those involved in how the brain functions get a great deal of vital data from PET scans.

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A 7-year-old Draper boy has died in an all-terrain vehicle crash at a family farm in southern Utah.

Landon Woodbury's father, Spencer Woodbury, says the boy and his 12-year-old sister were riding on ATVs at the farm near Monticello on Wednesday when the boy approached a dump truck that was carrying gravel.

The San Juan County sheriff's office says Landon Woodbury slammed into it and was thrown headfirst into the vehicle.

Landon Woodbury, who was wearing a helmet, sustained serious brain injuries and died on Thursday after being transferred to Primary Children's Medical Center in Salt Lake City.

San Juan County Sheriff Mike Lacy says rain and speed may have contributed to the accident, which is under investigation.
 

Read the full story by clicking here http://www.sltrib.com/

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Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. Recent data shows that, on average, approximately 1.4 million people sustain a traumatic brain injury annually.

A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury. The majority of TBIs that occur each year are concussions or other forms of mild TBI.

CDC’s research and programs work to prevent TBI and help people better recognize, respond, and recover if a TBI occurs.
 

 

Go to the CDC (Centers for Disease Control) to access the following facts sheets.  Click here.

 

Concussion in Sports
An estimated 1.6 to 3.8 million sports- and recreation-related concussions occur in the United States each year. This fact sheet provides an overview of concussion in sports and recreation and steps to take to help prevent these injuries.


Facts about Traumatic Brain Injury
This fact sheet was developed by CDC in collaboration with ten national organizations. It contains up-to-date information about the incidence, causes, risk factors, and cost associated with TBI in the United States.


Facts about Traumatic Brain Injury (Spanish) Datos sobre lesiones traumáticas del cerebro
Esta hoja informativa contiene la información más reciente sobre incidencia, causas, factores de riesgo y costos relacionados con lesiones traumáticas del cerebro.


Traumatic Brain Injury: A Guide for Criminal Justice Professionals
This guide provides an overview of TBI, information on the extent of TBI and related problems within the criminal justice system, and how these problem can be addressed.




Traumatic Brain Injury in Prisons and Jails: An Unrecognized Problem
This guide provides information for TBI professionals about what is known about individuals with TBI in prisons and jails, how TBI-related problems affect them and others while they are incarcerated, and what is needed to address these problems.


Victimization of Persons with Traumatic Brain Injury or Other Disabilities: A Fact Sheet for Professionals
This fact sheet was developed for professionals and provides an overview of the topic of victimization of persons with TBI or other disabilities.



Victimization of Persons with Traumatic Brain Injury or Other Disabilities: A Fact Sheet for Friends and Families
This fact sheet provides a general overview of victimization and risks to people with TBI or other disabilities.



 

 

* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

 

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A Massachusettes man is charged with shaking his girlfriend's 10-month old baby to death.

Authorities say the boy died at Hasbro Children's Hospital in Providence after being diagnosed with diffuse brain edema and bilateral retinal hemorrhaging, both symptoms of shaken baby syndrome.

Police said Lopez was the only adult present at the apartment when the baby suffered extensive injuries. The baby's mother was working.
 

Heartbreaking.

Reported at http://www.southcoasttoday.com/

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Dr. Baxter writes in response to my post on getting immediate care in brain injury:

Just last month I witnessed an 83 year old woman stumble and fall on her face. She wanted to go, but I kept her there, administered first aid and called paramedics. By the time she was strapped down to the back board in readiness to transport her (against her will) to the hospital, she began acting very combative. Combativeness in a victim of head trauma is a very strong sign that brain injury was sustained. You just can't tell immediately after the trauma. It is always best to take the proper precautions.

Recently, progesterone therapy has been found to have very potent anti-inflammatory effects on the brains of people that have suffered traumatic brain injury, thereby lessening the severity of the injury. This is just further evidence that there are many reasons why we all need to do all we can to promote hormone balance in ourselves and others.

Thank you for the comment.

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My friend and collegue, Sherry Stock, sent me this message.  Sherry is the mover and shaker at the Brain Injury Association of Oregon.  I have helped her and the Association in the past and encourage anyone willing to do the same.

We need your help right now-this morning—Get this out to your email list and friends-we need help right now
Call:
Senator Courtney (503-986-1600)
Senator Richard Devlin (503-986-1719)
Senator Margaret Carter (503-986-1722)

The Facts

RE: HB 2413

HB2413 only affects those who are breaking the law-not the general public.

HB2413 has passed both the House Human Services Committee and by House Revenue, which gave it a do-pass vote. The bill has never had any opposition from any group or lobbyist for any group.

BIAOR contacted public safety groups and asked if they had a position on HB 2413. The following groups stated that they either did not oppose or remained neutral on the $2 additional assessment on moving traffic violations or sent a letter of support.

Multnomah County Sherriff’s Office (sent letter of support)
Portland Police Association, Scott Westerman, President
Oregon Council of Police Associations
Oregon State Sheriff’s Association
Oregon District Attorneys Association

Important Facts:

Ÿ Each year, approximately 20,000 people in Oregon sustain a Traumatic Brain Injury (TBI). (This and all other statistics – unless noted otherwise – are estimates using statistics for TBI from the Center for Disease Control and Prevention.)

Ÿ More than 670 people in Oregon die every year as a result of TBI. The main causes of TBI deaths in Oregon are motor vehicle crashes.

Ÿ 32% of all TBIs that required hospitalization in 2006 were the result of motor vehicle accidents. (“Injury In Oregon, 2008” OR Department of Human Services)

Ÿ Nearly 20% of Oregon’s survivors with TBI will have a moderate to severe injury requiring assistance for the rest of their lives - 49% of these are from motor vehicle accidents.

Ÿ Blasts are the leading cause of TBI for active duty military personnel in war zones, including the Oregon National Guard– 320,000 nationally and an estimated 3500 Oregon National Guard.

 

Sherry Stock, MS CBIS
Executive Director
Brain Injury Association of Oregon
2145 NW Overton St, Portland OR 97210

Mailing Address:
PO Box 549
Molalla OR 97038

503.740.3155 800-544-5243 fax: 503.961-8730

biaor@biaoregon.org
sherry@biaoregon.org
http://www.biaoregon.org

IRS 501(c)(3) organization
Affiliated with the Brain Injury Association of America
Tax ID: 93-0900797

Only a life lived for others is a life worthwhile.
--Albert Einstein

 

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I found an article by Dennis Thompson, HealthDay Reporter, entitled "For Every Blow to the Head, Quick Action Is Urged; Symptoms may not be noticeable, but fatal brain damage can occur." Consumer Health News (English). HealthDay. 2009.   In it Mr. Thompson interviews Dr. O'Shanick, a neuropsychiatrist in Virginia who also heads the Brain Injury Association of America.  I have worked with Dr. O'Shanick on cases and present this article here to assist in making the point that delays in treatment in cases of traumatic brain injury can have devastating impact.

Gregory O'Shanick has been the Medical Director of the Center for Neurorehabilitation Services in Midlothian, Virginia since 1991. After attending Ohio State University, he entered the University of Texas Medical Branch at Galveston and graduated in 1977. His post-graduate studies were at Duke University Medical Center. His academic career includes faculty appointments at University of Texas Health Science Center at Houston, Medical College of Virginia and most recently, in the Department of Neurological Surgery at the University of Virginia. He has authored more than 100 publications, including editing or co-editing three textbooks. As a result of his international reputation in neuropsychiatry and neurorehabilitation, he was asked to be the first National Medical Director of BIAA in 1996, a post he still holds.

Dr. O'Shanick is a member of the American Neuropsychiatric Association, the American Academy of Neurology, the American Society of Neurorehabilitation and a Fellow of the American Psychiatric Association. He has previously chaired a panel developing evidence-based guidelines for the evaluation of mild traumatic brain injury.
The tragic death of actress Natasha Richardson in March riveted people's attention to the issue of brain injury and raised important questions about what to do if this happens to you or a loved one.

Richardson died hours after taking a minor fall while skiing at a Quebec resort. She picked herself up from the fall and refused medical attention, but three hours later in her hotel room, she complained of a headache. Within hours she was in critical condition. Two days after the fall, she died.

"Even when someone looks fine initially, it can still have devastating consequences," said Dr. Greg O'Shanick, national medical director for the Brain Injury Association of America. "The critical issue is that you don't have to lose consciousness to sustain a significant brain injury," he explained.

"In this case, Richardson had what's called an epidural hematoma," O'Shanick continued. "There's an artery that runs right underneath the skull, and the skull on the temple is very thin. You can break the bone, the bone cuts the artery and a high-pressure blood clot forms. That then squeezes the brain."

Richardson's death, though, is known to have saved at least one life. An Ohio couple whose 7-year-old daughter had been struck in the temple two days earlier by a baseball hit by her dad rushed the girl to a doctor after watching a news report on Richardson, according to published reports.

It turned out she was suffering from the same condition as Richardson. Her parents' quick action was credited with saving the little girl's life.

More than 1.4 million people suffer a traumatic brain injury each year in the United States, according to the Brain Injury Association of America. Most are treated and released from an emergency department, but 235,000 are hospitalized and 50,000 die.

Dr. Rade Vukmir, an emergency department physician, clinical professor of emergency medicine at the University of Pittsburgh and a spokesman for the American College of Emergency Physicians, credits media coverage of Richardson's accident and death with making people more aware of potential brain injuries.

However, Vukmir said, it's still too early to tell if that awareness has translated into more people coming to emergency departments worried about head injuries.

O'Shanick said his organization received many phone calls and Web site hits in the days after Richardson's injury. "They wanted to find out a lot about the basics of head injury, prevention issues, how much of a hit does it take to create that kind of injury," he said.

People seem to have a good understanding of the basics of head injuries, Vukmir said: "Most people who pass out know to come in. Most people who vomit know to come in."

But the real problem, illustrated by the cases of both Richardson and the Ohio girl, is that potentially fatal brain injuries don't always produce severe or noticeable symptoms.

Nonetheless, certain steps should be taken to ensure that someone who's taken a blow to the head will be all right. They include:

Stay with the person. "If there's a question of what's going on, don't let the person be by themselves," O'Shanick said. "Make sure there's a person in attendance, watching over them. If you see someone once and they go off to their hotel room, unless there's someone there watching, no one's going to know about any changes in behavior. You really do need to make sure there's someone watching."

Watch for behavior changes. If the person becomes suddenly drowsy, irritable or confused, acts in a drunken manner, begins repeating statements or has trouble walking or speaking, get the person to an emergency room immediately for treatment, O'Shanick said.

Be particularly cautious with high-risk groups. The very young, the very old, people on blood thinners and anyone who's intoxicated are at increased risk for brain injury and should be given special attention if an injury is suspected, Vukmir said.

Of course, there's no reason at all to maintain a wait-and-see attitude, he added.

"We encourage patients to present themselves if they have any questions about their head injury," Vukmir said. "Call a health care professional or present yourself for emergency care so we can ask the questions and sift through the information."
 

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While I do not expect this event to be picked up in the local paper, I am reporting that Traumatic Brain Injury and Death are real and all around us.

Last night as I, my wife, and children were watching television before bed we saw siren lights in front of our home.  Several neighbors had gathered around a firetruck and police cars.

We live in a gated community adjacent to a park.  Apparently some young boys aged 12 to 17, two of whom were brothers, were hopping the wall from the park into the neighborhood.  One fell to the concrete walkway on his head.  Another ran to the guard gate to get help explaining that his friend fell.  The boy gave the guard his home address which caused first responders to go to the wrong location.  When they finally figured out the correct location and arrived to assist, the boy was not moving.  His brother was found leaning over his motionless brother.  He was dead.

Who knows if the death could have been avoided had first responders not been sidetracked to the wrong location?  Whether the delay contributed to the death? It may have.  But the stark reality of how quickly and easily life can be taken was made startling real for my young daughters, wife and me.

 

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Brain Werner of the Balance Institue shared a "Great review of BPPV" from an article in Otolaryngology - Head and Neck Surgery (2008) 139, S47-S81.  He states " This is very common post mTBI and commonly missed."

A primary complaint of dizziness accounts for 5.6 million clinic visits in the United States per year, and between 17 and 42 percent of patients with vertigo ultimately receive a diagnosis of benign paroxysmal positional vertigo (BPPV).1-3 BPPV is a form of positional vertigo.
 

● Positional vertigo is defined as a spinning sensation produced
by changes in head position relative to gravity.
● Benign paroxysmal positional vertigo is defined as a
disorder of the inner ear characterized by repeated episodes
of positional vertigo.
 

Traditionally, the terms benign and paroxysmal have been used to characterize this particular form of positional vertigo. In this context, the descriptor benign historically implies that BPPV was a form of positional vertigo not due to any serious CNS disorder and that the overall prognosis for recovery was favorable.4 However, undiagnosed and untreated BPPV may not have “benign” functional, health, and quality-of-life impacts. The term paroxysmal in this context describes the rapid and sudden onset of the vertigo associated with an episode of BPPV. BPPV has also been termed benign positional vertigo, paroxysmal positional vertigo, positional vertigo, benign paroxysmal nystagmus, and paroxysmal positional nystagmus. In this guideline, the panel chose to retain the terminology of BPPV because it is the most common terminology encountered in the literature
and in clinical practice.
 

The Balance Institute sees patients for among other things:

•Adolescent balance disorders
•Amputee rehabilitation
•Aviation medicine
•Cerebral vascular
•Chemical toxicity
•Chronic mobility disorders
•Dizziness/Dysequilibrium
•Fall risk identification, prevention and management
•Head injuries/Concussion
•Movement disorders
•Neurogenerative diseases
•Pharmacological/Ototoxicity
•Spinal Cord Injury
•Sports medicine (performance enhancement)
•Vestibular disorders (e.g., BBPV)
•Worker's compensation/Legal 

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88 Plan

Named for Pro Football Hall of Famer and NFL legend John Mackey who wore jersey number 88 for the Baltimore Colts, the 88 Plan is the first program of its kind in this country. The 88 Plan provides retired players up to $88,000 per year for medical and custodial care resulting from dementia, including Alzheimer’s and Parkinson’s. Funding for dementia research is also being provided. Almost $3 million has been distributed to suffering players and their families through this benefit. 

The NFL Care plan includes disability, assisted living, joint repacement, spine treatment and prescrinption drug benefit.

 Read the full article here. 

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Carl,

Thank you for your comment on helmet laws. For those of you who have not seen Carl’s comment I am reprinting it here.

Could someone please help a concerned father out and point me in the direction of skateboarding helmet laws in Las Vegas. I have a teenage daughter who has a new friend who enjoys skating. I encourage Molly to try new things, with in reason. She's a good kid asking Mom and I if this new venture would be alright. Mom and I did share our concerns which came off unsupportive to our teen. In truth the girl does get 99% of all she asks for and will be getting her board too. Which will soon be sitting next to her bikes, in-line skates, and scooter in 3months, I'm OK with that! I just figure if I know and understand the laws surrounding this activity I can better help mom feel better about it as well. And we all can be clear on what is safe responsible ridding. Both by law and as concerned parents!

Thanks for whatever help can be offered...
Carl Foster!

I found this web site dealing with the status of laws in the country. http://www.iihs.org/laws/HelmetUseCurrent.aspx#NV

 Nevada has no law regarding bicycles and helmets.
 

I have 3 young girls and share your concern about the potential injury from riding on “wheelies” skateboards and the like. My suggestion would be to press hard on educating your daughter on what injury to the head and brain can do and how easily it can happen from a skateboard accident.

Talk about the recent actress, Natasha Richardson’s, Skiing accident. http://www.guardian.co.uk/culture/2009/mar/19/need-for-ski-helmets

Here are more sites you mind helpful. http://www.cpsc.gov/cpscpub/pubs/349.pdf http://www.neuroskills.com/tbi/cdcbikemenu.shtml

Good luck and best of health

Tim
 

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The cause of intracranial bleeding (hemorrhage) is an injury to the head, often as a result of an automobile or motorcycle accident or a seemingly trivial event, such as bumping your head. Mild head trauma is more likely to cause a hematoma if you're an older adult. There may be no open wound, bruise or other outward sign.

 

 

Although head injuries can be minor, an intracranial hematoma is a serious and possibly life-threatening condition that often requires immediate treatment.Your brain floats within your skull, surrounded by fluid that cushions it from the bounces of everyday movement. But the fluid may not be able to absorb the force of a sudden blow or a quick stop. In these situations, your brain may slide forcefully against the inner wall of your skull and become bruised.

 

 

An intracranial hematoma occurs when a blood vessel ruptures within your brain or between your skull and your brain. The collection of blood (hematoma) compresses your brain tissue.

 

Signs and symptoms of an intracranial hematoma may occur from immediately to several weeks or longer after a blow to your head. As time progresses, pressure on your brain increases, producing some or all of the following signs and symptoms:

■Headache
■Nausea
■Vomiting
■Drowsiness
■Dizziness
■Confusion
■Slurred speech or loss of ability to speak
■Pupils of unequal size
■Weakness in limbs on one side of your body

The Mayo Clinic publishes a very useful site for information on brain injury.  I selected a few interesting excerpts and you can access the site by clicking http://www.mayoclinic.com/health/intracranial-hematoma/DS00330.

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An FDA drug, rapamycin, has been found to help prevent forms of epilepsy caused by brain injury.  Epilepsy risks increase with the incident of brain injury.

"We hope to shift the focus from stopping seizures to preventing the brain abnormalities that cause seizures in the first place, and our results in the animal models so far have been encouraging," Dr. Michael Wong, senior author of the research, said

The study that included postdoctoral fellow Ling-Hui Zeng appears in the May 27 issue of The Journal of Neuroscience.

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A tremendously important story has gone virtually untold by the media, ignored by our political leaders and unknown to the American public. Despite the extraordinarily high price they have paid, America's severely wounded veterans are enduring humiliating financial hardships of epic proportions. Home evictions, utility shutoffs, car repossessions and foreclosures are commonplace.

Spouses have to give up their jobs to become caregivers, cutting family incomes by up to 50 percent or more. Most disabled vets receive much less in compensation and benefits than they did while on active duty, reducing incomes even further. Many are too dysfunctional to hold a meaningful job, if any, because of the devastating effects of post-traumatic stress syndrome (PTSD) and traumatic brain injury (TBI). 
 

Rick Amato of the Washington Press.  Rick Amato is a radio talk-show host in San Diego and with Washington Times Radio News. Amato Strategic Communications provides consulting services to nonprofit organizations, including veterans causes.
 

There is a great deal of information out there on PTSD and the military, and this may largely be due to the origins of the PTSD diagnosis.

Post traumatic stress disorder (PTSD) can be considered a "young" diagnosis. It was not until 1980 that the diagnosis of PTSD as we know it today came to be. However, throughout history, people have recognized that exposure to combat situations can have a profound negative impact on the minds and bodies of those involved in these situations.

In fact, the diagnosis of PTSD originates from observations of the effect of combat on soldiers. The grouping of symptoms that we now refer to as PTSD has previously been described in the past as "combat fatigue," "shell shock," or "war neurosis."

It is not surprising that high rates of PTSD have been found among soldiers from World War II, the Vietnam War, the Persian Gulf War, and the war in Iraq.

 Rick's perspectives include getting congress to put soldier and veterans disability right to top of the stimulus packages being authorized of late.  He quotes President Reagan "Until our politicians feel the heat, they won't see the light."

Read the whole article  in the Washington Press including a specific case of a military couple struggling to endure.

 

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The risks and prognosis of those who suffer brain injury go on well after the time of injury.  Here is a story about a woman's sister being abused 15 years after brain injury.  The sad reality of what can happen is seen here.

A Carson City woman is scheduled to stand trial in June on a misdemeanor battery charge while authorities continue to investigate felony abuse allegations in the death of her disabled sister.

A home health nurse reported allegedly seeing Patricia VonDracek, 50, slap and punch her disabled sister, 55-year-old Sandra VonDracek in April.

According to police reports, sheriff's Deputy Josh Stagliano said Patricia VonDracek denied hitting her sister, but Sandra, who has a brain injury from a traffic accident 15 years ago, said Patricia hit her often.

Stagliano called paramedics and had Sandra VonDracek, a Navy veteran, taken to the hospital. It was his understanding, according to police reports, that hospital staff would attempt to get her placed into the Veteran's Hospital in Reno and she would not be returned to her sister's care.

Based on the witness and victim's statements, Stagliano submitted a report to the District Attorney's office for a warrant.

On May 21, records show Stagliano and another deputy went to VonDracek's home to serve the arrest warrant. While there, Patricia told them her sister had been returned to her home and died May 15 while sitting in a recliner in the living room.

Stagliano arrested Patricia VonDracek on a single charge of domestic battery and she was jailed on $15,000 bail. He then contacted detectives.

"He was extremely concerned and asked me to look into it," Carson City sheriff's Detective Craig Lowe told the Nevada Appeal.

In his report, Lowe said he located Sandra's remains at a Carson City funeral home and was able to photograph "numerous contusions and what appeared to be scratch marks on Sandra's face."

Lowe had the body taken to the Washoe County Medical Examiner's Office for an autopsy.

Though a cause of death was not determined, the autopsy showed the woman suffered broken ribs and internal bleeding. Toxicology tests and a neurologist's report on a brain examination are still pending.

"According to the attending pathologist, there were signs of non-accidental injuries from numerous incidents," Lowe wrote in the report. He also said Patricia VonDracek's 14-year-old son told police that a week before his aunt died, his mother had stomped on her lower stomach as she lay on the floor.

The boy "claimed he restrained his mother and removed her from the room telling her to calm down and that he would care for Sandra," the report said.

Patricia VonDracek was interviewed by detectives and booked on suspicion of felony domestic battery with substantial bodily harm and felony abuse of a vulnerable person.

Her bail was set at an additional $100,000.

Information from: Nevada Appeal, http://www.nevadaappeal.com

 

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It's nearly impossible to tell if a former soldier convicted of killing an Iraqi family has brain damage because of the method used to scan his brain, a neurologist testified Tuesday.

Dr. Helen Mayberg, a professor at Emory University in Atlanta, said the wrong protocols were used during an MRI of former Pfc. Steven Dale Green. Instead of what amounted to a complete scan of Green's brain, his MRI included pauses between each scan, Mayberg said.
 

I first ran into Dr. Mayberg in a brain injury case I tried before a jury in the early 1990s.  She adamantly said that Positron Emission Tomography (PET) was not useful for corroborating diagnosis of brain injury caused by trauma. Dr. Joseph Wu of UC Irvine said it was one tool used among the others available.  The PET scan Dr. Wu performed was allowed into evidence by the court.

It is very interesting to note that so-called experts hired by defense lawyer firms come up with the same type of testimony in virtually every case.  What ever the treating or plaintiff's expert says is "wrong."

While hired in a criminal case:

Prosecutors called Mayberg to the stand to rebut the May 12 testimony of Ruben Gur, director of neuropsychology at the University of Pennsylvania School of Medicine.

Gur, called by the defense, reviewed a 2008 MRI and found Green has brain damage. He made the diagnosis after comparing Green's MRI to scans from 41 other men of roughly the same age without brain injuries. People with such injuries have "major difficulties" restraining their impulses, he said.
 

Defense attorneys have argued that Green's lack of impulse control was a factor in him taking part in the slayings of the al-Janabi family.

Defense attorney Scott Wendelsdorf, while questioning Mayberg, said MRI's don't necessarily tell the entire story of what is happening in someone's brain.

"A normal MRI doesn't mean nothing is wrong with a brain, does it?" Wendelsdorf asked.

"That's a very true statement," Mayberg said.
 

Dr. Mayberg has made a good living testifying against plaintiffs and criminal defendants.  Read about the case by clicking here.

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Indiana National Guard Sgt. Gerald "G.J." Cassidy, who served his country in Bosnia and Iraq, died alone and ignored in a barracks at Fort Knox from an accidental drug overdose. His fate left a legacy that has changed the lives of thousands of wounded soldiers, Army officials say.

Cassidy began experiencing migraine headaches after a roadside bomb exploded about 11 feet from his Humvee in Iraq in August 2006. With diagnoses of post traumatic stress disorder and mild traumatic brain injury.

One Fort Knox soldier told investigators, "The staff at the WTU did not keep accountability of soldiers and were not making any checks on the welfare of soldiers" with PTSD and brain injury.

On the day Cassidy died, his platoon sergeant reported him at formation when he actually hadn't seen him for two days.

After repeated calls from Melissa Cassidy after she had not heard from him in a couple of days, Sgt. Cassidy was found dead in his chair. A toxicology report from the Armed Forces Institute of Pathology ruled his death accidental, caused by "multi-drug toxicity," compounded by coronary artery disease.

Excerpted from Soldier's hospital death leads to changes as published in Associated Press.  Information from: The Courier-Journal, http://www.courier-journal.com

 

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Research is the key to understanding and dealing with Traumatic Brain injury.

National Institute of Neurological Disorders and Stroke (NINDS)conducts and supports research on Traumatic Brain Injury (TBI) to better understand the biological mechanisms of injury, to develop strategies and interventions to limit the primary and secondary brain damage that occur following TBI, and to devise effective treatment strategies to improve long-term recovery of function. NINDS areas of research include:

1.  Assessment of posttraumatic brain function and pathology
2.  Discovering mechanisms of brain injury and repair processes
3.  Identification of therapeutic targets
4.  Translational research for therapy development
5,  Clinical trials to evaluate therapeutic efficacy
6.  Current TBI clinical trials at NIH and other organizations
7.  NINDS Clinical Research Overview 

The NINDS publishes Traumatic Brain Injury: Hope through Research and NINDS Shaken Baby Syndrome Information Page.  Click on either link to see more.
 

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Wikipedia defines Diffuse axonal injury (DAI) as

one of the most common and devastating types of traumatic brain injury, , meaning that damage occurs over a more widespread area than in focal brain injury. DAI, which refers to extensive lesions in white matter tracts, is one of the major causes of unconsciousness and persistent vegetative state after head trauma. It occurs in about half of all cases of severe head trauma and also occurs in moderate and mild brain injury.

The outcome is frequently coma, with over 90% of patients with severe DAI never regaining consciousness. Those who do wake up often remain significantly impaired.

Nowadays, other authors state that DAI can occur in every degree of severity from (very) mild or moderate to (very) severe. Concussion may be a milder type of diffuse axonal injury.

DAI is not easily detected by physicians in mild and moderate cases. Imaging studies and neuropsychological evaluations in addition to observations of relatives, friends and co-workers are some of the devices used when diagnosing DAI. Cases involving mild to moderate brain injuries are harder to tackle than cases in which there is objectively discernible injury such as loss of consciousness, skull fracture, or intracranial bleeding on imaging studies. Often such cases involve allegations of diffuse axonal injury (DAI), an injury to the brain that can occur at the microscopic level and not be detectable even by computerized tomography or magnetic resonance imaging.

Nonetheless, DAI can cause significant changes in personality or cognition which can create significant life change.
 

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"The decision to resume driving after stroke can be complicated by the sequelae of stroke as well as the established finding that even healthy adults overestimate their driving ability. This study evaluated whether stroke survivors (n = 67) disproportionately overestimated their driving ability as compared to healthy significant others ( n = 67)," researchers in the United States report.

"Comparison to a known target reduced self-bias among both groups, but shift toward enhanced accuracy was significantly greater among survivors than significant others. Additionally, self-bias may reflect a pervasive trait of cognitive ability, as overestimation of driving ability was paralleled on a cognitive estimation task," wrote C.A. Scott and colleagues, Wayne State University.

The researchers concluded: "Use of a specific criterion can facilitate accurate self-ratings of driving ability among survivors; however, actual decisions regarding driving status may be unrelated to self-view."

Scott and colleagues published their study in the Journal of Clinical and Experimental Neuropsychology (Self-assessment of driving ability and the decision to resume driving following stroke. Journal of Clinical and Experimental Neuropsychology, 2009;31(3):353-362).

 

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An interesting study comparing the effect of dual tests on memory and activities of daily living in truamatic brain injury patients was released.

According to a study from Nagoya, Japan, "We quantitatively evaluated memory performance in patients in the chronic stage of closed traumatic brain injury using dual visual tasks."

"Simple memory tests and questionnaires concerning activities of daily living (ADL) were also utilized to evaluate any correlation with the results of the dual tasks. The results of dual tasks and memory tests were correlated with the daily activity scores, but there was no correlation between the results of dual tasks and memory tests," wrote J. Hasegawa and colleagues, Nagoya University, Medical Department.

The researchers concluded: "We concluded that the dual task was effective for detecting memory and ADL disturbances, which were not disclosed by conventional memory tests."

"Data on clinical and experimental neuropsychology described by researchers at Nagoya University, Medical Department." Psychology & Psychiatry Journal. NewsRX. 2009. Retrieved May 08, 2009 from HighBeam Research: http://www.highbeam.com/doc/1G1-198635191.html
 

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A recent study by Mount Sinai faculty suggests that a gene associated with onset of type-2 diabetes also decreases in Alzheimer's disease dementia cases. The research, led by Dr. Giulio Maria Pasinetti, MD, Ph.D., The Aidekman Family Professor in Neurology, and Professor of Psychiatry and Geriatrics and Adult Development at Mount Sinai School of Medicine, was published this week in the scientific journal, Archives of Neurology.

Read the full article by clicking here.
 

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In an amazing story, A Jackson County man died and his wife was critically injured Tuesday in what authorities described as an attempted murder and suicide at a home off Tanner Williams Road in the Harelston community.

Jackson County Sheriff Mike Byrd said a witness called for help after she was able to escape the home of the victim, Tammy H. Sexton, 47, who had been shot in the head.

The woman was found lying on the bed talking to authorities.  Authorities, cited in the Sun Herald, stated. "“It’s truly a miracle that she survived something like this and was talking and conscious,” Byrd said Wednesday. “She had a gunshot wound that went in over her left eye and exited the back of her skull. Based on everything I’ve seen in my career, she shouldn’t be alive.”

 

Once again, a story of a severe brain injury where the victim walks and talks afterwards.  It is reported Tammy Sexton offered authorities tea even with the penetrating would she sustained.

This is similar to the famous case of Phinneas Gage who suffered a railroad iron through his head and frontal lobe and never lost conciousness in 1848.  He survived however lived a forever changed life in that his personality was irreparably compromised.

 

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Part of the attorney's job in evaluating a case is to obtain and analyze medical records.  This makes communication with the client very important.  Getting medical records for the current injury as well as past records play a crucial role in evaluating the case.

Many times clients are reluctant to reveal past injuries or events.  This creates problems later in the case since information they are unaware of may exist in other records.

Within medical records lies the hidden detail that could prove negligence or that could absolve the unjustly accused practitioner. Though the records often seem incomprehensible, attorneys can
find crucial information in them if they know where to look. Following is a summary of what information should be included in various types of hospital records.

Progress Notes – A daily narrative of a patient’s medical care. They describe the patient’s progress, symptoms and course of recovery. Often written by a resident or intern, and then signed
or initialed by the treating physician. Each entry should be dated and signed.

Admission Notes – Done on the day of hospitalization by the treating physician. Notes should include a history and physical examination, diagnosis and recommendations for treatment.

Examination Form – The history should include the chief complaint, details of the present illness, relevant past, social and family histories and inventory of the body systems. This should
be completed within 24 hours of admission.The physical examination should reflect a general evaluation and a notation of blood pressure, pulse and respiration; the skin, eyes, ears, nose
and throat; neck; breasts, lungs, and heart, abdomen; genitalia or pelvis; rectum; extremities and lymph nodes. A neurological examination should be recorded and allergies noted. A final
impression should be stated.

Doctor’s Orders – Requests for diagnostic testing and therapeutic treatment. All orders should be dated and signed by the physician. Verbal orders are expected to be signed by the doctor during the next patient visit, or within 24 hours. The treating physician is responsible to check that the patient is receiving what was ordered. The nursing staff should conduct a 24-hour review of the orders. Treating physicians should be notified of impending stop orders.

Surgical Records – Documents the preparation of a patient scheduled for surgery. Generally includes a surgical check list of preparatory steps taken by the nursing staff the night before surgery.

Operative Report – A complete and detailed report made within 24 hours. Contains identification of procedures used, a description of all findings, including anomalies encountered, specimens
removed, postoperative diagnosis, unusual events and name of primary surgeon and assistants. A progress note, written by the physician concerning the operation should appear in the records.

Anesthesia Record – Documents the anesthesiologist’s visit, including conversation with the patient, efforts to obtain information pertinent to the patient’s past surgeries, a physical
examination, and complete review of the patient’s chart. During surgery, the anesthesia record should show:
- The length of time anesthesia was administered;
- Time needed to complete surgery;
- Quantities and types of drugs, blood, and intravenous fluids
administered during surgery;
- Continuous record of pulse, blood pressure and respiration;
- Observation notes to include reaction to anesthesia surgery.

Consent Form – Informed consent is necessary for elective treatment and diagnostic procedures involving invasion or disruption of the integrity of the body. A consent form should
include: The date, identity of the patient, and the name of the procedure or treatment interpreted in laymen’s terminology, as well as the name of the person administering treatment and
authorization for anesthesia. The form should state possible risks or complications that have been explained to the patient; authorization for disposal of tissue or body parts; explanation of
alternative treatment, and signature of the patient and a witness.

Nursing Notes – Written on a per shift basis, should be recorded at the time of or immediately after patient events, depending on hospital policy or patient condition. The notes should detail the
progress of the patient and be made in chronological order. They should be signed by the person performing a procedure or witnessing an event.

Discharge Summary – Should be a recap of relevant diagnosis, operative procedures performed significant findings, treatment rendered, the condition of the patient upon discharge and the
discharge instructions. It should be dictated by the treating physician.
 

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Mild & Minor Traumatic Brain Injury: An Unfortunate Oxymoron (Part 1)
Timothy R. Titolo
Attorney

I have often heard it said “if it’s to the brain, any injury is significant!” Huh? Hello? Is anyone paying attention? I said, " ‘if it’s to the brain, any injury is significant!’ “

 

 Introduction

The literature and research has come a long way in helping to provide answers and guides for the previously disbelieved and improvable "mild brain injury” and "post concussion syndrome.” As a trial lawyer, representing victims and families who have suffered from traumatic brain injury, I have immersed myself in the medical literature in an attempt to better represent and understand my clients and their injuries. The purpose of this article is to provide a legal perspective on the information available and the misconceptions lay people and many lawyers have regarding "mild brain injury.”

As lawyers, medical practitioners, and lay people, we are all probably too familiar with the results of paraplegia, quadriplegia, neurodisease, and varying degrees of dementia. These are all spinal cord injury and traumatic brain injury outcomes. What about those who Ronald Ruff, Ph.D., neuropsychologist, has coined "the miserable minority?”

 Defining and Understanding Mild Brain Injury

Trauma comes in as the third leading cause of death in the United States following only cardiovascular disease and cancer. (Trunkie, 1983). With the advent of technologically enhanced mode of transportation, motor vehicle travel, cases of head trauma have proportionally increased. Motor vehicle crashes are responsible for a large majority of head trauma. As emergency medical care improves and becomes more available and developed, individuals in our modern society are surviving the acute phases of their injuries and require continued rehabilitation.

What about those whose outcomes are not visibly evident as with paraplegia? Science and medicine have brought the current state of knowledge to a universal agreement that microscopic sized injury to the neurons and axons of the brain can have devastating effects on a person”s cognitive ability, psychiatric and psychological outcomes. And, as one would expect, these types of microscopic lesions and their outcomes are of greatest controversy between medical practitioners and legal professionals. Judges do not understand the specifics of diagnostic testing and yet are allowed, under Daubert to act as the gate keeper for allowing evidence to be brought into a courtroom to help further the understanding of the fact finder. Many lawyers simply do not have the understanding or education necessary to properly pursue a claim for traumatic brain injury. And finally medical practitioners of varying skill levels will provide opinions about matters for which they have been given, many times for the defense, an inadequate base of information to make a diagnosis. This results in Dr. Ruff”s "miserable minority.”

A closed head injury occurs when the soft tissue of the brain is forced into contact with the hard, bony, outer covering of the brain, the skull. Along with the head injury, the average patient usually experiences neck and back injuries. Mild closed-head injuries can occur after a severe neck injury without the head actually striking any surface. The severity of the injury can range from mild to more severe. The symptoms are worse when there is a rotational component to the head injury in addition to back and forth movement of the head. In milder injuries with post concussion syndrome, loss of consciousness need not always occur. There is, however, always some alteration of consciousness: some interruption of brain function. Sometimes a patient remains confused or agitated for a period of time following a closed head injury. With milder injuries, loss of consciousness usually lasts less than an hour (Bernad, 1998).

PRACTICAL NOTE - One must be on guard of medical practitioners hired by the defense who justify their diagnosis and conclusions on the assumption that there was no loss of consciousness. Typically a witness to the patient”s loss of consciousness is not available. Usually the first one to the scene might be a bystander coming to provide aid or the ambulance paramedic who arrives some minutes after the event. The defense medical practitioner will look at the Aevidence available” and conclude from the ambulance and emergency room records that, if they do not indicate a loss of consciousness, then it is reasonable to assume there was none. And, very frequently, these medical practitioners are not provided with deposition testimony or other evidence or information from other observers who may have described the injured party as disorientated or passed out, etc.

All too often I have gotten the defense medical examiner to agree that being provided with Aadditional information” could change their diagnosis. Then I hear something to the affect that since we do not live in a Aperfect world” and we are dealing with time as a Acommodity” such Alimitless” information is not obtainable. What this means, is since the reviewing doctor only got paid to spend an hour or whatever with the patient, there was not enough compensation involved to allow for the sincerest evaluation of the patient.

For instance, I rarely see a neurologist or neuropsychologist, hired by the defense, request of the defense lawyer, information to help in the diagnosis and conclusions. This should certainly not be missed and is a great opportunity to discredit that witness. Rarely has the defense medical examiner taken the time to review what people, who have known the patient, have noticed as changes since the trauma. Is this relevant? You bet it is. Did Dr. Ruff do it in the case at hand-absolutely not! Why? Because he did not live in a Aperfect world” and did not have the Afunding” to do a more extensive evaluation. Ironically, the information had already been made available to his hiring lawyer who skipped getting information from these people before hiring their expert neuropsychologist.

 

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The Senate adopted its fiscal 2010 budget resolution (S Con Res 85) Thursday night, a few hours after the house adopted its version (H Con Res 85).

While neither budget exactly mirrors President Obama's proposal, they do pave the way for implementing his proposals on health care, energy and education. Conference negotiations will focus on whether to include provisions that would, like the House plan, allow health care overhaul legislation move through the filibuster proof reconciliation process and how much in discretionary spending should be provided to the Appropriations panels to write the 12 annual spending bills.

According to Congressional Quarterly, the Senate plan would provide the Appropriations panel with $1.08 trillion, which is $15 billion less than the president requested and about $8 billion less than the House resolution.
 

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A study published at the University of Nevada Department of Psychology and in the Journal Applied Neuropsychology (Structure of attention in children with traumatic brain injury. Applied Neuropsychology, 2009;16(1):1-10) reveals differences in children with traumatic Brain Injury

The researchers concluded:

"These findings support the utility of a multicomponent model of attention to understand attention deficits resulting from TBI, and may be useful in determining those aspects of attention that are differentially impacted by TBI, in order to assist in assessment and rehabilitation planning."

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One question that I always ask a defending neurologist or neuropsychologist is whether a person is walking and talking after a brain injury automatically rules out the presence of brain injury.  They invariably say no and the recent Nataha Richardson case illustrates the fact.

JESSICA LEEDER  states that Condition masks severity of brain injury, prompting victims, such as Natasha Richardson, to refuse medical treatment, experts say

Natasha Richardson's fatal descent began when she suffered a rare bout of "talk and die syndrome" after falling on a Quebec ski hill with limited access to head-trauma specialists.

Brain-injury experts say victims of the infrequent syndrome, which masks head injuries, are often conscious after hitting their heads and lucid enough to deem themselves unhurt, as Ms. Richardson did this week, laughing off her tumble on a beginners hill at Mont Tremblant and declining an ambulance. Victims can appear healthy even though they require medical attention and, in some cases, are on the brink of death.

"You can't drag them screaming to the hospital," said Charles Tator, a University of Toronto neurosurgeon who emphasized that talk and die syndrome is an infrequent occurrence in brain-injury cases. Still, he said: "Every health-care professional, paramedic and ski patroller knows about this phenomenon. That's why you never allow a head-injured person to be alone."

Mont Tremblant employees told The Globe and Mail they monitored the actress after she returned to her hotel after the fall and summoned an ambulance when her condition began to deteriorate.

An autopsy revealed yesterday that Ms. Richardson sustained a brain-killing clot called an epidural hematoma. Although severe, epidural hematomas can be difficult to detect at the outset.

"I have had the privilege of saving many lives during my career in just this situation, where somebody bangs their head, has a lucid interval, has a blood clot, and is brought immediately for attention," said Dr. Tator, who is also the founder of ThinkFirst, a non-profit organization for the prevention of brain injury.

As the circumstances around Ms. Richardson's death have become more clear, they have prompted much hand-wringing at resorts, where officials feel there are limits to the amount of safety precautions and medical attention they can compel guests to accept.

"It gets to be a difficult call, particularly when the guest insists that they go home ... and don't take us up on the offer to see someone," said Brian Leighton, safety manager at the Whistler Blackcomb resort in British Columbia. "If the patients are conscious and able to make these decisions on their own, we can't force them onto a spine board or into an ambulance."

In the absence of legal regulations requiring skiers to wear helmets - resorts can suggest guests wear protective headgear but cannot ban adults who refuse - head injuries are difficult to prevent.

"People fall down on ski hills all the time," said Doug Firby, a spokesman for Sunshine Village Ski and Snowboard Resort in Banff, Alta. "Some of them bang their heads. I can't imagine a scenario in which you could actually force all those people to go to hospital."

Continue Reading...

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Each year in the United
States, an estimated 1.4
million people sustain a
TBI.

Each year in the United
States, an estimated
80,000 - 90,000 people
experience the onset of
long-term disability
associated with a TBI.

Direct medical costs and
indirect costs (such as lost
productivity) of TBI are
estimated at $60 billion
annually. This number
does not take into account
returning military service
personnel with TBI.

10% to 20% of Marines
and Soldiers returning
from Afghanistan and Iraq
may have experienced
brain injuries.
 

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DID YOU KNOW?

• A concussion is the most common type of brain injury sustained in sports.
• Most concussions do NOT involve loss of consciousness.
• You can sustain a concussion even if you do NOT hit your head. An indirect blow elsewhere on the body can transmit an “impulsive” force to the head and cause a concussion to the brain.
• Multiple concussions can have cumulative and long lasting life changes.
• Concussions typically do NOT appear in neuroimaging studies such as MRI or CAT Scans.
• An estimated 1.6-3.8 million sports- and recreation-related concussions occur in the United States each year.
• During 2001-2005, children and youth ages 5–18 years accounted for 2.4 million sports-related emergency department (ED) visits annually, of which 6% (135,000) involved a concussion.
• Of the 1.4 million traumatic brain injuries sustained by children and adults in the United States each year, at least 75% are mild and/or concussions.
• Among children and youth ages 5–18 years, the five leading sports or recreational activities, which account for concussions, include bicycling, football, basketball, playground activities, and soccer.

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In case you missed it, reported in yesterday's, Post Chronicle: Tragedy: Vanessa Redgrave Daughter, Natasha Richardson Brain Dead:

The daughter of Vanessa Redgrave, Natasha Richardson, has tragically been declared brain dead, according to sources close to Richardson and her family, and they are reportedly preparing to take the actress off life support.

It seems that what appeared to be a simple fall during a ski run has become a tragedy after Natasha Richardson's headache apparently turned into cerebral hemorrhaging.

The actress' husband, Liam Neeson, is by Natasha's bedside at a New York hospital, along with her mother, children and possibly other family members.

A close friend of the family tells People Magazine of Natasha's condition: "There is no chance...It is a fact that her heart is beating but she is brain dead."

Doctors have described Natasha's condition as a "leakage of blood between the brain and skull" and other doctors have said that her brain may have suffered pressurized swelling.

Another report has called Natasha's condition an Acute Subdural Hematoma, which is a form of traumatic brain injury in which blood gathers within the inner meningeal layer of the dura (the outer protective covering of the brain). Subdural hematomas are usually the result of a serious head injury. Acute subdural hematomas are among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, leaving little room for the brain, and are associated with brain injury.

Now the family of Natasha will have to decide if they will take her off life support.

"It's not official yet, but they basically will detach her," a friend revealed to the press.

Neeson and Richardson have two sons, 13-year-old Michael and 12-year-old Daniel.

 Image: CraveOnline

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TBI:
The Invisible Injury

A traumatic brain injury (TBI) is a blow or jolt to the head or a penetrating head
injury. The injury is caused by falls, motor vehicle crashes, assaults and other
incidents. Blasts are a leading cause of TBI for active duty military personnel in
war zones.

Any TBI—whether diagnosed as mild, moderate or severe—can temporarily or
permanently impair a person’s cognitive skills, interfere with emotional wellbeing
and diminish physical abilities.

Individuals with TBI may experience memory loss; concentration or attention
problems; slowed learning; and difficulty with planning, reasoning, or judgment.
Emotional and behavioral consequences include depression, anxiety,
impulsivity, aggression, and thoughts of suicide.

Physical challenges of TBI may include fatigue, headaches, problems with
balance or motor skills, sensory losses, seizures, and endocrine dysfunction.
TBI often leads to respiratory, circulatory, digestive, and neurological diseases,
including epilepsy, Alzheimer's disease, and Parkinson's disease.

Poor outcomes after TBI result from shortened length of stays in both inpatient
and outpatient medical settings; insurance coverage denials for rehabilitative
treatment; and inadequate funding for public services. Too often individuals with
TBI are prematurely discharged to untrained, unsupported family caregivers or
inappropriately placed in nursing homes, psychiatric institutions or correctional
facilities.

Maximal recovery and long-term health maintenance for people with brain injury
can only be achieved through a comprehensive, coordinated neurotrauma
disease management system providing for immediate treatment, medicallynecessary
rehabilitation, and supportive services delivered by appropriately
trained TBI specialists in the public and private sectors.
 

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This excerpt is from the AP:

The number of U.S. troops who have suffered wartime brain injuries may be as high as 360,000 and could cast more attention on such injuries among civilians, Defense Department doctors said Wednesday.

The estimate of the number injured — the vast majority of them suffering concussions — represents 20 percent of the roughly 1.8 million men and women who have served in Iraq and Afghanistan, where blast injuries are common from roadside bombs and other explosives, the doctors said.

The estimate came in a Pentagon news conference on activities planned this month to bring attention to brain injuries. The doctors said the number could be as low as 180,000, based on estimates that between 10 percent and 20 percent of troops might have received such injuries.

The previous high estimate offered publicly was 320,000 in a study released a year ago by the private Rand Corp. It was based on about 1.6 million who had done tours of duty in the wars from late 2001.

Though so-called "traumatic" brain injury can range from a mild form such as concussions to severe forms with penetrating head wounds, officials said the majority of injuries among troops are the mild form.

The overwhelming majority heal — and heal without treatment — but an estimated 45,000 to 90,000 troops have suffered more severe and lasting symptoms, said Brig. Gen. Loree Sutton, the head of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

The Army alone spent $242 million last year for staff, facilities and programs to serve troops with brain injuries, said Lt. Col. Lynne M. Lowe of the Army surgeon general's office.

Sutton said that, as in previous wars, the research and other work being done by the military will eventually benefit the civilian world. Whether the injuries occur while people ride bicycles, play football, skateboard or ski, "we know that this is an issue across the country," she said.

"In the past ... it was difficult to get this on the radar screen," said Dr. James Kelly, director of the National Intrepid Center for brain injuries and psychological health. "Brain injury was not recognized as a problem ... of any consequence and was, especially in the sports community, often dismissed or trivialized."

"I think that now you're seeing it being taken very seriously," Kelly said. "The wartime experience has been a big part of that."

 

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The Michael J. Fox Foundation for Parkinson's Research awarded approximately $1.9 million total to six teams working to develop neuroimaging technologies that would allow scientists to non-invasively visualize the clumping of the alpha-synuclein protein in the living human brain. Such technologies would dramatically accelerate research into the cause, progression and treatment of PD.

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When humans are exposed to traumatic events that may or may not be sufficient enough to cause brain injury, many experience symptoms of post-traumatic anxiety and panic attacks. For example, motor vehicles accidents are a leading cause of post-traumatic stress disorder (PTSD) with a significant subgroup having persisting symptoms after a year (Mayou et al., 1997, 2002). They are also the leading cause of brain injury, particularly in younger adults (Langlois, 2003). Blast injury is another traumatic event that can cause brain injury from secondary or tertiary factors (see blast injury article) but can also cause one to be psychologically traumatized due to the threat to one’s life and/or physical integrity.

Too often, I encounter clinical situations where some health care providers have not specifically inquired into all posttraumatic stress disorder and panic attack symptoms in patients with a history of known or suspected mild traumatic brain injury (MTBI). On other occasions, some of the symptoms have been mentioned by the patient but the only diagnosis listed in the impression section is mild traumatic brain injury and “post concussion syndrome.” This is problematic since some of the signs and symptoms of PTSD in the Diagnostic and Statistical Manual of Mental Disorders-IV (APA, 1994) are identical to those of post-concussional disorder. Shared symptoms include irritability, sleep disturbance, and concentration problems. In addition, DSM-IV postconcussional disorder criteria include apathy and lack of spontaneity, which are very similar to the PTSD symptoms of restricted affect and diminished interest or participation in significant activities. Also, many patients with PTSD develop panic attacks. Dizziness is a symptom of panic attacks and is also a symptom of postconcussional disorder.

Whereas PTSD and panic attacks have enough research behind them to be considered legitimate diagnoses in DSM-IV, this is not the case for postconcussional disorder, which is listed in the section entitled “Criteria Sets and Axes Provided for Further Study.” According to the text, diagnoses are listed in that section because “…there was insufficient information to warrant inclusion of these proposals as official categories or axes in DSM-IV.” When considering this, clinicians need to be careful before telling patients that persisting symptoms after a known or suspected MTBI are caused by persisting effects of brain injury. In evaluating the possibility that other conditions may account for persisting symptoms, clinicians should routinely inquire about the presence of PTSD symptoms.

DSM-IV criteria for PTSD are as follows:
 

A. The person has been exposed to a traumatic event in which both of the following have been present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more

Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

Likewise, clinicians also should inquire about the presence of panic attacks symptoms.

DSM-IV criteria for panic attacks are as follows

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

1) palpitations, pounding heart, or accelerated heart rate
2) sweating
3) trembling or shaking
4) sensations of shortness of breath or smothering
5) feeling of choking
6) chest pain or discomfort
7) nausea or abdominal distress
8) feeling dizzy, unsteady, lightheaded, or faint
9) derealization (feelings of unreality) or depersonalization (being detached from oneself)
10) fear of losing control or going crazy
11) fear of dying
12) paresthesias (numbness or tingling sensations)
13) chills or hot flushes

When panic attacks recur and are followed by one month (or more) of one (or more) of the following, the person may be experiencing panic disorder: a) persistent concern about having additional panic attacks, b) worry about the implications of the panic attack or its consequences (e.g., losing control, having a heart attack, "going crazy"), and c) a significant change in behavior related to the attacks. To conclude someone is having panic attacks, one needs to rule out that the symptoms are not due to a general medical condition, the effects of a substance (e.g., drug abuse, medications), or another mental disorder.

Lastly, the clinical should also explore whether the patient is experiencing agoraphobia, which often co-occurs with panic disorder. In agoraphobia, there is anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and travelling in a bus, train, or automobile. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion. Of course, the anxiety and phobic avoidance cannot be explained by another mental disorder to be diagnosed as agoraphobia.

If symptoms of PTSD, panic disorder, panic attacks, and/or agoraphobia are overlooked/ignored, an overemphasis can be placed on a brain injury diagnosis which may be inaccurate. When this happens, patients can continue to suffer with an anxiety-based condition (i.e., PTSD) that is generally responsive to treatment. In addition, patients may continue to incorrectly believe that symptoms of these anxiety-based disorders are actually brain injury symptoms. The symptoms will likely worsen over time because the anxiety condition remains untreated, whereas TBI symptoms should generally improve over time. This can lead to situations where clinicians misinterpret severe psychiatric symptoms as signs of “severe” brain injury when all objective evidence points to the brain injury as being mild. Of course, mild traumatic brain injury and anxiety-based conditions can co-occur but an early focus should be on identifying and treating anxiety based disorders (and depressive disorders) to improve outcome.

REFERENCES

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association.

Langlois, J.A. (2003). Traumatic Brain Injury-Related Hospital Discharges Results from a 14-State Surveillance System, 1997. Morbidity and Mortality Weekly Report. June 27, 2003, 52, No. SS-4, 1-20.

Mayou, R. A., et al. (1997). Long term outcome of motor vehicle accident injury. Psychosomatic Medicine, 59, 365–368.

Mayou, R.A., et al. (2002). Posttraumatic stress disorder after motor vehicle accidents: 3-year follow-up of a prospective longitudinal study. Behaviour Research and Therapy, 40, 665–675

 

Dr. Carone Copyright © 2009, MTBIFacts.com.

 

 

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Injuries are the leading cause of death in the United States for people ages 1-34. Of all injuries, those to the brain are most likely to result in death or permanent disability. Each year over 50,000 people die as a result of a brain injury and as many as 90,000 others are left with a long-term disability. Most of these brain injuries are preventable. (stats from CDC)
 

Please be reminded that brain injury is real and serious condition.  The causes of brain injury are variable and sometimes help is difficult to find.  Call or email me if you have questions.  702.869.5100  tim@titololawoffice.com.

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The following is a BIAA update:

ECONOMIC STIMULUS PACKAGE APPROVED BY HOUSE

This week the House passed their $819 billion economic stimulus bill, setting the stage for Senate action next week. House Speaker Nancy Pelosi portrayed her chamber's vote as swift and bold action that "honors the promises our new president made from the steps of the Capitol" during his Jan. 20 inauguration. (Congressional Quarterly)

As reported last week, the legislation would provide an additional $87 billion of critical Medicaid funding to states, increasing through the end of FY 2010 the share of Medicaid costs the Federal government reimburses all states by 4.8 percent. This funding is intended to prevent cuts to health benefits in state Medicaid programs at a time when state revenues are declining. BIAA continues to strongly support this increase in federal support for Medicaid, to prevent states from having to cut back on vital Medicaid services that many individuals with brain injury depend on.

The bill would also extend the moratorium, (which BIAA has been strongly supportive of), on harmful Medicaid and Medicare regulations through October 1, 2009. The legislation also adds a moratorium on the Medicaid Outpatient Rule.

APPROPRIATIONS UPDATE

Earlier this week, Minority leader Steny Hoyer announced that the House will take up the Fiscal Year 2009 omnibus appropriations bill next week. We will continue to monitor the situation closely and keep everyone informed as to the content of the bill next week.

As many of you remember, BIAA sent out a Legislative Action Alert in late December, when the House and Senate were conferencing critical sections of this omnibus bill, urging everyone to call their Representatives in Congress to increase TBI funding. Thank you to everyone who took action on this important issue!

GAO REPORT EXAMINES TBI CLAIMS PROGRAM FOR INJURED SERVICEMEMBERS

This week, GAO issued an investigative report regarding the traumatic injury insurance benefit program (TSGLI). The program was created in 2005, to be administered by Veterans Affairs in collaboration with the Department of Defense, to help ease financial burdens on members of the armed services that sustain a brain injury or other serious injuries.

During their investigation, GAO sought out the advice of BIAA in terms of the difficulty in identifying mild brain injury and the variance in the length of time that symptoms present post injury. BIAA also counseled GAO on the difficulty in getting objective data about the severity of brain injuries from a functional standpoint.

In conclusion of their investigation, GAO recommended that both DOD and VA implement a quality assurance review process to help ensure that decisions are accurate and consistent within and across the services and take steps to ensure the data required to assess the approval rate for traumatic brain injury and timeliness of the claims process are reliable and comprehensive.

 

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A commonly held belief is that the pressure alone from an explosive blast injury is sufficient to cause brain injury in human beings. While this would intuitively seem to make sense, what many people do not realize is that there are no published, peer reviewed, prospective research studies with human subjects that have demonstrated this to be the case. The evidence to date is based on a few old single case studies, military documents that were not scientific research studies, and data from animal research.

There is no doubt that explosive blasts are associated with brain injury. However, there are many components to a blast that can cause injury to the body. First, there is the primary pressure wave injury, which is injury caused by the changes in the atmosphere caused by the explosion. The organs that are most vulnerable to this type of injury are those with air-fluid interfaces, such as the lungs, intestines, or inner ear. These tend to be hollow body parts. The most common type of injury from a primary pressure wave explosion is an eardrum rupture.

Then there are secondary blast injuries, in which the force of the explosion causes objects to fly through the air and strike someone. There is no doubt that this can cause a brain injury, since an object can fly through the air at considerable force and cause blunt trauma to the skull and its underlying contents. A tertiary injury is when the force of the explosion causes the person to be thrown into solid object. Clearly, this can also cause brain injury, if the person is thrown forwards with enough force.

One of the problems in stating that primary pressure waves causes brain injury in humans is that it is often impossible to know whether or not someone (such as a soldier) was only exposed to a primary blast injury or whether secondary or tertiary injuries also occurred. As Hurley and colleagues (2006) stated, “A still unresolved controversy is whether primary blast forces directly injure the brain” (p. 143, emphasis added). Similarly, Bochicchio and colleagues (2008) noted “...it is difficult to clearly distinguish between primary versus secondary or tertiary blast injury” (p.270). It is important to emphasize that no one denies this is possible, or even that it is likely, but caution needs to be taken before it is stated as a scientific fact in humans.
 

The word “humans” is emphasized because there is evidence that primary pressure waves alone can cause brain injury in animals. However, generalizing from animal studies to humans is not always possible. To begin with, the brains of mice, which is the animal group most often researched in these types of studies, are extremely small, structurally different, and not at all identical to the brains of humans. Secondly, the animal studies typically involve exposing them to blast forces at the end of a giant shock tube. While this may be something you see in an episode of a Tom and Jerry cartoon, it is not necessarily something that can be generalized to what soldiers experience during war time. To quote Hurley and colleagues, “The vulnerability of the human brain to primary blast injury is controversial and an area of active research” (p. 145).

As the committee of the Institute of Medicine (IOM) reported in December 2008, "There is a paucity of information in the scientific literature regarding the sequelae of blast injury, and there is a need for prospective, longitudinal studies to confirm reports of long-term effects of exposure to blasts." The IOM report was commissioned by the Department of Veterans Affairs and based on an analysis of 1,900 peer-reviewed studies.

MTBIFacts.com fully supports future research in this area but cautions against definitive statements on this topic until such research has been performed, replicated, and accepted by the general scientific community.

REFERENCES

Bochicchio et al. (2008). Blast injury in a civilian trauma setting is associated with a delay in diagnosis of traumatic brain injury. The American Surgeon, 74, 267-270.

Hurley et al. (2006). Blast-related traumatic brain injury: What is known? J Neuropsychiatry Clin Neurosci, 1, 141-145.

Copyright © 2009, MTBIFacts.com.

Dr. Carone offers paid lectures on MTBI, “post concussion syndrome,” and symptom validity testing upon request. He can be contacted at info@mtbifacts.com.

 
 

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I have published articles on this topic previously but it is worth reprinting.  This one is by neuropsychologist Dr. Carone.  He  offers paid lectures on MTBI, “post concussion syndrome,” and symptom validity testing upon request. He can be contacted at info@mtbifacts.com.

Another one of the most popular myths perpetuated by some health care providers and some in the media is that mild traumatic brain injuries (TBIs) can be equated with moderate to severe traumatic brain injury. While this is not usually stated in such precise language, the way the topic is discussed often conveys this impression. This occurs when the effects of “brain injury” are discussed with patients or the public. What often happens is that findings from patients with moderate to severe TBIs are misapplied to those with injuries on the mild end of the spectrum. The assumption seems to be that a brain injury is a unitary construct when this is not actually true. As Dr. Michael McCrea (2008) writes in his evidence based text, moderate to severe TBI is a completely different animal than mild TBI. There are many examples, which are nicely summarized in McCrae’s text and the interested reader should read that book for specific references supporting the statements below. Some of these examples are presented and expanded upon below.

1. USEFULNESS OF SEVERITY GRADING TOOLS: In moderate to severe TBI, there are measures available that are useful for grading the severity of the injury whereas the scales on the mild end of the spectrum are not as helpful. The most commonly used severity index is the score on the Glasgow Coma Scale (Teasdale & Jennett, 1974) which assesses level of consciousness. The scale ranges from 3 to 15 points and provides a way to rate patients on their eye movements, motor responses, and verbal responses. The TBI classification scheme based on the GCS is as follows: 13-15 (mild), 9-12 (moderate), and 3-8 (severe). While a significant injury and/or alteration in consciousness is required to obtain a GCS score between 3 and 12, the same cannot be said for the mild end of the TBI severity range. For example, consider a person who merely bumps his head into a wall with a minimal degree of force that was not significant enough to cause a brain injury. Assume, however, that the person develops a headache and is concerned that he has a brain injury, causing him/her to go to the ER. When the person goes to the ER, he/she is physically examined and a GCS score of 15 is assigned because there were no abnormalities with eye movements, motor responses, or verbal responses. According to the criteria above, a GCS score of 15 is equated with a mild TBI. Clearly, however, this example shows a GCS score of 15 does not always equate to brain injury.

2. ACUTE INJURY CHARACTERISTICS: In moderate to severe TBIs, the acute injury characteristics are the strongest predictors of outcome. In mild TBIs, there is only a limited correlation between acute injury characteristics and outcome. For example, in mild TBI, a brief and transient loss of consciousness is not strongly predictive of outcome. Conversely, loss of consciousness in a severe TBI patient, which could last for weeks and beyond, is strongly correlated with outcome. One of the problems is that acute injury characteristics are not as clearly documented in MTBI cases because of a lack of witnesses and the transient nature of the event. For example, a mild TBI patient may lose consciousness for a few minutes but if no one was present to witness this, it cannot be confirmed. Conversely, in a moderate to severe TBI case, LOC usually lasts long enough such that paramedics or some other observer would be able to confirm its presence.

3. CRITERIA FOR DIAGNOSIS: The criteria for diagnosing moderate to severe TBI tends to be more consistent throughout the literature compared to mild TBI. The criteria used to diagnose MTBI are largely based on self-reported subjective symptoms (e.g., altered mental status) without collaborating and/or objective data (e.g., witnesses, neuroimaging findings). In moderate to severe TBI, objective data are often sufficient enough (e.g., diffuse bleeds throughout the brain) such that self-report is not required to make the diagnosis.

4. NEUROIMAGING: In moderate to severe TBI, the results of neuroimaging are critical to deciding how to manage the patient. For example, if a bleed is large enough, this might require neurosurgery to remove pressure on the brain. This sometimes requires repeat brain scans in the acute injury phase to monitor the size and effects of an intracranial lesion (e.g., a brain bleed). In MTBI cases, initial neuroimaging results in the ER do not show abnormalities between 90 to 95% of the cases. Thus, after an initial negative brain CT scan, clinical management of the MTBI patient is often based on subjective symptoms (e.g., headache) rather than objective findings.

5. COURSE: In moderate to severe TBI, the recovery course is well-defined and empirical, with the most drastic improvement occurring in the first six months, additional recovery over the next six months, and slower recovery up to 18 to 24 months. In mild TBI, the course of recovery is clear for the vast majority of people which would suggest that most recover within a week to a few months. However, the course of recovery for those who experience persisting symptoms (more than three months) is less clearly understood.
 

6. OUTCOME: As noted above, outcome is strongly related to acute injury characteristics in moderate to severe TBI cases and it is generally an exception when psychological factors confound outcome (although this certainly can occur). Conversely, in mild traumatic brain injury, outcome is poorly related to acute injury characteristics. Rather, non-injury related factors tend to be the most predictive of outcome. Examples of non-injury factors include litigation/compensation-seeking, psychological distress, pre-injury psychiatric history, post-injury stressors, substance abuse, and various other psychosocial issues.

7. DISABILIY: In moderate to severe TBI, disability (a form of outcome) is more clearly attributed to injury severity, the functional neuroanatomy of the injury, and resulting impairments. In mild TBI, there is a less clear association between the clinical presentation of the patient and the degree to which neurological and psychological factors play a role.

These examples show that one cannot speak of traumatic brain injury as if it has the same meaning across the severity spectrum. The media and health care providers are strongly encouraged to clearly distinguish between mild and moderate to severe brain injuries when discussing this topic with patients and the public.

REFERENCES

McCrea, M. (2008). Mild traumatic brain injury and postconcussion syndrome. The new evidence base for diagnosis and treatment. New York: Oxford University Press.

Teasdale, G, Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2:81–84.

 Copyright © 2009, MTBIFacts.com.
 

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As I have been focusing on cases of shaken baby syndrome these past weeks, the December issue of Discover magazine publishes an article entitled The Shaken Baby Debate. Author Mark Anderson raises the issue of how the legal system pigeonholes the issue and, at times, wrongfully prosecutes.

“On one side of the courtroom, representing mainstream medical opinion, are those who believe shaken baby syndrome (SBS) is a valid diagnosis…On the other side, a growing number of skeptics are now claiming that the evidence for the syndrome rests on dubious medical ground with questionable biophysical models supporting it…Each side is battling for the high moral ground.”

Just as in other areas of litigation – you can always get what you pay for.
“Money…has brought otherwise good people over to what…colleagues call the ‘dark side,’ doubting SBS.”
 

Eli Newberger, assistant professor of pediatrics at Harvard Medical School, states, “I have never ceased to be amazed about what highly regarded, well published, scientifically informed doctors will do when they’re offered large amounts of money.”

The advocates of diagnosing SBS base their observations of modern scientific diagnostic technology such as Magnetic Resonance Imaging (MRI). The skeptics, conversely, say that innocent families around the world have been left in ruins by prosecutors and child protective agencies who have wrongfully accused parents and child-care workers of child abuse.

My personal thoughts, as always, make room for salient arguments on both extremes. If the system wrongfully prosecutes even one, then the entire system loses credibility for the rest who then fear similar retribution. However, let us never lose sight of what we are potentially doing by ignoring the signs and symptoms of SBS. The condition is serious and must be so regarded.
To read more about the article click here. And always have access to my web site at www.titololawoffice.com.
 

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 A trial involving abuse of a toddler is gearing up.  Lets remember that young children's brains are more suseptible to injury.  What is referred to as Shaken Baby Syndrome.  Click here.

 Wikipedia defines Shaken baby syndrome (SBS) as a form of child abuse that occurs when an abuser violently shakes an infant or small child, creating a whiplash-type motion that causes acceleration-deceleration injuries. The injury is estimated to affect between 1,200 and 1,600 children every year in the USA.[1] It is common for there to be no external evidence of trauma.[2] Injuries from impacts with hard objects may accompany SBS; this combination of shaking with striking against a hard object is sometimes termed the shaken impact syndrome or shaken/slam syndrome.

The concept of SBS was initially described in the early 1970s, based on a theory and a wide variety of circumstances by Dr. John Caffey, a radiologist, as well as Dr. Norman Guthkelch, a neurosurgeon.[3][4]

SBS, a major cause of death in infants, is often fatal and can cause severe brain damage, resulting in lifelong disability. Estimated death rates (mortality) among infants with SBS range from 15 to 38%; the median is 20–25%.[2] Up to half of deaths related to child abuse are reportedly due to shaken baby syndrome.[5] Nonfatal consequences of SBS include varying degrees of visual impairment (including blindness), motor impairment (e.g. cerebral palsy) and cognitive impairments.

 

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Another verdict for a boy suffering brain damage.

A jury has awarded the parents of a brain-damaged boy $11.4 million in a medical malpractice case.

Chad and Amy Jelinek of Eastman claimed in a 2006 lawsuit that negligent care by a nurse and nurse midwife at Gunderson Lutheran Medical Center in La Crosse resulted in brain injuries to their son Laine during his birth in 2005.

A Crawford County jury sided with the Jelineks on Oct. 17 after a three-week trial. The Jelineks' attorney, Jeff Goldberg, says the money is barely compensation but should improve Laine's life.

The hospital issued a statement saying it believes the care was appropriate.

 

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Here is something to think about.  "Here are the complete answers to a series of questions placed before U.S. Senate candiates Rep. Tom Udall and Rep. Steve Pearce. Both candidates were asked to give yes or no answers to the following questions with the option of explaining their answers.
 

Should a psychological evaluation be required for veterans returning from Iraq and Afghanistan?

Pearce: No

Udall: Yes. We should ensure all of our soldiers receive full medical examinations when they return from war, including psychological evaluations. Although not every medical condition can be immediately identified, such examinations help identify the signs of serious injuries to our service members and open the door to needed medical care and treatments. Veterans returning from Iraq and Afghanistan should be evaluated for behavioral health conditions and post-traumatic stress disorder, but prior to that they should be tested for traumatic brain injury. If veterans are treated with pharmaceuticals for PTSD, it could permanently complicate treatment of TBI. Further, we should ensure that there is mandatory health care funding for all veterans so that every man and women who served in uniform receives the care they were promised.

In Congress I co-sponsored several bills to increase funding for veterans with PTSD and TBI and to address some of the core issues that are preventing our veterans from receiving the best care possible when they return home. The Veterans TBI Act of 2007, for example, created a long-term care program for veterans with traumatic brain injury and created a transition office to ensure no veterans slip through the cracks.

 

 

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The Associated Press brought news of the death of an Arkansas news Anchor caused by a beating.  I represent victims of assault and battery.  Defendants and Insurance Companies typically defend cases like this.  I am working on several beating and brain injury cases.

Read the whole article by clicking here.

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This just in from the Associated Reporter.  This office handles several cases with AIG as the insurer.

American International Group, the insurance giant rescued by $85 billion in federal loans last month, has agreed to an $18 million settlement with the father of a disabled former Raleigh man.

AIG's decision to conclude the settlement with accident victim Mark Pellegrin's father comes after a judge ordered the company to pay $75 million when a subsidiary failed to defend the case in Wake Superior Court.

Such settlements rarely become public, but the details were discussed earlier this month in an open court session before U.S. District Judge Terrence Boyle attended by a reporter for the News & Observer of Raleigh. Lawyers for both sides asked to keep the settlement confidential, but Boyle did not take up their request.

Lawyers also said they were moving to settle quickly because of AIG's financial condition. In September, the Federal Reserve saved the imperiled company with a two-year, $85 billion credit line in return for a 79.9 percent stake in AIG.

The lawsuit settlement appears to be one of the largest in the state's history for a personal injury case, local lawyers said.

"That's huge," said Dan Hartzog, a Raleigh attorney who specializes in civil cases and was not involved in the case. "It would be a big jury verdict, but it's a really big settlement."

In May, state Superior Court Judge Orlando Hudson granted the request by Pellegrin's attorneys to order the company to pay damages of $75 million. No one representing National Union Fire Insurance Co. of Pittsburgh, an AIG subsidiary, showed up for trial to defend the company that owned the pickup truck involved in the incident and the employee who drove it.

National Union then asked that the case be taken up by the federal court. The company also began settlement talks with Pellegrin's attorneys.

One of National Union's attorneys, Jim Exum, told the federal court that the insurance policy had a maximum payout of $21 million.

The lawsuit was filed last year against KCI Technologies and one of its employees, Kelly Joe McKiernan, 29, who maintained the company's cell phone towers. McKiernan said in a deposition that on New Year's Eve 2005, after drinking beer and Jagermeister, he jumped into his company-issued truck. He was ready to leave Pellegrin's apartments after some roughhousing between the two friends left McKiernan upset.

But as McKiernan put the truck in gear, Pellegrin ran in front of the vehicle to try to get him to stop. The truck hit Pellegrin, who suffered severe brain injuries that left him with limited movement and speech.

Pellegrin, 29, is being cared for at his father's home near Houma, La.

Pellegrin's father, Jerry, said he was satisfied with the settlement, which pays $6 million immediately, invests another $6 million for future costs, and pays $6 million to Pellegrin's attorneys, who took the case on a contingency basis.

Boyle accepted the settlement but postponed judgment on the attorneys fees.
 

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The International Brain Injury Association published an article entitled Overcoming Anomy: The Impact of Positive Rituals on Quality of Life issue 3 2008. 

Thomas E. Pomeranz, Ed.D., President, Universal LifeStiles, LLC, Research and Policy Fellow Minot State University, has this to say:

Quality of life can be elusive and complicated for all individuals and can be dramatically so for people with traumatic brain injury who are globally challenged. Physical prowess, cognitive functioning, family, friends, sexuality, employment and hope are among the markers of a quality of life that may be jeopardized or lost for many with TBI. These losses and/or perceived losses combined with a lowered threshold for mediating one’s emotional state, commonly give rise to demonstrations of anger and hostility. This article is intended to provide the reader with an alternative therapeutic strategy to address these behaviors which interfere with a quality of life. If my life has no meaning or value, then I will behave in a way to cause your life to be void of meaning and value as well. When this statement was first shared with me I was struck by its profound implication relative to a variety of quality of life issues affecting many people with TBI. It was immediately evident that for a significant percentage of people with TBI, especially those requiring pervasive supports, that their life lacks meaning – diminished of value.

Read the full article by clicking Overcoming Anomy: The Impact of Positive Rituals on Quality of Life.
 

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Have you ever driven by the tent of cardboard boxes under the freeway and wondered why the people that live there don't get out and get a job or help themselves out of the dilemma?

A recent article points out that many homeless people suffer brain injury and are stuck in the very predicament they are in due to it.

More than one in three of Toronto's homeless suffered a traumatic brain injury prior to ending up on the streets, a new study indicates, suggesting that mental health is linked to homelessness.

Read the entire article by clicking here.

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Please Click here to link to an interesting resource on Concussions related to Youth Sports.  Now that school is back in full swing it would be wise to refamiliarize with the issues applicable to our kids.

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The Department of Defense awards $35M to study Mild Traumatic Brain Injury.  Of the 1.5 million people who suffer brain injury each year, roughly 75% are classified as "Mild" and have longterm and permanent impairments and disabilities.

A consortium of physicians and scientists in the Houston region is now undertaking a research initiative to improve diagnosis of mild traumatic brain injury (MTBI) and develop innovative treatment strategies.

The Department of Defense Post-Traumatic Stress Disorder and Traumatic Brain Injury Research Program of the Office of Congressionally Directed Medical Research Programs recently awarded the Mission Connect Mild TBI Translational Research Consortium a grant totaling approximately $35 million to support the five-year research program. The consortium includes research teams from The University of Texas Health Science Center at Houston, The University of Texas Medical Branch at Galveston (UTMB), Baylor College of Medicine, Rice University and the Transitional Learning Center in Galveston. The work will be done within the existing framework of Mission Connect, a consortium established by the TIRR Foundation in 1997 to facilitate collaborative research to improve outcomes for patients with brain and spinal cord injuries and neurological disorders.
 

To read the entire article click here.

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What do you really know about the human brain? That's the question that The Human Brain Web site asks. This site from the Franklin Institute contains "the fruit of decades of research."

In addition to participating in what the site describes as today's neuroscience renaissance, teachers, students and others interested in learning more about the care and feeding of the human brain will find this an interesting place to visit. Information on nourishing the brain features the "Brain Food Pyramid" diet and menu. Also included is information on protecting the brain and on the importance of exercise, sleep and stress relief in renewing the brain.
 

Click here to visit www.fi.edu/brain.

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Many times I am confronted by defenses amounting to genuine brain injury must impact all areas of impairments.  Not true.

In this article you can read about a man who was t-boned at 55 mph 8 years ago.  He describes his memory impairment. "It's like a file cabinet where all the files have been moved and overturned and moved around so I can't get to them."

"It's real bad, it upsets me too, big time, because just the knowledge that all the information that I've ever learned in my life is up here but I can't get to it."

Contrary to the notion that having a brain injury impacts each and every area of brain function and if it does not it must be something else, brain injury impacts individual brains in unique ways.  Just as all brains are unique to the individual, similar impacts have different consequences on differenct people.

 

Read the entire article by clicking here.

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Many times I am confronted by defenses amounting to genuine brain injury must impact all areas of impairments.  Not true.

In this article you can read about a man who was t-boned at 55 mph 8 years ago.  He describes his memory impairment. "It's like a file cabinet where all the files have been moved and overturned and moved around so I can't get to them."

"It's real bad, it upsets me too, big time, because just the knowledge that all the information that I've ever learned in my life is up here but I can't get to it."

Contrary to the notion that having a brain injury impacts each and every area of brain function and if it does not it must be something else, brain injury impacts individual brains in unique ways.  Just as all brains are unique to the individual, similar impacts have different consequences on differenct people.

Read the entire article by clicking here.

 

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Dr. Cardasis is a forensic psychiatrist; as opposed to a clinician.  He concludes that a person's tattoos makes it more likely than not the person has anti social personality disorder.  This is a rather general conclusion and my point in blogging this message is to illustrate how behavior can be interpreted and based on studies like this.  In terms of litigation of brain injury cases we may have to deal with potentially false conclusions about ourselves made by forensic experts who make a living testifying in court.

Dr. William Cardasis has worked at the Michigan Center For Forensic Psychiatry since 1996, where he is currently Director of the Male Admissions Unit, and in private practice of forensic psychiatry since 1997. He is a Distinguished Fellow of the American Psychiatric Association, a Fellow of the American Academy of Forensic Sciences, and a member of the American Academy of Psychiatry and the Law, and has rendered over one hundred court testimonies as an expert witness in forensic psychiatry.  

The presence of tattoos on forensic psychiatric inpatients should alert clinicians to a possible diagnosis of Antisocial Personality Disorder (ASPD), and also about the potential for histories of suicide attempt, substance abuse, and sexual abuse, according to research published today in Personality and Mental Health.

ASPD is a mental disorder characterised by several psychological and behavioural phenomena, including a lack of empathy and remorse, a low tolerance for anxiety, and shallowness. People with ASPD prefer action to thought, and pathological lying, cheating, stealing, physical aggression and drug abuse are not uncommon. To be diagnosed with ASPD, the individual must have developed this behaviour before the age of 15, and as such is qualitatively different from the idea of a scheming, dishonest business person or politician, unless the behaviour began earlier in life.

Cardasis W., Huth-Bocks A. and Silk K.; Tattoos and Antisocial Personality Disorder Personality and Mental Health 2008: Volume 2, Issue 3, 171-182. DOI: 10.1002/pmh.43

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Truck drivers with medical conditions are found to be a major cause of traumatic brain injuries. 

To see a short infomative video click here.

The AP had this to say:

Deadly Tolls: Sick truckers causing fatal wrecks

By HOPE YEN and FRANK BASS
Associated Press Writers

AP Photo/BILL HABER

WASHINGTON (AP) -- Tractor-trailer and bus drivers in the United States have suffered seizures, heart attacks or unconscious spells behind the wheel that led to deadly crashes on highways. Hundreds of thousands of drivers carry commercial licenses even though they also qualify for full federal disability payments, according to a new U.S. safety study obtained by The Associated Press.

The problems threatening highway travelers persist despite years of government warnings and hundreds of deaths and injuries blamed on commercial truck and bus drivers who blacked out, collapsed or suffered major health problems behind the wheels of vehicles that can weigh 40 tons or more.

The U.S. agency responsible for cracking down on unfit truckers, the Federal Motor Carrier Safety Administration, acknowledges it hasn't completed any of eight recommendations that U.S. safety regulators have proposed since 2001. One would set minimum standards for officials who determine whether truckers are medically safe to drive. Another would prevent truckers from "doctor shopping" to find a physician who might overlook a risky health condition. It's unclear whether any of the eight recommendations will be done before President Bush leaves office.

"We have a major public safety problem, and we haven't corrected it," said Gerald Donaldson, senior research director at the Washington-based Advocates for Highway and Auto Safety, whose members include consumer, health and safety groups and insurance companies. "You have an agency that is favorably disposed to maintaining the integrity of the industry's economic situation."

Truckers violating federal medical rules have been caught in every state, according to a review by the AP of 7.3 million commercial driver violations compiled by the Transportation Department in 2006, the latest data available. Texas, Maryland, Georgia, Florida, Indiana, Pennsylvania, Illinois, Michigan, Alabama, New Jersey, Minnesota and Ohio were states where drivers were sanctioned most frequently for breaking medical rules, such as failing to carry a valid medical certificate. Those 12 states accounted for half of all such violations in the United States.

Consider these cases:

-A Florida bus driver who suffers from lung disease and uses three daily inhalers to control breathing told congressional investigators that he "occasionally blacks out and forgets things." He works as a substitute driver despite not having a medical certificate, and his commercial license expires in 2010. The driver, who was not identified but will figure prominently in a congressional hearing this week, has collected Social Security benefits since 1994. He confided to investigators that he "gets winded" walking to his mailbox but has no problem driving a passenger bus.

-A Virginia trucker with a prosthetic leg from a farm accident more than 10 years ago is permitted to drive tanker trucks until at least 2012, even though he doesn't have the proper federal paperwork required for amputees. Virginia revoked the medical license for the official who approved him to drive over charges the official was caught illegally distributing controlled substances.

-George Albright Jr., 61, smashed his 70,000-pound tractor-trailer into congested traffic on Interstate 70 in June 2006, killing four women in a Ford sedan about 30 miles east of Columbia, Mo. Albright's employer agreed earlier this year to pay $18 million in a settlement. A Missouri jury acquitted Albright this month on four counts of second-degree involuntary manslaughter, after his lawyers argued in court that a diabetic episode "put him in an altered state of consciousness." Albright wasn't injured.

-A gasoline tanker plunged from an overpass and exploded in flames on Interstate 95 near Baltimore in January 2004, killing four people. Witnesses reported the driver slumped over the wheel. Maryland investigators concluded the driver, Jackie M. Frost, had suffered a heart attack or other medical emergency, but his family disputed that.

-The driver of a 15-passenger "Tippy Toes" day-care bus traveling 63 mph on Interstate 240 in Memphis, Tenn., in April 2002 crashed into a bridge, killing the driver and four of the six children aboard. The National Transportation Safety Board said the driver, Wesley B. Hudson, 27, fell asleep, "quite likely due to an undiagnosed sleep disorder." Investigators said children sometimes had to wake up Hudson, whom the NTSB described as obese and a marijuana user.

-A 55-passenger bus rolled off Interstate 610 in New Orleans in May 1999, killing 22 passengers. The NTSB said the bus driver, Frank Bedell, 46, suffered life-threatening kidney and heart conditions but held a valid license and medical certificate. Moments before the crash, a passenger recounted seeing the driver slumped in his seat. Bedell died three months later of an apparent heart-related illness. Investigators said he was treated at least 20 times in the 21 months before the accident for various ailments.

Some truckers said the government should enforce existing rules, not make new ones.

"Do you enjoy your clothing and house? Without the truck driver you would have none of it," said Gary Hull, 52, a trucker for a Louisiana company, as he drove from Edinburg, Texas, to Mansfield, La. "Our economy is based on the truck. People don't understand the ramifications of making it more restrictive for truck drivers to drive."

Hull said most drivers are hard workers who earn a modest salary and cope with rising diesel prices. New regulations could add to costs and force truckers to evade the rules, he said.

"There are enough government regulations as it is," agreed Ken Cornell, interviewed at a truck stop. "The medical profession should be able to take care of it. If they have a condition where they shouldn't be driving, they should be able to catch them."

The Transportation Department said 5,300 people died in crashes involving large commercial trucks or buses in 2006, the latest year for which figures are available, and about 126,000 more were injured. A federal safety study last summer found that cases where drivers fell asleep, suffered heart attacks or seizures or otherwise were physically impaired were a leading cause of serious crashes involving large trucks. But those cases included healthy drivers who fell asleep.

"The problem is major," said Dr. Kurt Hegmann, chairman of the federal motor carrier administration's medical oversight board, which is urging more doctor visits in many cases for truckers with serious medical conditions. "It's one of the biggest causes of occupational death in the United States today."

Congress may take action soon. The House Transportation and Infrastructure Committee, led by Rep. James Oberstar, D-Minn., will conduct oversight hearings Thursday. One proposal would create a clearinghouse for drug test results for commercial truck drivers to make it easier for employers to conduct checks. Oberstar's committee asked the Government Accountability Office to investigate unfit truck drivers.

The 30-page GAO study, obtained by the AP in advance of its release later this week, said 563,000 commercial drivers were determined by the Veterans Affairs Department, Labor Department or Social Security Administration to also be eligible for full disability benefits over health issues. It said disability doesn't necessarily mean a driver is unfit to operate a commercial vehicle, but its investigators found alarming examples that raised doubts about the safety of the nation's highways. They identified more than 1,000 drivers with vision, hearing or seizure disorders, which generally would prohibit a trucker from obtaining a valid commercial license.

The chief safety officer for the Federal Motor Carrier Safety Administration, Rose McMurray, acknowledged problems that could lead to unfit truck drivers on the roads. She blamed delays in reforms on a lack of federal money and difficulty coordinating with 50 states. McMurray said changes to strengthen the medical oversight program may not be done for months or even years.

"We have done a lot to recognize the deficiencies in our medical oversight program, and the building blocks we're establishing are very smart and very strong," McMurray said.

Families of crash victims said stronger safety rules can't happen soon enough.

William Hieronymus II of Salina, Kan., said he remembers eating cereal each morning with his 10-month-old son. His son William and wife, Amanda, died in May 2005 when a truck crossed a median and struck their SUV.

The driver, Scott A. Wegrzyn, pleaded guilty to two counts of vehicular homicide. Prosecutors said Wegrzyn knew he suffered from sleep apnea and went to a second doctor without disclosing the condition to obtain the medical certification he needed to drive.

"I try to go through a day without crying," Hieronymus said during Wegrzyn's trial. "I wonder every day what (Will) would have grown up to be, what he would have stood for." 


 

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I read an article in the August edition of Discover Magazine entitled, The Brain. In it, author, Carl Zimmer, asserts that “It’s possible that we reverse time in our memories in order to focus our brains on goals.”

“Staring at an angry face for five seconds feels longer than staring at a neutral one.”

Zimmer postulates, based on scientific studies, that “Keeping track of time is essential for perceiving what’s happening around us and responding to it.” In order to hear where a voice is coming from we unconsciously register how long the sound takes to reach both ears.

“It’s just a brief pause that makes the difference between ‘Excuse me while I kiss the sky’ and ‘Excuse me while I kiss this guy.’

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People who eat high levels of some soy products, including tofu and other so-called superfoods, may be at an increased risk of memory loss.

Loughborough and Oxford scientists, funded by the Alzheimer's Research Trust, worked with Indonesian colleagues to investigate the effects of high soy consumption in 719 elderly Indonesians living in urban and rural regions of Java.

The researchers' findings, to be published in Dementias and Geriatric Cognitive Disorders later this month, include evidence that a high consumption of tofu is associated with worse memory.

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A recent study appears in the July 2 online issue of Neurology, the medical journal of the American Academy of Neurology.

Research has shown that dementia prevalence for both men and women increases from age 65 to 85. The frequency of dementia increases with age from less than 2 percent for the 65-69-year-olds, to 5 percent for the 75-79-year-olds and to more than 20 percent for the 85-89 year olds.

Women over 90 are significantly more likely to have dementia than men of the same age, according UC Irvine researchers involved with the 90+ Study, one of the nation's largest studies of dementia and other health factors in the fastest-growing age demographic.

 

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The New York Times today reports that dementia drugs are being overused in the United States.  Read the full article by clicking here.

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Led by A/Prof Gary Egan, the Neuroimaging group at the Howard Florey Institute said that his group was using one of the most powerful Magnetic Resonance Imaging (MRI) scanners in the world - an ultra-high field 7 Tesla - to help develop the new brain mapping technology.

In a ground-breaking move, researchers at the Howard Florey Institute in Melbourne are developing a new technology to create individualised brain maps that will change the way disease is diagnosed, and will also enhance the accuracy of brain surgery.

Right now, researchers and neurosurgeons use coarse maps of the brain's structure that are based on a small number of individuals' brains after death. But these maps fail to show differences that can occur between people's brains.

This new brain mapping technology will be created by developing acquisition and analysis processes and software that will offer microscopic level investigation of individual brains.

In this project, Florey researchers are contributing neuroscience, engineering and mathematical expertise, while collaborators from the Neuroscience Research Institute in South Korea are providing the equipment.

The researchers are hoping that this technology will become widely available in the next two to three years.

Led by A/Prof Gary Egan, the Neuroimaging group at the Howard Florey

Read more click here.

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You might not just realize this while downing a mug of chilled beer on a summer afternoon, but a new study has revealed that too much alcohol can cause permanent damage to brain.

The study has shown that too much alcohol can also cause brain injury and degeneration by inhibiting insulin and insulin-like growth factor (IGF)

Insulin is not just for diabetes anymore.  New evidence reveals it is vital to normal brain function and alchohol inhibits it.

With the help of postmortem human brain tissue, researchers showed that chronic alcohol abuse can decrease levels of genes needed for brain cells to respond to insulin/IGF, leading to neurodegeneration similar to that caused by Type 2 diabetes mellitus.

"Insulin is one of the most important hormones in the body," said Suzanne de la Monte, professor of pathology/ neuropathology and clinical neuroscience at Rhode Island Hospital and the Warren Alpert School of Medicine at Brown University.

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I have read many articles and book chapters authored by Dr. Erin Bigler.  Dr. Bigler is a neuropsyhologist in Utah.  Dr. Bigler has assisted me in understanding neuroimaging along with neuropsychological issues of many of my clients.

Dr, Bigler was featured in a recent article in the Honolulu Star:

Technology to diagnose brain injuries has improved tremendously over 30 years, says Dr. Erin Bigler, noted clinical neurophysiologist.

"But the problem is we haven't made tremendous gains in how to treat these people," he added in an interview. "The brain is very complicated."

Bigler is a professor of psychology and neuroscience at Brigham Young University, adjunct professor of psychiatry at the University of Utah School of Medicine and faculty member of the Utah Brain Institute.

He is an author and researcher who is sharing his expertise with Hawaii psychologists and physicians as the Morita Distinguished Fellow for 2008 at the Rehabilitation Hospital of the Pacific.

He is also giving a class for psychology and neuropsychology fellows at Tripler Army Medical Center and a new neuroscience class at Brigham Young-Hawaii.

Bigler was at the Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix in 1975 when it was one of the first places to get computerized tomography.

"The first time I saw a CT scanner, it was like, 'Wow!'" he said. "It was very primitive, but we were now actually looking at brain tissue, not just a silhouette of the internal cavity."

Now, with improved CTs and magnetic resonance imaging, he said, "What we view today is exactly what you would see if you had an anatomic specimen."

This 3-D image shows a corpus callosum, which connects two halves of the brain. The different colors show the direction of major fiber tracks.


While the new imaging tools allow physicians to better diagnose problems in the brain, he said, "we're still in infancy in how to treat these. That's the focus that is so important right now.

"Brain tissue doesn't regenerate," he explained. "Therefore you have to deal with pathways that survive and how to re-engage those pathways. That is the goal of rehabilitation when the brain is injured."

The brain is well designed to withstand minor problems, Bigler said. "It recovers from a fall and a blow quite well. But it's a new era we're in. The brain isn't designed to withstand high-velocity impact," he said, such as from motor accidents, sports and military combat.

Gladiators were not at risk for traumatic brain injuries as much as National Football League players, he said.

An estimated 40,000 head injuries have occurred in Afghanistan and Iraq, Bigler said, noting former ABC World News co-anchor Bob Woodruff's recovery from traumatic brain injury in Iraq was "unbelievable." He said Woodruff's case shows much more could be done to treat brain injuries "if we had unlimited resources."

"Traumatic brain injury is a huge issue," he said. Many people in the past discounted effects of a mild head injury or concussion, thinking it could not have significant consequences, he said.

Most people do recover from a mild concussion, Bigler said, explaining he was knocked out playing football when he was a high school senior. He spent the night in the hospital but played the game the next weekend and went on to graduate, he said.

But more than 1 million to 1.5 million Americans have concussions, and 5 percent to 10 percent "don't have a good outcome," he said.

He said the key to knowing how to treat a brain disorder is to first understand the pathology, which is what he has been focusing on.

"When we started doing three-dimensional work with the brain ... it took us over six years to analyze the data because all of it had to be done by hand," he said. With automation, he said, his lab and others "can do in minutes to hours what would literally take us months to years to do a few years ago."

"We're looking to centers like REHAB to take the information and hopefully use it to guide therapies, to understand the brain better.

"With newer imaging techniques," Bigler said, "we may be able to target specific areas and tell how functional that area is, and there may be ways to engage that brain region" with medications, cell regeneration, cell growth stimulation, reconnections or repairing neurons.

The Morita Distinguished Fellow Program was established in 2003 in memory of SONY founder Akio Morita and his wife, Yoshiko. Morita received treatment at REHAB Hospital and became one of its major supporters.

Credit: By Helen Altonn haltonn@starbulletin.com

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Dr Joshua M Susskind and colleagues from the Department of Psychology, University of Toronto in Canada carried out this research, supported by a Canada Research Chairs program and a Natural Sciences and Engineering Research Council grant. It was published in the peer-reviewed science journal Nature Neuroscience.

"Fearful faces 'spot threats better'" is the headline on Channel 4 News. The Observer also reported on the same study at the weekend, claiming that a team of Canadian neuroscientists had solved the evolutionary mystery of why our faces contort in a certain way when we are scared.

The researchers found that when a group of students were told to make their eyes bulge or nostrils flare to mimic the facial expressions of fear, their ability to sense danger improved more than when they mimicked the face of disgust. This, the researchers say, supports Darwin's 1872 idea that facial expressions of emotion are often remarkably similar across human cultures, and even the animal kingdom, implying they may have a common evolutionary benefit. The researchers say that their experiment shows how a fearful expression is a protective one rather than a social one because it increases the range of vision, speeds up eye movement and improves airflow through the nose.

It is not clear how the facial expressions of fear or disgust might affect the selection processes that form the basis of evolutionary theory. However, the results of this testing demonstrate a plausible sequence of events for how selection might occur.

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Neuroscientist Dr Elizabeth Coulson's research was recently published in the Journal of Neuroscience.

Queensland Brain Institute (QBI) neuroscientists at UQ have discovered a new way to reduce neuronal loss in the brain of a person with Alzheimer's disease.

Memory loss in people with Alzheimer's disease can be attributed to several factors.
To read more click here.

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Italian Scientists in Turin have discovered evidence of neurogenesis, the creation of new neurons, in the cerebellum of rabbits.

These findings  mean stimulating the growth of the new neurons might be of greater value for the repair of injured brain tissue than stem cells.

The researchers said they are also considering the hypothesis that the neurogenesis they discovered in rabbits might well be related to the rabbits' relatively longer lifespan, compared with the lifespan of rodents, their close relatives. This authors say that hypothesis could create new areas of research concerning neurogenesis in the human brain.

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Progesterone in traumatic brain injury: time to move on to phase III trials.

Crit Care. 2008 May 29;12(3):153 published an article by  Vandromme M, Melton SM, Kerby JD.  The following is the abstract. 

ABSTRACT: There are several candidate neuroprotective agents that have been shown in preclinical testing to improve outcomes following traumatic brain injury (TBI). Xiao and colleagues have performed an in hospital, double blind, randomized, controlled clinical trial utilizing progesterone in the treatment of patients sustaining TBI evaluating safety and long term clinical outcomes. These data, combined with the results of the previously published ProTECT trial, show progesterone to be safe and potentially efficacious in the treatment of TBI. Larger phase III trials will be necessary to verify results prior to clinical implementation. Clinical trials networks devoted to the study of TBI are vital to the timely clinical testing of these candidate agents and need to be supported.

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Brain damage may occur due to a wide range of conditions, illnesses, injuries, and as a result of iatrogenesis. Possible causes of widespread (diffuse) brain damage include prolonged hypoxia (shortage of oxygen), poisoning by teratogens (including alcohol), infection, and neurological illness. Chemotherapy can cause brain damage to the neural stem cells and oligodendrocyte cells that produce myelin. Common causes of focal or localized brain damage are physical trauma (traumatic brain injury), stroke, aneurysm, surgery, or neurological illness.

The extent and effect of brain injury is often assessed by the use of neurological examination, neuroimaging, and neuropsychological assessment.

Brain injury does not necessarily result in long-term impairment or disability, although the location and extent of damage both have a significant effect on the likely outcome. In serious cases of brain injury, the result can be permanent disability, including neurocognitive deficits, delusions (often specifically monothematic delusions), speech or movement problems, and mental handicap. There may also be personality changes. Severe brain damage may result in persistent vegetative state, coma, or death.

Various professions may be involved in the medical care and rehabilitation of someone who suffers impairment after brain damage. Neurologists, neurosurgeons, and physiatrists are physicians who specialise in treating brain injury. Neuropsychologists (especially clinical neuropsychologists) are psychologists who specialise in understanding the effects of brain injury and may be involved in assessing the extent of brain damage or creating rehabilitation programmes. Occupational therapists may be involved in running rehabilitation programs to help restore lost function or help re-learn essential skills.

It is a common misconception that brain damage sustained during childhood has a better chance of successful recovery than similar injury acquired in adult life. It is contested that in recent studies, severe brain damage inflicted upon children can be alleviated by the interaction of nicotinamide repropagation in nerve cells. In fact, the consequences of childhood injury may simply be more difficult to detect in the short term. This is because different cortical areas mature at different stages, with some major cell populations and their corresponding cognitive faculties remaining unrefined until early adulthood. In the case of a child with frontal brain injury, for example, the impact of the damage may be undetectable until that child fails to develop normal executive functions in his or her late teens and early twenties.

The effects of impairment or disability resulting from brain injury may be treated by a number of methods, including medication, psychotherapy, neuropsychological rehabilitation, snoezelen, surgery, or physical implants such as deep brain stimulation.

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Green tea may shield brain from sleep apnea effects, says Amy Norton in Reuters Health -

 Compounds found in green tea may help ward off the neurological damage that can come with the breathing disorder sleep apnea, a new animal study hints.

Researchers found that when they added green tea antioxidants to rats' drinking water, it appeared to protect the animals' brains during bouts of oxygen deprivation designed to mimic the effects of obstructive sleep apnea (OSA).

The findings suggest that green tea compounds should be further studied as a potential OSA therapy, the researchers report in the American Journal of Respiratory and Critical Care Medicine.

OSA is a common disorder in which soft tissues in the throat temporarily collapse and block the airway during sleep, causing repeated stops and starts in breathing throughout the night.

The immediate symptoms include chronic loud snoring and gasping, as well as daytime sleepiness. Left untreated, OSA can eventually have widespread effects in the body; it's linked to high blood pressure, and research suggests that the intermittent dips in oxygen to the brain may lead to memory and learning difficulties.

In the new study, Dr. David Gozal and colleagues at the University of Louisville School of Medicine in Kentucky looked at whether green tea compounds called catechin polyphenols could help shield the brain from this oxygen deprivation.

Catechin polyphenols act as antioxidants, which means they help neutralize cell-damaging particles called oxygen free radicals. Free radicals are normal byproducts of metabolism, but in excess they lead to a state known as oxidative stress.

It's thought that the oxygen deprivation of OSA leads to oxidative stress, and that this, at least in part, explains the cognitive problems seen in some people with the sleep disorder.

Gozal and his colleagues found that when rats were exposed to periodic bouts of oxygen deprivation over 14 days, it did boost signs of oxidative stress in the brain. This didn't happen, however, if rats had been given water containing green tea polyphenols.

What's more, compared with rats given plain water, these animals performed better on a standard test of learning and memory -- a water "maze" designed to encourage the animals to remember the location of an escape platform.

In theory, Gozal told Reuters Health, a regular cup of green tea could be beneficial, used alongside standard OSA treatment.

"However," he said, "definitive proof that green tea would help will have to await a trial in human patients."

SOURCE: American Journal of Respiratory and Critical Care Medicine, May 15, 2008

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If you're one of the nearly 30 million Americans* who suffers from migraine headaches, you now have a new way to fight them. This month, a new drug is expected to land in pharmacies that combines two existing migraine drugs.

Find out more here.

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A compilation of studies reveal that overeating and undereating can contribute to onset of Alzheimers.  These findings as a risk factor may be important to lifestyle changes and propensities.

 

Read the full article here.

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In a medical era governed by managed health care and scientific advances, physicians have increasingly emphasized disease prevention and early diagnosis. Such a strategy both reduces costs, as it is generally much more cost-effective to prevent a disease than it is to treat its manifestations, and increases treatment efficacy, as most diseases are more easily cured or ameliorated earlier in their progression.

The premise is doing MRI scans BEFORE symptoms arise.  MRI is being offered to the public for as low as $200.

The pros and cons are discussed in an article entitled Brain Magnetic Resonance Imaging Scans for Asymptomatic Patients: Role in Medical Screening.

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Title: psychology

Date: 4/24/2008; Publication: The Columbia Encyclopedia, Sixth Edition;

psychology science or study of the thought processes and behavior of humans and other animals in their interaction with the environment. Psychologists study processes of sense perception , thinking, learning , cognition, emotions and motivations , personality , abnormal behavior, interactions between individuals, and interactions with the environment. The field is closely allied with such disciplines as anthropology and sociology in its concerns with social and environmental influences on behavior; physics in its treatment of vision, hearing, and touch; and biology in the study of the physiological basis of behavior. In its earliest speculative period, psychological study was chiefly embodied in philosophical and theological discussions of the soul.

Development of Modern Psychology

The De anima of Aristotle is considered the first monument of psychology as such, centered around the belief that the heart was the basis for mental activity. The foundations of modern psychology were laid by 17th-century philosopher Thomas Hobbes , who argued that scientific causes could be established for every sort of phenomenon through deductive reasoning. The mind-body theories of Rene Descartes , Baruch Spinoza , and G. W. Leibniz were equally crucial in the development of modern psychology, where the human mind's relation to the body and its actions have been significant topics of debate.

In England the empirical method employed in modern psychological study originated in the work of John Locke , George Berkeley , Thomas Reid , and David Hume . David Hartley , James Mill , John Stuart Mill , and Alexander Bain stressed the relation of physiology to psychology, an important development in the scientific techniques of modern psychology. Important contributions were made in the physiological understanding of human psychology by French philosopher Condillac , F. J. Gall , the German founder of phrenology, and French surgeon Paul Broca , who localized speech centers in the brain.

In the 19th cent., the laboratory work of Ernst Heinrich Weber , Gustave Fechner , Wilhelm Wundt , Hermann von Helmholtz , and Edward Titchener helped to establish psychology as a scientific discipline—both through the use of the scientific method of research, and in the belief that mental processes could be quantified with careful research techniques. The principle of evolution, stemming from Charles Darwin 's theory of natural selection, gave rise to what became known as dynamic psychology. The new approach, presented by American psychologist William James in his Principles of Psychology (1890), looked at consciousness as an evolutionary process.

Out of the new orientation in psychology grew the clinical experiments in hysteria and hypnotism carried on by J. M. Charcot and Pierre Janet in France. Sigmund Freud , in his influential theory of the unconscious, gave a new direction to psychology and laid the groundwork for the psychoanalytic model. Freudian theory took psychology into such fields as education, anthropology, and medicine, and Freudian research methods became the foundations of clinical psychology.

The behaviorism of American psychologist John B. Watson was highly influential in the 1920s and 30s, with its suggestion that psychology should concern itself solely with sensory stimuli and behavioral reaction. Behaviorism has been important in modern psychology, particularly through the work of B. F. Skinner since the 1930s.

Equally important was the development of Gestalt psychology by German psychologists Kurt Koffka , Wolfgang Köhler , and Max Wertheimer . Gestalt theory contended that the task of psychology was to study human thought and behavior as a whole, rather than breaking it down into isolated instances of stimulus and response.

Another influential school of psychology was developed in the 1950s and 60s by Abraham Maslow and Carl Rogers . Their humanistic theory asserts that people make rational, conscious decisions regarding their lives, and optimistically suggests that individuals tend to reach toward their greatest potential.

Modern Psychology

Modern psychology is divided into several subdisciplines, each based on differing models of behavior and mental processes. Psychologists work in a number of different settings, including universities and colleges, primary and secondary schools, government agencies, private industry, hospitals, clinics, and private practices. Recent years have seen a rise in the significance of applied psychology—as can be seen from the areas contemporary psychologists concern themselves with—with an attendant decline in the importance of psychology in academia. In the United States, clinical psychology has become a significant focus of the discipline, largely separate from psychological research. Clinical psychologists are responsible for the diagnosis and treatment of various psychological problems.

Biological models of behavior have become increasingly prominent in psychological theory, particularly with the development of various tools—such as the positron emission tomography (PET) scan—for mapping the brain. The field of neuropsychology, which studies the brain and the connected nervous system, has been an outgrowth of this contemporary focus on biological explanations of human thought and behavior. Cognitive models, derived from the Gestalt school of psychology, focus on the various thinking processes which mediate between stimuli and responses.

Educational psychology, derived from the 18th and 19th cent. educational reforms of Friedrich W. Froebel , Johann Pestalozzi , and their follower Johann Herbart , was later expanded by G. Stanley Hall and by E. L. Thorndike . It is concerned with the development of improved methods of teaching and learning.

Social psychology, developed by British psychologists William McDougall and Havelock Ellis , studies the effects of various social environments on the individual. Some other branches of the field include developmental psychology, which studies the changes in thought and behavior through the course of life; experimental psychology, which is the laboratory research involved in the understanding of the mind; and personality psychology, which deals specifically with individual personality and the processes by which it is formed.

In recent years a number of new fields of psychology have emerged. Industrial/organizational psychology, emerging from social psychology, focuses on the workplace and considers such topics as job satisfaction, leadership, and productivity. Health psychology examines how psychological factors contribute to pathology, and demonstrates how psychology can contribute to recovery and illness prevention for such somatic disorders as heart disease, cancer, and diabetes. In environmental psychology, research focuses on how individuals react to their physical environments, and suggests improvements which may be beneficial to psychological health. Other new areas of psychology include counseling psychology, school psychology, forensic psychology, and community psychology.

Bibliography

See R. Fancher, Pioneers in Psychology (1979); D. Robinson, An Intellectual History of Modern Psychology (1986); E. Hilgard, Psychology in America (1987); M. Ash and W. Woodward, Psychology in 20th Century Thought and Society (1989); R. B. Evans, V. S. Sexton, and T. C. Cadwallader, ed., The American Psychological Association (1992).

Author not available, PSYCHOLOGY., The Columbia Encyclopedia, Sixth Edition 2008
The Columbia Encyclopedia, Sixth Edition. Copyright 2008 Columbia University Press

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brain the supervisory center of the nervous system in all vertebrates. It also serves as the site of emotions, memory, self-awareness, and thought.

Anatomy and Function

Occupying the skull cavity (cranium), the adult human brain normally weighs from 2 1/4 to 3 1/4 lb (1-1.5 kg). Differences in weight and size do not correlate with differences in mental ability; an elephant's brain weighs more than four times that of a human. In invertebrates a group of ganglia or even a single ganglion may serve as a rudimentary brain.

By means of electrochemical impulses the brain directly controls conscious or voluntary behavior, such as walking and thinking. It also monitors, through feedback circuitry, most involuntary behavior—connections with the autonomic nervous system enable the brain to adjust heartbeat, blood pressure, fluid balance, posture, and other functions—and influences automatic activities of the internal organs. There are no pain receptors in brain tissue. A headache is felt because of sensory impulses coming chiefly from the meninges or scalp.

Anatomically the brain has three major parts, the hindbrain (including the cerebellum and the brain stem ), the midbrain, and the forebrain (including the diencephalon and the cerebrum). Every brain area has an associated function, although many functions may involve a number of different areas. The cerebellum coordinates muscular movements and, along with the midbrain, monitors posture. The brain stem, which incorporates the medulla and the pons, monitors involuntary activities such as breathing and vomiting.

The thalamus , which forms the major part of the diencephalon, receives incoming sensory impulses and routes them to the appropriate higher centers. The hypothalamus , occupying the rest of the diencephalon, regulates heartbeat, body temperature, and fluid balance. Above the thalamus extends the corpus callosum, a neuron-rich membrane connecting the two hemispheres of the cerebrum.

The cerebrum, occupying the topmost portion of the skull, is by far the largest sector of the brain. Split vertically into left and right hemispheres, it appears deeply fissured and grooved. Its upper surface, the cerebral cortex, contains most of the master controls of the body. In the cortex ultimate analysis of sensory data occurs, and motor impulses originate that initiate, reinforce, or inhibit the entire spectrum of muscle and gland activity. The parts of the cerebrum intercommunicate through association tracts consisting of connector neurons. Association neurons account for approximately half of the total number of nerve cells in the brain. The tracts are believed to be involved with reasoning, learning, and memory. The left half of the cerebrum controls the right side of the body; the right half controls the left side.

Other important parts of the brain include the pituitary gland , the basal ganglia, and the reticular activating system (RAS). The pituitary participates in growth regulation. The basal ganglia, located just above the diencephalon in each cerebral hemisphere, handle coordination and habitual but acquired skills like chewing and playing the piano. The RAS forms a special system of nerve cells linking the medulla, pons, midbrain, and cerebral cortex. The RAS functions as a sentry. In a noisy crowd, for example, the RAS alerts a person when a friend speaks and enables that person to ignore other sounds.

Nerve fibers in the brain are sheathed in a near-white substance called myelin and form the white matter of the brain. Nerve cell bodies, which are not covered by myelin sheaths, form the gray matter. The billions of nerve cells in the brain are structurally supported by the hairlike filaments of glial cells. Smaller than nerve cells and ten times as numerous, the glia account for an estimated half of the brain's weight. Cranial blood vessels in the brain have certain selective permiability characteristics that largely constitute the "blood-brain barrier." The entire brain is enveloped in three protective sheets known as the meninges , continuations of the membranes that wrap the spinal cord . The two inner sheets enclose a shock-absorbing cushion of cerebrospinal fluid.

Neural Pathways

Sensory nerve cells feed information to the brain from every part of the body, external and internal. The brain evaluates the data, then sends directives through the motor nerve cells to muscles and glands, causing them to take suitable action. Alternatively, the brain may inhibit action, as when a person tries not to laugh or cry, or it may simply store the information for later use. Both incoming information and outgoing commands traverse the brain and the rest of the nervous system in the form of electrochemical impulses.

The human brain consists of some 10 billion interconnected nerve cells with innumerable extensions. This interlacing of nerve fibers and their junctions allows a nerve impulse to follow any of a virtually unlimited number of pathways. The effect is to give humans a seemingly infinite variety of responses to sensory input, which may depend upon experience, mood, or any of numerous other factors. During both sleep and consciousness, the ceaseless electrochemical activity in the brain generates brain waves that can be electronically detected and recorded (see electroencephalography ).

Research

Brain research, now often referred to as a part of neuropsychology, cognitive science, psychobiology, or other similar fields, has become much more active in recent years. Aided largely by advanced new imaging techniques such as MRI ( magnetic resonance imaging) and the PET (positron emission tomography) scan, neuroscientists have been better able to localize specific functions involving thought, language, perceiving, mental imaging, memory, and other abilities. Much more has been learned about the roles of neurotransmitters as well. New life has been given to the traditional philosophical debate on how to reconcile the seeming contradiction between the richness of subjective experience, including self-awareness, with purely scientific explanations of brain function.

Bibliography

See D. Dennett, Consciousness Explained (1991); J. A. Hobson, The Chemistry of Conscious States (1994); S. A. Greenfield, The Human Brain (1997); M. R. W. Dawson, Understanding Cognitive Science (1998); J. M. Allman, Evolving Brains (1999).

Author not available, BRAIN., The Columbia Encyclopedia, Sixth Edition 2008
The Columbia Encyclopedia, Sixth Edition. Copyright 2008 Columbia University Press

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WHAT does it mean to be human, to be in control of one's own mind? What is the nature of consciousness, the mysterious property of self-awareness that we all have and yet which no scientist understands? Is there any such thing as free will, or are our minds at the mercy of some unknown force? These are the fundamental questions that have perplexed philosophers and, increasingly, scientists for centuries.

Until recently they seemed utterly unfathomable; after all, how do you test for something like free will in the laboratory? But now science is coming up with some fascinating -- and deeply uncomfortable -- answers.

This week, for instance, Professor John-Dylan Haynes and colleagues at the Max Planck Institute in Germany report the findings of an extraordinary experiment which seems to show that 'free will' -- the most cherished tenet of humanity, which decrees that Man has total control of his own actions -- may, in fact, be little more than an illusion.

For in their experiment, the scientists found that we may not be making conscious choices at all. Rather, our subconscious minds may be dictating our actions, long before we realise.
Analyse It is a troubling suggestion. As Prof Haynes says: 'The impression that we are freely able to choose between different possible courses of action is fundamental to our mental health.' If we are not in control after all, then that makes humans little more than automatons.
In his experiment, volunteers were asked to view a stream of letters on a computer screen and told, at some point, of their choosing, to press a button either with their left or right index finger -- and remember the letter that was on the screen when they did so.

The volunteers were also connected to brain-scanning MRI machines which were able to monitor and analyse brain patterns. These 'mind- reading' scanners could recognise when the brain had decided on a course of action.

To the researchers' astonishment, it turned out that the volunteers' brains would reach a decision about pressing one of the buttons several seconds before the volunteers actually thought they had made up their minds.

The implications are hugely significant, because the experiby ment suggests that what we think of as a 'conscious decision' may, in fact, be no such thing.

The traditional 'folk science' picture of the mind has our 'conscious self' as a little man sitting in our heads, pushing buttons and pulling levers, filing 'thoughts', receiving messages from eyes and ears and making our muscles move.

What Prof Haynes's experiment seems to show is that we need a new picture; instead of that little man pushing and pulling levers, he is merely a passive observer, lazing back in his chair and watching it all happen.

It is as though what we are actually aware of is no more than a film show, and the decision-making is made purely unconsciously.

Disturbing It is a disturbing picture, because it reinforces the view that we are mere machines, pieces of biological clockwork that have no more free will than a Swiss watch.
This sounds counter to common sense, but the more you think about it the more it is clear that much of what we do is done on 'autopilot' and that free will is rarely necessary.
If you regularly drive to work, for instance, at the end of your commute tomorrow try to remember the details of your journey. The chances are you will not be able recall more than the basics. When top tennis players are asked to think, consciously, about every stroke and every movement, their game falls to pieces.

Studies of elite sportsmen show that at the top of their game they are performing in a sort of semi-conscious fugue, purely on autopilot.

The 'will', if there is any, comes during the training process, not during the match.
Of course, if we really do not have free will, this opens a can of worms about human morality.
If the brain is a machine, whose decisions are entirely out of our conscious control, then can a criminal be held responsible for his actions? This is a dangerous road to go down. As Prof Haynes admits: 'It would lead to no one being held responsible for anything.' But this isn't the first time science has given a worrying insight into the workings of our brains.

Earlier this year, Nature magazine reported an extraordinary experiment in mind-reading technology.
No stage magic, smoke or mirrors here -- just the clever use of brain-scanning machines and computers to pinpoint and identify actual thoughts as they arise in the brain.

The scientists, led by Dr Jack Gallant of Berkeley University in California, again used MRI scanners to monitor brain activity when volunteers were shown various black and white photographs of everyday scenes -- a house and garden, various countryside views and so on.
The scanner and the computer it was attached to first had to 'learn' how the brain reacted to thousands of images -- what electrical patterns arose when the volunteer was looking at a picture of, say, a house or a car.

The volunteer was then shown photographs and the 'mindreading system' had to work out, from the patterns of electrical activity detected in the brain, what the subject was looking at.
Astonishingly, nine times out of ten the machine was able to work out what the person was looking at. As the authors freely admit, the way is now open to a general mind-reading machine, 'perhaps even to access the visual content of purely mental phenomena, such as dreams and imagery'.

If we can read minds, and even dreams, and prove that free will is a nonsense, then what does that say about the mystery of our minds? In fact, the human brain, for all this, remains by far the most mysterious object known to science.
It is still completely unknown how 3lb of wet jelly, plus tiny electrical currents powered by the energy we release from our food, can give rise to consciousness.
But it does.

Mystery Few modern people believe that the brain is pervaded by some sort of mysterious 'soul'; but how the neurones and synapses of the mind can generate subjective experiences of colour, smell, hate, fear and love is an utter mystery. In fact, many scientists believe it is the greatest mystery of all.

But unless we want to believe in 'souls' or 'auras', we must believe that the brain is a machine -- a very complicated machine, but a machine nonetheless. And that means its workings must, in principle, be deducible, that we can predict its every move, as this freewill experiment seems to show.

Does that mean we will one day be able to calculate what powers love, creates artistic masterpieces, sows awe, and experiences both great sorrow and utter joy? Maybe one day science will have an explanation for all this, but one suspects that even after the questions of the atoms and quarks, the planets and galaxies are finally answered, the deep puzzle of what exactly is going on in our heads will remain forever unsolved.
And perhaps that's the way it should be..

Copyright 2008 Daily Mail Date: 4/18/2008; Publication: Daily Mail; Author: Michael Hanlon

This document provided by HighBeam Research at http://www.highbeam.com

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Here is the latest Columbia Encyclopedia definition available for Title: PET scan

Date: 4/24/2008; Publication: The Columbia Encyclopedia, Sixth Edition;

PET scan or positron emission tomography , a medical imaging technique that monitors metabolic, or biochemical, activity in the brain and other organs by tracking the movement and concentration of a radioactive tracer injected into the bloodstream. The technique uses special computerized imaging equipment and rings of detectors surrounding the patient to record gamma radiation produced when positrons (positively charged particles) emitted by the tracer collide with electrons.

PET scans are especially valuable in imaging the brain. They are used in medicine to diagnose brain tumors and strokes, and to locate the origins of epileptic activity; in psychiatry to examine brain function in schizophrenia , bipolar disorder , and other mental illnesses; and in neuropsychology to study such brain functions and capabilities as speech, reading, memory, and dreaming.

Author not available, PET SCAN., The Columbia Encyclopedia, Sixth Edition 2008
The Columbia Encyclopedia, Sixth Edition. Copyright 2008 Columbia University Press

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Lawyers USA published an article last week entitled Defense experts using controversial 'malingering' test.

The author is continuing a series of criticisms leveled at Dr. Paul Lees Haley who is the creator of the Fake Bad Scale.  He uses it to categorize personal injury victims as "malingerers" and "fakes."  The fake bad scale was created in 1991 by Dr. Paul Lees-Haley, a neuropsychologist in Woodland Hills, Calif. who testifies as an expert witness for the defense.

Since the test recently gained acceptance by the University of Minnesota (the author of the Minnesota Multiphasic Personality Inventory, or MMPI scales), Lees-Haley's Fake Bad Scale is receiving clout.  Clout, according to leading doctors and lawyers, is false and misleading.

A person scores a point for answering questions positively.  The fake bad scale is a series of 43 true or false questions such as "I have very few headaches," "I have nightmares every few nights" and "My sex life is satisfactory."

Each response of a symptom adds a point toward the total score.

A total score of 23 out of 43 would be considered a "high score" and should "raise suspicions of over-reporting of symptoms," said Dr. Manfred Greiffenstein, a proponent of the test. He added that it would be virtually impossible for anyone who is not exaggerating to score 30 or higher.

However, critics note that the cut-off score has changed. The author previously recommended a cut-off of 20, while others have suggested a cut-off score of 26 for women.

Greiffenstein acknowledged that the test is scored on a "sliding scale."

A leading critic of the test, Dr. James Butcher, PhD, a senior author of the MMPI-2 and a professor at University of Minnesota, said that the fake bad scale does not meet the standards set by other MMPI-2 scales and "greatly overestimates" malingering.

As lawyers, Daubert and evidentiary challenges are raised as to the use and misuse of the Fake Bad Scale.

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A new 5 year study is underway to determine how to recognize and treat post traumatic brain stress disorder.

Military and civilian researchers from across Texas will be involved in a five-year study of the best way to detect and treat post-traumatic stress disorder.

The $33 million project will be led by the University of Texas Health Science Center and open to soldiers serving or being treated at Texas military installations, the San Antonio Express-News reported.

Few studies have been conducted that look for the best way to treat veterans and active duty personnel, said Alan Peterson, a retired U.S. Air Force psychologist and health science center professor.

The study will evaluate current forms of the standard treatment and medications. In addition, it will include neuro-imaging to observe changes in brain and genetic studies to search for genes that may place some people at greater risk for the disorder.

Read more from the United Press International.

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I came across this brief explanantion of some of the topics I will be presenting with Dr. Joseph Wu of University of California, Irvine, in next week's Brain Injury Association of America Conference in Las Vegas.  Here CT, MRI,fMRI, Spect and PET are discussed.  These diagnostics show us the structure and metabolism of the brain.  EEG (not discussed below) reveals electrical activity of the brain.

Dr. Wu is the Director of the Brain Imaging Center and will be discussing advances in Positron Emission Tomography technology and use in brain injury detection.  This information was derived from Microsoft® Encarta® Online Encyclopedia 2007:

Brain Imaging

Several commonly used diagnostic methods give images of the brain without invading the skull. Some portray anatomy—that is, the structure of the brain—whereas others measure brain function. Two or more methods may be used to complement each other, together providing a more complete picture than would be possible by one method alone.

Magnetic resonance imaging (MRI), introduced in the early 1980s, beams high-frequency radio waves into the brain in a highly magnetized field that causes the protons that form the nuclei of hydrogen atoms in the brain to reemit the radio waves. The reemitted radio waves are analyzed by computer to create thin cross-sectional images of the brain. MRI provides the most detailed images of the brain and is safer than imaging methods that use X rays. However, MRI is a lengthy process and also cannot be used with people who have pacemakers or metal implants, both of which are adversely affected by the magnetic field.

Computed tomography (CT), also known as CT scans, developed in the early 1970s. This imaging method X-rays the brain from many different angles, feeding the information into a computer that produces a series of cross-sectional images. CT is particularly useful for diagnosing blood clots and brain tumors. It is a much quicker process than magnetic resonance imaging and is therefore advantageous in certain situations—for example, with people who are extremely ill.

Changes in brain function due to brain disorders can be visualized in several ways. Magnetic resonance spectroscopy measures the concentration of specific chemical compounds in the brain that may change during specific behaviors. Functional magnetic resonance imaging (fMRI) maps changes in oxygen concentration that correspond to nerve cell activity.

Positron emission tomography (PET), developed in the mid-1970s, uses computed tomography to visualize radioactive tracers (see Isotopic Tracer), radioactive substances introduced into the brain intravenously or by inhalation. PET can measure such brain functions as cerebral metabolism, blood flow and volume, oxygen use, and the formation of neurotransmitters. Single photon emission computed tomography (SPECT), developed in the 1950s and 1960s, uses radioactive tracers to visualize the circulation and volume of blood in the brain.

Brain-imaging studies have provided new insights into sensory, motor, language, and memory processes, as well as brain disorders such as epilepsy; cerebrovascular disease; Alzheimer's, Parkinson, and Huntington's diseases (see Chorea); and various mental disorders, such as schizophrenia.

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I came across this brief explanation of some of the topics I will be presenting with Dr. Joseph Wu of University of California, Irvine, in next week's Brain Injury Association of America Conference in Las Vegas.  Here Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Functional Magnetic Resonance (fMRI), Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) are discussed.  These diagnostics show us the structure and metabolism of the brain.  EEG (not discussed below) reveals electrical activity of the brain. Dr. Wu is the Director of the Brain Imaging Center and will be discussing advances in Positron Emission Tomography technology and use in brain injury detection. 

This information was derived from Microsoft® Encarta® Online Encyclopedia 2007:

Brain Imaging

Several commonly used diagnostic methods give images of the brain without invading the skull. Some portray anatomy—that is, the structure of the brain—whereas others measure brain function. Two or more methods may be used to complement each other, together providing a more complete picture than would be possible by one method alone.

 

Magnetic Resonance Imaging or MRI

Magnetic resonance imaging (MRI), introduced in the early 1980s, beams high-frequency radio waves into the brain in a highly magnetized field that causes the protons that form the nuclei of hydrogen atoms in the brain to reemit the radio waves. The reemitted radio waves are analyzed by computer to create thin cross-sectional images of the brain. MRI provides the most detailed images of the brain and is safer than imaging methods that use X rays. However, MRI is a lengthy process and also cannot be used with people who have pacemakers or metal implants, both of which are adversely affected by the magnetic field.

Computed Tomography or CT

Computed tomography, also known as CT scans, developed in the early 1970s. This imaging method X-rays the brain from many different angles, feeding the information into a computer that produces a series of cross-sectional images. CT is particularly useful for diagnosing blood clots and brain tumors. It is a much quicker process than magnetic resonance imaging and is therefore advantageous in certain situations—for example, with people who are extremely ill.

Functional Magnetic Resonance Imaging of fMRI

Changes in brain function due to brain disorders can be visualized in several ways. Magnetic resonance spectroscopy measures the concentration of specific chemical compounds in the brain that may change during specific behaviors. Functional magnetic resonance imaging (fMRI) maps changes in oxygen concentration that correspond to nerve cell activity.

Positron Emission Tomography or PET

Positron emission tomography (PET), developed in the mid-1970s, uses computed tomography to visualize radioactive tracers (see Isotopic Tracer), radioactive substances introduced into the brain intravenously or by inhalation. PET can measure such brain functions as cerebral metabolism, blood flow and volume, oxygen use, and the formation of neurotransmitters. Single photon emission computed tomography (SPECT), developed in the 1950s and 1960s, uses radioactive tracers to visualize the circulation and volume of blood in the brain.

Brain-imaging studies have provided new insights into sensory, motor, language, and memory processes, as well as brain disorders such as epilepsy; cerebrovascular disease; Alzheimer's, Parkinson, and Huntington's diseases (see Chorea); and various mental disorders, such as schizophrenia.

 

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Why is it that when a group of soldiers share a horrific battle experience, some are able to work through it and get on with their lives while others suffer the persistent anxiety, emotional numbness and bomb-blasted nightmares of post-traumatic stress disorder (PTSD)?

The answer, researchers have long believed, is that an individual's response to trauma — whether in battle, or as result of a natural disaster, a violent crime or some other horror — depends not only on the intensity of that trauma but also on a complex interplay of past experiences and genetic factors. A new paper, published in the current issue of the Journal of the American Medical Association, provides remarkable support for this explanation and identifies a specific gene that influences susceptibility to PTSD.

Read the whole Time Article by clicking here http://www.time.com/time/health/article/0,8599,1723204,00.html?xid=rss-health

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A boater who was killed when a ray jumped out of the water in the Florida Keys and hit her face died of skull fractures and brain injuries, not from the animal's poisonous barb, a medical examiner said Friday.

Judy Kay Zagorski, 57, a community leader around her hometown of Pigeon, Mich., was in the front of a boat going 25 mph on Thursday when a 75-pound spotted eagle ray leapt from the water and hit her in a freak collision.

Monroe County's medical examiner, Dr. Michael Hunter, determined that the cause of death was "blunt force" head injury and that the collision with the ray killed her off Marathon, about 50 miles northeast of Key West.

Hunter's report noted she suffered "multiple skull fractures and direct brain injury resulting in sudden death," said Jorge Pino, spokesman for the Florida Fish and Wildlife Conservation Commission.

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Archeologists recently unearthed remains in Greece that appear to be evidence of brain surgery on a woman who died 1800 ago!

A bone expert who studied the finds said the skeleton belonged to a woman up to 25 years old who had suffered a severe blow to the crown of her head, Graikos said. The operation was apparently an attempt to save her life.

He said the clearly defined shape of the hole left in the woman's skull was a sign of relatively sophisticated surgery.

"She probably did not survive the operation, as the wound was very large, and there are no signs of healing around the edges," Graikos told The Associated Press.

The discovery in Veria appears to be similar to several others made in other parts of the former Roman Empire, said Simon Mays, an expert on human skeletal remains at English Heritage, a body which advises the British government.

"That kind of operation dates back a long way ... the earliest example dates back about 5,000 years ago in Europe," said Mays, who was not connected to the Greek excavation.

In early examples, cruder holes were made in the skull by slowly scraping the bone away around the edges, but more precise instruments were used in Roman times, he said.

"We know that (brain) surgery was carried out in the Roman empire, and some of the Roman textual sources give quite precise instructions as to how it should be carried out," Mays said.

"This probably fits in with a pattern about what we know (the Romans) could do

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Insurance companies are once again trying to preserve their income by cutting health care.  The rising cost of CT and other neuroimaging techniques is prompting insurance companies to look for ways to decrease their use.

There is certainly an argument that doctors have been placed in the unenviable position of having to protect themselves by practicing "defensive medicine."  But more compelling is the information neuroimaging provides in saving lives or prescribing proper care.

It is no wonder that diagnostic tests increase as technology increases.  Moreover, doctors' ability to see and treat disease increases with the use of neuroimaging technology.  Just as the Hubbell telescope  allows us to see things in outer space previously unseen and allows us to create theories of Relativity, we are better informed and able to understand that sun does not evolve around earth but earth around sun.

Fortunately health insurance companies do not dispute such theories and facts - but if they could save money doing it I bet they would!

Read the article in today's Newsday.

To read more click Study by Center for Studying Health System Change http://hschange.org/CONTENT/968/

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The work of Lakoff and Moskowitz has shown the value of understanding 21st century jurors attitudes and beliefs.  "Biconceptualism" is in and polarized conservative and progressive is out.

And, of course, David Ball and his comtemporaries have taught us all the value of focus groups in assessing the potential verdicts in cases.

Now a neuroscientist at Berkley is teaming with other specialists to expand the work of cognitive science.  Dr. Knight's name popped into the news when it was announced that Nielsen Co., still the world leader in "audience measurement," had made what it called a "strategic investment" in a theretofore unheard-of California company called NeuroFocus, where Dr. Knight additionally serves as chief science adviser and where Dr. A.K. Pradeep, who holds a PhD in engineering, serves as chief executive officer. Together they blend the science side and the business side of an enterprise that uses brainwave analysis to, they assert, unlock the Holy Trinity of advertising. As in:

Are you paying attention?

Are you emotionally engaged?

Have you retained the information that the advertiser is trying to implant in that brain of yours?

As for focus groups, on that subject Dr. Knight's animus is unvarnished. "They're a little bit like juries where it's eight to four for acquittal on the first vote. Then it's 12 to nothing for guilty four days later and it's usually because of social factors and group dominance and all those kinds of behaviours that emerge in a group situation."

"The simple fact is the brain makes behaviour," Dr. Knight continues. "If you can effectively measure the brain, which we think we can ... We can give you information that's not available by any other methodology. You just can't get it in conventional marketing."

This exciting field of cognitive science is making great strides in a variety of fields.  To read more click here http://www.theglobeandmail.com/servlet/story/LAC.20080315.RCOVER15/TPStory/?query=brain+guy

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Dr. Brian Levine of the Rotman Research Institute and the University of Toronto, whose study appears in the journal Neurology, finds brain volume loss occurs when tissue dies follwoing brain injury.  Levine found losses involved both frontal and posterior brain regions, and the damage was greatest to white matter: tissue that makes up the brain's communication network.

Levine studied brain scans taken from 69 traumatic brain injury patients whose head injuries ranged from mild to moderate or severe. The researchers used high-resolution magnetic resonance imaging or MRI to study changes in brain volume a year after the injury.

They ran a computer analysis of these images and found that even patients with mild brain injuries with no apparent scarring had less brain volume.

These findings, published in a widely recognized journal, will help physcians in assisting patients.  Levine said the study does not mean that people who have had mild head injuries will have a disability, but it might help to explain why some people never quite recover from their head injury.

"You hear this all the time from people, that they're not the same. A lot of times doctors don't know why," Levine said.

According the U.S. Centers for Disease Control and Prevention, at least, 1.4 million people in the United States suffer a traumatic brain injury each year.

At least 5.3 million Americans, or about 2 percent of the U.S. population, need help to perform activities of daily living as a result of their brain injuries.

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U.S. scientists have demonstrated living human nerve cells can be engineered into a network that might be used to repair nervous system damage.

University of Pennsylvania School of Medicine researchers created a three-dimensional neural network -- a mini nervous system in culture -- that can be transplanted en masse, said Professor Douglas Smith, director of the school's Center for Brain Injury and Repair.

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U.S. scientists have demonstrated living human nerve cells can be engineered into a network that might be used to repair nervous system damage.

University of Pennsylvania School of Medicine researchers created a three-dimensional neural network -- a mini nervous system in culture -- that can be transplanted en masse, said Professor Douglas Smith, director of the school's Center for Brain Injury and Repair.

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The Wall Street Journal published an article yesterday about the efficacy of the Fake Bad Scale.  Recently added to the MMPI personality test, the scale has generated heated controversy.

On one side are injury victims and their lawyers. who have the backing of Dr. Butcher, among others, and point out that the scale gives false conclusions.  On the other side is Dr. Paul Lees-Haley, the creator of the scale, backed by insurance companies and its lawyers, purporting the test is valid only in the subset of personal injury lawsuits.

Dorothy Clay-Sims, a Florida lawyer has lead the effort to expose the Fake Bad Scale as a tool that will, almost without exception, find anyone who takes it, a malingerer.

Read the full article here: http://online.wsj.com/article_email/SB120466776681911325-lMyQjAxMDI4MDA0NTYwNjU3Wj.html

 

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A Special Report in New Scientist  that scans reveal propensity of agression in teenagers was released today.  Specific brain anatomy is proportionate to agressive behavior.  Amygdalas were bigger in both sexes of adolecents demonstrating aggression when confronted in controlled tests.

For those who have children in adolesence, this information may, at least, make some sense of parenting this age group.

To read more click here. http://www.newscientist.com/channel/being-human/brain/dn13373-its-not-fair-brains-may-compel-teens-to-tantrum.html?feedId=brain_rss20

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Blast Injuries and veteran brain damage is gaining attention as the war in Iraq continues.  Here is an article that addresses how the brain is injured in explosion events and how the brain may actually become increasing damaged as the trauma continues.

Blasts cause delayed brain trauma

Improvised explosive devices have killed at least 1,600 soldiers in Iraq since the United States invaded in 2003. Thanks to high-tech body armor, new helmets, and better resuscitation techniques, many more soldiers now survive blasts. But this has revealed a new problem: Blast exposure, especially repeated exposure, can cause brain damage so subtle that soldiers may not realize they've been wounded. Ibolja Cernak, director of the Biomedicine Business Area at the Applied Physics Laboratory, says that these mild brain injuries can lead to gradual neurodegeneration, similar to Alzheimer's disease.

Most experts acknowledge that explosions can injure the brain even when there is no direct blow to the head. The prevailing argument has been that waves of compressed air emanating from the blast shake the skull with enough force to strain or stretch the brain, not unlike what happens in a bad car crash. "It's like a turbo-charged whiplash," says Ross Bullock, a professor in the Department of Neurological Surgery at the University of Miami.

But Cernak's research suggests a different mechanism. She posits that energy from the explosion compresses the abdomen and chest, generating oscillating waves in large blood vessels such as the aorta. These waves, she says, then carry that energy, at the speed of sound in water, to the brain, where it induces slight physiological changes in brain structures — for instance, slowing a cell's metabolism or altering the permeability of its membrane — that can lead to delayed neuronal cell death. The effects can cascade over time. Symptoms such as balance problems and impaired speech may manifest months or years after the blast. Cernak calls this syndrome blast-induced neuro-trauma (BINT).

"If what she's saying is true," says Jeff Bazarian, a brain injury expert at the University of Rochester Medical Center in New York, "then how the brain gets injured by a blast is very different than how it gets injured in a car accident." Not everyone is convinced that Cernak is right, but if she is, her hypothesis has implications for body armor design. Armor currently used in the field contains hard plates that could, according to Cernak's hypothesis, concentrate the power of a blast and make neurological damage worse.

Cernak began her career at the Military Medical Academy in Belgrade. During the fighting that followed the collapse of Yugoslavia in the late 1980s, she was one of the first to study the neurological effects of blast injuries, sometimes collecting blood samples on the battlefield minutes after an explosion. Today most of her research takes place in the lab, where she replicates blast pressure waves using a shock tube, and studies their effect on rodents.
"I've been fighting since 1990 with the military medical community to convince them that BINT exists," Cernak says. "It is still a fight, but finally this problem is getting acknowledged." —Cassandra Willyard, A&S '07 (MA)

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I am passing on this email to anyone interested in reviewing Craig's amazing story.  Actually there are many amazing stories of brain injury recovery to tell.  It helps to tell them especially since there are many more with less amazing endings.

Hello Mr. Titolo,

I am interested in providing encouragement to our veterans and the soldiers who have been wounded while protecting our great country. Additionally, I am interested in providing practical information and insight to assist their families. My name is Craig J. Phillips. I am an alumnus of Oral Robert’s University Class of 1985, an alumnus of the University of Kentucky, graduate program in Rehabilitation Counseling Class of 1990, and a traumatic brain injury survivor. I sustained an open skull fracture with right frontal lobe damage and remained in a coma for 3 weeks at the age of 10 in August of 1967. I underwent brain and skull surgery after waking from the coma. Follow-up cognitive and psyche / social testing revealed that I would not be able to succeed academically beyond high school. In 1967 Neurological Rehabilitation was not available to me, so I had to teach myself how to walk, talk, read, write and speak in complete sentences. I completed high school on time and went on to obtain both my undergraduate and graduate degrees. For an in depth view of my process please read my post, http://secondchancetolive.wordpress.com/2007/02/18/my-journey-thus-far/

Through out my lifetime I developed strategies to overcome many obstacles and in so doing I have achieved far beyond all reasonable expectations. On February 6, 2007 at the encouragement of a friend I created Second Chance to Live. Second Chance to Live, which is located at http://secondchancetolive.wordpress.com presents topics in such a way to encourage, motivate and empower the reader to live life on life’s terms. I believe our circumstances are not meant to keep us down, but to build us up. As a traumatic brain injury survivor, I speak from my experience, strength and hope. As a professional, I provide information to encourage, motivate and empower both disabled and non-disabled individuals to not give up on their process. Please read my post, http://secondchancetolive.wordpress.com My interest is to provide encouragement, hope, motivation and empowerment to survivors and their families.

Please encourage your readers to visit Second Chance to Live at http://secondchancetolive.wordpress.com and consider adding Second Chance to Live to your web site as a useful resource and placing a notice in your newsletter.

Thank you for your time and kindness.
Have a simply phenomenal day!

Craig J. Phillips MRC, BA
Second Chance to Live

Our circumstances are not meant to keep us down, but to build us up!
Note: I recently found out that Second Chance to Live has been published by the European Brain Injury Society E.B.I.S. with in their Autumn 2007 Newsletter http://www.ebissociety.org/automn/newsletter-angl.htm in both French and English. Specifically, My Journey thus Far has been printed. I am encouraged by the growing global interest of the material presented in Second Chance to Live and wanted to share the good news with you.
My article, Traumatic Brain Injury and Displaced Energy has been published by the Brain Injury Association of Niagara, Newsletter January 2008 http://www.niagara.com/bian/
Virginia Commonwealth University’s Department of Physical Medicine & Rehabilitation Neuropsychology http://www.tbi.pmr.vcu.edu/ My Journey thus Far, TBI Today Volume 6 Issue I — winter 2008 issue News, Ideas and Resources from the Virginia TBI Model System

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All members of the American armed forces will soon have their brain functions tested and recorded before and after deploying to a war zone, courtesy of federal legislation co-written by U.S. Sens. Susan Collins of Maine.

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The Boston Globe reported the case and verdict of a woman injured when hit by a bus.

A Middlesex County jury, after deliberating just four hours, awarded $10 million yesterday to a 58-year-old Somerville woman who suffered brain damage when she was hit by an MBTA bus while waiting to get to work. 

Louise Scialdone is unable to work and has trouble with her balance and her memory, said her lawyer, Paul Mitchell of Boston. She is sensitive to light and noise and, though formerly an avid reader, she can now handle only third-grade-level material, he said. She has good days and bad ones, Mitchell added.

"She can certainly pick up the phone and give you a call, but she might not be able to tomorrow," said Mitchell, who represented Scialdone at trial with his partner John DeSimone.

With interest, the Massachusetts Bay Transportation Authority now owes Scialdone close to $12.8 million from the date the suit was filed, said her lawyers and the MBTA. 

Scaldone will use the money to upgrade her care, which she needs around the clock, at a cost of about $200,000 a year, Mitchell said. She will move from a nursing home to a brain injury rehabilitation center.

It was icy on Feb. 4, 2004, when Scialdone, who used a walker because of arthritis, was waiting at a bus stop on McGrath Highway, on her way to her job as a clerk at the Massachusetts Department of Transitional Assistance. The bus driver lost control of the vehicle, fishtailed onto the sidewalk, and knocked Scialdone off her feet, Mitchell said. Scialdone was thrown 5 feet, and her head hit a parked car, Mitchell said. She was knocked unconscious and hospitalized for 13 hours. A week later, she was readmitted for 20 days. She filed the lawsuit 18 months later.

Scialdone's lawyers told the 16-member jury that the bus driver was traveling too fast for the slick roads. A witness estimated that the bus, which was out of service, was moving about 30 miles per hour, the lawyers said.

The T argued that some of Scialdone's injuries were caused by her preexisting arthritic condition. Because of her injuries, Scialdone attended only part of the two-week trial, Mitchell said.

The bus driver who hit Scialdone, Tracy Sullivan, remains on the job, Mitchell said.

Pesaturo, citing policy, would not confirm the driver's name but said she served a one-day suspension before returning to work.

Attempts to reach her through the MBTA were unsuccessful.

Before the case went to trial, Mitchell offered to settle for $9 million, but the T offered no more than $1 million, Mitchell said.

Stephanie Mackesy, Scialdone's daughter, drove from Bennington, N.H., to attend the trial.

She said her mother used to take her 14-year-old grandchild on vacations and day trips to museums, but cannot interact the same way with her 3-year-old granddaughter.

"It's completely ruined my mother's life," said Mackesy.


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Congress held numerous budget and appropriations hearings this week, as well as several hearings addressing health care provided to wounded service members and veterans.

The House Appropriations Subcommittee on Labor, Health and Human Services, and Education (Labor-HHS-Ed) held a hearing on Thursday on this year’s proposed budget for the Department of Health and Human Services, featuring HHS Secretary Michael Leavitt as a witness. At the same time, BIAA signed on this week to a coalition letter to the Subcommittee urging its Members to provide $30 million for TBI Act programs this year.

Also this week, both chambers of Congress held important hearings on efforts to improve health care for returning service members, as well as to improve the veterans’ disability benefits system. BIAA submitted questions and comments in relation to several of the hearings.

A significant victory in Medicaid policy was achieved late this week as well, as a Senate Amendment to prevent implementation of the Administration’s proposed regulation restricting reimbursement for Medicaid Targeted Case Management (TCM) was successfully added to an Indian health bill. The Amendment would establish a Moratorium on implementation of the TCM interim rule until April 1, 2009.

Please note that Congress will be not be in session next week, as both chambers observe a week-long Presidents’ Day Recess.

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 Time magazine reports that Post Traumatic Stress Disorder risk is elevated in situations where a concussion occurs.  But not all concussions result in PTSD and not all PTSD requires concussion.

The article, along with the many others since the Afghanistan and Iraq wars, have brought the focus on brain injury and related issues into the public forum.  I hope this "awakening" will help educate lawyers, insurance companyies, Judges and juries about the very real "unseen" injury.

To read the article click here.

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Great article in the Wall Street Journal.  Researchers studying brain injury believe they've found a common thread running through many cases of seemingly unrelated social problems: a long-forgotten blow to the head.

"Unidentified traumatic brain injury is an unrecognized major source of social and vocational failure," says Wayne A. Gordon, director of the Brain Injury Research Center at Mount Sinai School of Medicine in New York, where much of the research is being done.

To read the full article click here.

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This is an interesting video I came across while reading the Wall Street Journal's piece on Brain Injury.  Check it out here.

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Laura Schiebelhut, BIAA Public Affairs Manager asked me to distribute this update:

President Bush signed the National Defense Authorization Act for Fiscal Year 2008 (H.R. 4986), containing important wounded warrior provisions related to TBI care which BIAA actively lobbied for last year, into law on Monday.

At the same time, negotiations continued over the development of an economic stimulus package, as the House passed its version of the bill, which represents a compromise with the Bush Administration. This House version does not include increases in federal Medicaid payments to states, which BIAA strongly supports. BIAA will continue advocating for the inclusion of provisions to raise Medicaid reimbursement rates to states as Senate negotiations on the package go forward next week.

Looking ahead, President Bush’s Proposed Budget for Fiscal Year 2009 will be delivered to Congress on Monday, February 4. Unfortunately, early reports are that funding for government health programs will be dramatically decreased by more than $2 billion.

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I continue to follow the efforts made in diagnosing and treating brain injuries of war veterans.  The NY TImes reported a new study published in the New England Journal of Medicine.

About one in six combat troops returning from Iraq have suffered at least one concussion in the war, injuries that, while temporary, could heighten their risk of developing post-traumatic stress disorder, researchers are reporting.

The study, in The New England Journal of Medicine, is the military’s first large-scale effort to gauge the effect of mild head injuries — concussions, many of them from roadside blasts — that some experts worry may be causing a host of undiagnosed neurological deficiencies.

The new report found that soldiers who had concussions were more likely than those with other injuries to report a variety of physical and mental symptoms in their first months back home, including headaches, poor sleep and balance problems. But they were also at higher risk for the stress disorder, or PTSD, and that accounted for most of the difference in complaints, the researchers concluded.

Read more click here.

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The Las Vegas Review Journal reports on the Canadian Wait time for medical care.  I have been following this in my blogs over the past month.  Seems that the consensus is that there is a downside to socialized medicine when it comes to getting care quickly and that certainly is a DOWNSIDE.

To read more and see how the democratic candidates weigh in click here.

American supporters of socialized medicine have learned not to call it that, anymore. Instead, they use euphemisms such as "single payer" -- as though they seek to hold some giant lottery in which a Yazoo City garage mechanic named Billy Bob Bufus would be selected to reach into his coveralls and pay everybody else's medical bills for a year.

Early on in his administration, looking for something for the first lady to do, Bill Clinton appointed his wife to head up a giant secret task force to draw up a proposed new nationalized "Health Security Act." Mrs. Clinton put together a 1,300-page doozy. Under her plan, anyone attempting to "get out of line" and pay cash for faster medical attention could have gone to jail.

That sounds far-fetched, but it's actually typical of any "one-payer" government medical monopoly. If things in limited supply are not rationed by price, they have to be rationed by bureaucrats.

Stuart Browning is a young filmmaker who has put together a series of short films warning Americans about the dangers of collectivized medicine and the benefits of free markets in health care. One of these films, "A Short Course in Brain Surgery" can be viewed for free in only a few minutes on your home computer, at www.freemarketcure.com/brainsurgery.php. It's worth the time.

The five-minute short introduces us to a retired Ontario body shop manager named Lindsay McCleith. Mr. McCleith had terrible headaches and suffered a seizure. Both he and his doctor suspected a brain tumor, and asked the Canadian National Health system to schedule the diagnostic test known as an MRI. Mr. McCleith got his appointment -- four months away.

He and his wife offered to pay cash to get faster attention. But that's not allowed in Ontario. (Sound familiar?)

He crossed the border to Buffalo, N.Y., and got his test in four days. Turned out he had a brain tumor the size of a golf ball. Armed with this evidence of the seriousness of his condition, he returned to Canada, seeking quick surgery and reimbursement for his expenses. The Canadian "single-payer" system which American leftists yearn to emulate would do neither.

His doctor estimates Mr. McCleith would have waited eight months for treatment in his home country. Here, the whole process -- diagnosis, consultation, surgery -- took one month.

Fortunately, he and his wife had enough money to cover the $28,000 cost -- though Sandra McCleith says she would have gladly mortgaged her home to pay the bills. "When your life is in danger, you're desperate," she says.

That only works if you can get to America, though. No amount of money would have bought them timely treatment in Canada. Even "asking for permission" to go to the United States takes eight months.

Today, Hillary Clinton says she's "learned her lesson" about proposing socialized medicine.

But one examines her written and spoken record in vain for any declaration that government-enforced collectivism is inherently wrong, in medicine or anywhere else. Instead, we're left to conclude the "lesson" Sen. Clinton has learned is that it's wiser to impose socialized medicine incrementally, one small step at a time, rather than be honest and spell out your intentions, handing fans of freedom as fat and juicy a target as her gigantic "Health Security Act."

Nor is there any indication that her remaining Democratic opponent, Sen. Barack Obama, has foresworn this vital plank in the socialists' century-old roadmap to serfdom, either.

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Rep. Baron Hill, D-Ind. (9th CD), has issued the following news release:

"Americans were shocked to learn one year ago of a crisis in care for soldiers returning from Iraq and Afghanistan," Hill added. "America can do better, and this historic funding increase, paired with our Wounded Warriors Act reforms, puts us on the right track for America's veterans."

With the release of these funds, the 110th Congress has provided an extra $6.7 billion over last year for the largest single funding increase in the 77-year history of the Department of Veterans Affairs. This funding is primarily aimed at:

* X Strengthening quality health care for 5.8 million patients, including about 263,000 Iraq and Afghanistan veterans, in the 5th year of the war in Iraq;

* X Investing in much-needed maintenance for VA health care facilities and treatment for Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury for returning veterans;

* X Reducing the backlog of veterans (400,000 claims) waiting for their earned benefits by adding 1,800 claims processors.

* X Building on the first steps by this Congress at the beginning of 2007 - increasing veterans' health care and benefits by $5.2 billion for improved care and shorter waiting lines for veterans waiting 177 days to receive their earned benefits.

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BIAA policy corner coordinator Laura Schiebelhut asked to post this latest legislative update.

The Senate passed this week a slightly revised version of the National Defense Authorization Act for Fiscal Year 2008 (H.R. 4986), following House approval of the same bill last week. Important wounded warrior provisions related to TBI care remain unchanged in the new version, which President Bush is expected to sign into law shortly.

Also this week, negotiations ensued over an economic stimulus package, resulting in a bipartisan agreement by the week’s end. BIAA signed on to a coalition letter urging House and Senate leaders to raise Medicaid reimbursement to states.

In addition, on Tuesday, Sen. Michael B. Enzi (R-WY) unveiled, “Guidelines for Assisting Those with Accessibility Needs,” a manual designed to make congressional offices more accessible to individuals with disabilities. BIAA helped provide suggestions for the guide, which was distributed to all House and Senate offices.

Looking ahead, President Bush will deliver his State of the Union Address on Monday, January 28. This will be followed by the release of the President’s Proposed Budget for Fiscal Year 2009 on Monday, February 4.

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

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

Senate Passes Revised Defense Authorization Bill

On Tuesday, the Senate passed a slightly revised version of the National Defense Authorization Act for Fiscal Year 2008 (H.R. 4986), following House approval of the same bill last week. Important wounded warrior provisions related to TBI care remain unchanged in the new version, which President Bush is expected to sign into law shortly.

The revised bill contains new language altering a provision in the original bill which expanded the rights of victims to sue foreign governments designated by the State Department as state sponsors of terrorism.

The White House unexpectedly announced on December 28, 2007, that President Bush would not sign the original bill because it included a provision which could allow plaintiffs to freeze Iraq government assets in the United States while their claims against Iraq were being litigated (Iraq was listed as a state sponsor of terrorism under Saddam Hussein’s regime).

One of BIAA’s policy goals for 2008 will be to monitor the implementation of the important TBI provisions contained in this bill. (The December 14, 2007 edition of Policy Corner contains more detailed information on these TBI provisions. You can access this issue, as well as all other archived issues of Policy Corner, by visiting BIAA’s webpage at http://www.biausa.org/policycorner.htm).

Negotiations Ensue Over Economic Stimulus Package

Also this week, negotiations focused on putting together an economic stimulus package, resulting in a bipartisan agreement by the week’s end, although the Senate is expected to possibly bring up further amendments during its consideration of the package in coming weeks.

BIAA signed on to a coalition letter urging House and Senate leaders to temporarily raise Medicaid reimbursement to states in order to prevent states from being forced to make cutbacks in essential state services. Such essential Medicaid services include health care and long-term services and supports, which are often especially important to individuals with disabilities.

BIAA Helps Make Congressional Offices More Accessible

Earlier this week, Sen. Michael B. Enzi (R-WY) unveiled, “Guidelines for Assisting Those with Accessibility Needs,” a manual designed to make congressional offices more accessible to individuals with disabilities.

Through the hard work of Robert Demichelis, BIAA helped provide suggestions for the guide, which was distributed to all House and Senate offices.

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The Ministry of Defence reported the following:

Brain injuries can result from relatively minor head injuries or exposure to blasts.
The MoD's surgeon general, Lieutenant General Louis Lilly-white, initiated a project in June last year to investigate mTBI and make recommendations concerning clinical care, education and research.

The Under Secretary of State for Defence, Derek Twigg, said: "The commissioning of this study by the surgeon general shows that the MoD is determined to do all that it can to look after the mental health of our forces.

"The study has concluded that there is no evidence to suggest that the operational capability of the UK's Armed Forces is being affected by mTBI. We routinely screen every member of the military for mTBI who undergoes treatment at any of our emergency medical facilities, regardless of the nature of their injuries. However, research is continuing, covering not only such areas as identifying and diagnosing mTBI cases, but also their prevention."

The Royal Centre for Defence Medicine in Selly Oak, Birmingham, has identified 585 cases of casualties with Traumatic Brain Injury from a total of more than 36,000 patients treated since 2003.

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The young women had survived the car crash. In the five months since parts of her brain had been crushed, she could open her eyes but didn't respond to sights, sounds or jabs. In the jargon of neurology, she was judged to be in a persistent vegetative state. In crueler everyday language, she was a vegetable

Try to comprehend what it is like to be that woman. Do you appreciate the words and caresses of your distraught family while racked with frustration at your inability to reassure them that they are getting through? Or do you drift in a haze, springing to life with a concrete thought when a voice prods you, only to slip back into blankness? If we could experience this existence, would we prefer it to death? And if these questions have answers, would they change our policies toward unresponsive patients--making the Terri Schiavo case look like child's play?

Click here to read the whole story in Time.

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In the ongoing quest to understand and treat war injuries, the NIH has shown that certain organic injury to the brain actually reduces the the occurence of non-organic injury.

NINDS is a component of the National Institutes of Health (NIH), and is the nation's primary supporter of biomedical research on the brain and nervous system.

Brain scans of combat-exposed Vietnam War veterans showed that certain serious head injuries to certain parts of the brain can prevent soldiers from developing post-traumatic stress disorder (PTSD).

The findings, from the National Institutes of Health (NIH) and the National Naval Medical Centre, suggested that drugs or pacemaker-like devices aimed at dampening activity in these brain regions might be effective treatments for PTSD.

Jordan Grafman, Ph.D., a senior investigator at the National Institute of Neurological Disorders and Stroke (NINDS), part of NIH, turned to the Vietnam Head Injury Study (VHIS) to make that distinction. The VHIS is a registry of Vietnam veterans who sustained penetrating brain injuries (which are less common in Iraq compared to concussion brain injuries). It has received support from the Department of Defense, the Department of Veterans of Affairs and NIH, and is currently supported by NINDS.

"If we could show that lesions in a specific brain region eliminated PTSD, we knew we could say that the region is critical to developing the disorder," said Dr. Grafman. The results of his study appear online today in "Nature Neuroscience".

To read the full article click here.

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Important research may lead to amending the Diagnostic and Statistical Manual for Mental Disorders (DSM) to include Attention Deficit Disorder (ADD).

"As an organization dedicated to providing information and resources to adults with ADHD, we are excited to see such attention paid to this disorder," said Evelyn Polk-Green, MS, Ed., ADDA President-elect and adult living with ADHD. "The reason why these findings are so important is that they help to inform people that ADHD is not just a childhood disorder, but in fact, a disorder that may affect multiple aspects of adult life and should be properly diagnosed and treated. This research also reinforces the need for formalized and validated criteria for the diagnosis of adult ADHD and may play a significant role in the development of this diagnostic criteria and the addition of it to the Diagnostic and Statistical Manual of Mental Disorders."

You can visit the Attention Deficit Disorder Association (ADDA) by clicking here.

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eBay has begun selling Psychological tests used in the assessment and evaluation of criminal defendants, students and others, including TBI victims, online.  Harcourt, the publisher of the Weschsler Adult Intelligence Scale (WAIS) argues that allowing such public dissemination of the test will impugn the test's credibility since unscrupulous lawyers or parents will attempt to abuse its availability.

Given more than a million times a year nationwide, according to Harcourt, the intelligence tests often are among numerous tests ordered by prosecutors and defense attorneys to determine the mental competence of criminal defendants. A low IQ, for example, can be used to argue leniency in sentencing.

This issue, whether to allow dissemination of psychological tests to non-psychologists, in cases of traumatic brain injury is ongoing.  Frequently, neuropsychologists who do not want the raw data they have compiled for a testee scrutinized, will assert that releasing test booklets is a violation of ethics.  Doing so, they argue, will allow lawyers to coach their clients to give false results.

"In order to maintain its integrity, there needs to be limited availability,"  Harcourt spokesman Russell said.

This issue is frequently seen in cases of traumatic brain injury when plaintiff lawyers try to analyze the results of the testing done at the insurance company's insistence.

To read the AP article click here.

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The Associated Press reports senate approved defense spending bill to assist troops.

The Senate on Friday passed a defense policy bill that would offer more help to troops returning from combat and set conditions on contractors and pricey weapons programs.

The measure reflects the best Democrats could do this year on their national security agenda while holding such a slim majority. Powerless to overcome GOP objections in the Senate, the bill does not order troops home from Iraq, as Democrats would have liked.

To Read the full story click here.

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A New York Times report reveals the effects of a child's I.Q. and family income.

Children develop most of their basic verbal, memory and abstract reasoning skills from ages of 6 to 10, and the effect of family income on these abilities may be smaller than previously thought, scientists are reporting. The findings, which appear online in The Journal of the International Neuropsychological Society, are from a large, continuing government study tracking changes in cognitive abilities and brain structure. The difference in I.Q. scores between low-income and high-income was about 10 points, when youngsters with learning disabilities were excluded; previous studies have found differences of 15 to 20 points. “The purpose is to provide a large, public database of healthy, normal brain development,” said the lead author, Dr. Deborah P. Waber, a pediatric researcher at Children’s Hospital Boston and Harvard University.

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Dr. Elizabeth Zelinski of the University of Southern California is making a presentation today at the annual meeting of the Gerontological Society of America.  She is revealing initial data from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training study (IMPACT).  This study is the largest  for aging and cognitive training.

The right kind of brain exercise enhances memory and other cognitive abilities of older adults.  To read the entire article click here.

The website Posit Science: Your Brain will Thank You is a great resource to improve you cognitive ability.  The Brain Fitness Program is a series of computer-based exercises that are scientifically proven to improve important brain functions.

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Leading neuroscientists and practitioners debunk common myths related to health and fitness of the brain in a new whitepaper from SharpBrains, Inc. The 11 experts help illuminate the growing research on the role of "brain exercise" for brain fitness, one of the promising areas being discussed this week during the 37th annual meeting of the Society for Neuroscience in San Diego.

Health and Medicine-related myths

- Myth 1: It's all in our genes. Reality: A big component of our lifelong brain health and development depends on what we do with our brains. Our own actions, not only our genes, influence our lives to a large extent.

- Myth 2: The field of Brain Fitness is too new to be credible. Reality: The field rests on solid foundations dating back more than a decade - what is new is the number and range of tools that are now starting to be available for healthy individuals.

- Myth 3: Medication is and will remain the only evidence-based intervention for problems such as ADD/ ADHD for many years to come. Reality: Cognitive training programs are starting to show value as complements to drug-based interventions.

Education-related myths

- Myth 4: We need to buy expensive computer-based programs to improve our brains. Reality: Every time we learn a new skill, concept or fact, we change the physical composition of our brains. Lifelong learning means lifelong neuroplasticity.

- Myth 5: Schools should just focus on basic skills like Reading and Math. Reality: "Mental muscles," such as working memory, are fundamental to academic performance and are currently overlooked by the school system.

Corporate Training myths

- Myth 6: On-the-job training is the only way to train one's mind. Reality: Computer-based programs can be more effective at developing specific "mental muscles."

- Myth 7: Brain exercise is only for seniors. And, only about memory. Reality: People of all ages can benefit from a variety of regular brain exercises. For active professionals, managing stress and emotions is often a good first step.

- Myth 8: This all sounds too soft to be of real value to business people. Reality: There is nothing soft about the hard science-based training of specific cognitive and emotional skills.

Gaming-related myths

- Myth 9: Videogames are always a waste of time. Reality: Scientifically designed, computer-based programs can be a good vehicle for training specific skills. For example, it has been shown that short term memory can be expanded by such programs.

- Myth 10: This means kids will spend more time playing videogames. Reality: In Japan - the world's earliest adopter of brain-related videogames - overall home videogame sales have declined, with children playing less over time. Interestingly, adults in Japan have started to play brain-related videogames more. 

 For more information about health and fitness and the brain, visit www.SharpBrains.com.

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Any blast that impacts the eye is a "head injury" and impacts the brain as well.  Glenn Minney lost most of his sight from a combat explosion. But it wasn't just the injuries to his eyes that cost him his vision it was also damage to his brain.  

Minney, then a Navy corpsman, was wounded when a mortar landed near him in Haditha, Iraq, in 2005. The blast threw him 30 feet. His back struck a metal railing, whipping his head backward. He lost his right eye. Vision in his left eye is impaired from physical injury and brain damage, he says.

An emerging threat from the fighting in Iraq and Afghanistan is damage to the brain that affects vision, Pentagon and Department of Veterans Affairs medical researchers say. This type of injury could mean that there are thousands of veterans with undiagnosed vision problems, says Tom Zampieri, of the Blinded Veterans Association.

Doctors didn't find Minney's neurological damage until after he left the military and was screened for brain injuries by the VA. "The public doesn't know the true extent of these (brain) injuries," says Minney, 40, married and the father of two. He's now a patient advocate for the VA in Frankfort, Ohio.

Concerns about eye injuries have prompted federal legislation that would create a $5 million Pentagon-based center for research and treatment of injured eyes. It also would create a registry to track eye wounds.

Minney suffered severe vision loss. Researchers are finding that less-severe vision problems also can occur among troops who suffer minor brain concussions from combat, particularly exposure to a blast. "There are a lot of patients who have suffered mild to moderate brain injuries. Upon initial examination their eyes looked healthy, but they were still reporting problems with their vision," says R. Cameron VanRoekel, an Army optometrist at Walter Reed Army Medical Center in Washington.

Gregory Goodrich, a research psychologist at VA facilities in Palo Alto, Calif., had similar findings in a study of 101 Iraq and Afghanistan war veterans with mild traumatic brain injuries. Many are still in the service.

Goodrich found that 40% to 45% of the patients suffered vision loss even though their eyes were physically healthy. The biggest problem was an inability for both eyes to operate precisely together. This can lead to eye strain and blurred vision.

Left undiagnosed, it can also hamper vocational or educational training and aggravate depression and post-traumatic-stress disorder, Goodrich says. Veterans may need an eye care specialist and corrective eyewear, he says.

But Goodrich fears that routine eye examinations may not uncover the problems. "In many cases, we're seeing active-duty troops, and they want to get back and join their units," he says. "So they don't want to hear that there's something they need to go get treated for."

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USA Today reports that blast injuries are producing more damage than previously realized.  The war in Iraq will be no different in producing a "signature wound" only this time the wound is in the brains of those affected. Medical experts are witnessing an emerging and significant increase in Traumatic Brain Injury (TBI).

The new findings are the result of blast experiments in recent years on animals, followed by microscopic examination of brain tissue. The findings could mean that the number of brain-injured soldiers and Marines — many of whom appear unhurt after exposure to a blast — may be far greater than reported, says Ibolja Cernak, a scientist with the Johns Hopkins University Applied Physics Laboratory.

Blast injuries are getting the attention of the war as a laboratory.  And now that attention is revealing what is already known from other familiar mechanisms of injury:  brain injury occurs at the cellular level.

The North American Brain Injury Society formed a committee to examine blast injuries.  Dr. Mariusz Ziejewski, biomechanical engineer, is heading that effort.  For more information go to http://www.nabis.org/public/message.shtml

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60 Minutes just aired an incredible piece on new findings for brain injured people in a minimally conscious state. 

The story describes fireman Don Herbert who was injured when a roof fell on him while making a rescue attempt.  Unconscious for 10 years, Don is shown waking up and being aware of the fact that he was "gone."

The next story is of George Menendez who also sustained brain injury and was minimally conscious.  His mother thought to give him Ambien for sleep one night when he was moaning.  George, for the first time, opened his eyes and was able to communicate with his family.

Experts believe there is a subset of brain injured people who may respond to Ambien.  PET scans were done before and after Ambien was ingested and the results were remarkable.  The brain showed distinctive functioning after Ambien.

This is an exciting discovery and I hope there is more to come.  To see the amazing 12 minute video click here.

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The National Football League's Sean Taylor, a star defensive player for the Washington Redskins, was in critical condition after being shot at his home near Miami by a suspected intruder on Monday, police said.

Taylor, 24, who was the Redskins' first pick in the 2004 draft, was airlifted to Miami's Jackson Memorial Hospital for treatment, police said.

The Miami Herald newspaper reported that Taylor and his girlfriend were startled after hearing an intruder at the rear door of his home and said Taylor, who suffered severe blood loss, was wounded by a gunshot to the groin.

Police declined to confirm those details, including the Herald's report that Taylor faced possible brain injury due to blood loss, but said he remained in critical condition on Monday evening.

Read the full article here.

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I received a comment on my blog entry titled "TBI Rehabilitation" posted on by attorney Steve Doroghazi.  His wife Cynthia underwent surgery in 1990 that left her permanently brain injured. 

Fortunately Cynthia went on to recover from many of her impairments and graduated college some years later.

Cynthia has written a book which can be reviewed at http://www.newriverpublications.com/Searching_for_the_Open_Door.html. 

I am always appreciative and very interested in the writing and publication efforts of those who suffer brain injury.  Please take a look at Cynthia's work.

Thank you Steve for sharing this wonderful comment:

As an attorney and husband of a medical malpractice TBI PATIENT, I agree with your observations completely. My wife, Cynthia suffered a traumatic brain injury during a routine operation at George Washington University Medical Center in May 1990. That operation was designed to correct a condition known as hydrocephalus (water on the brain), by inserting a VP shunt in the meninges of her brain, thereby relieving intracranial pressure caused by the hydrocephalus. Unfortunately, a bleed occurred during the operation and went undetected long enough for her brain to begin collapsing in on itself, long enough for her to experience respiratory failure, and long enough for her to suffer permanent neurological damage.

After spending three months in the hospital, Cynthia was transferred by ambulance to Magee Rehabilitation hospital (Magee) in Philadelphia. After three months of intensive therapy at Magee, she was able to walk, with a quad cane, about sixty feet at a time. While she still wore diapers, her feeding tube had been removed, and she was beginning to communicate on an adult level, although with a flat affect to her speech. You can see from the photos on her web site that Cynthia has progressed far beyond this point, and far beyond all doctors' predictions.

Twenty-two months after her release from Magee, Cynthia resumed her master's program at The Johns Hopkins School of Advanced International Studies(SAIS)as a Philip Merrill fellow. She graduated in 1994; and, in 1995, her medical malpractice case was tried before the Superior Court of the District of Columbia.

Wanting to tell her amazing story and, simultaneously, communicate her messages of hope, inspiration and the overall power of family, friends and prayer, Cynthia has written a book - Searching For The Open Door, A Woman's Struggle For Survival After A Traumatic Brain Injury. Cynthia plans to donate ten to twenty percent of book sales to Magee. This is her attempt to "give back" and provide others with the hope and inspiration to put up a good fight. To read a sample chapter of Cynthia's book, go to: http://www.newriverpublications.com/Searching_for_the_Open_Door.html

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PET is a very uselful procedure in assessing brain function after brain injury.  When procedure results are compared to neuropsychological findings, treatment can be specified to enhance recovery.

Definition
Positron emission tomography (PET) is an imaging test that uses a radioactive substance (called a tracer) to look for disease in the body. Unlike magnetic resonance imaging (MRI) and computed tomography (CT) scans, which reveal the structure of organs, a PET scan shows how the organs and tissues are functioning.

PET scans use a small amount of a radioactive substance injected into a vein, usually on the inside of the elbow. The substance travels through the blood and collects in organs or tissues.

The scan begins approximately 60 minutes after receiving the radioactive substance. The individual then lies on a table that slides into a tunnel-shaped hole in the center of the PET scanner.

The PET machine detects energy given off by the radioactive substance and converts it into 3-dimensional pictures. The images are sent to a computer, where they are displayed on a monitor for the physician to read.

The test takes about 30 minutes.

How to Prepare for the Test
You must sign a consent form before having this test. You will be told not to eat anything for 4 - 6 hours before the PET scan, although you will be able to drink water.

Tell your doctor if you are pregnant or think you might be pregnant.

Also tell your doctor about any prescription and over-the-counter medicines that you are taking, because they may interfere with the test.

Be sure to mention if you have any allergies, or if you've had any recent imaging studies using injected dye (contrast).

During the test, you may need to wear a hospital gown. Take off any jewelry, dentures, and other metal objects because they could affect the scan results.

Why the Test is Performed
A PET scan can reveal the size, shape, position, and function of the brain and other organs.  It is used to diagnose cancer, heart problems, and brain disorders. It can see how far cancer has spread, reveal areas of poor blood flow to the heart, and check brain function.

Normal Results
A normal scan reveals no problems in the size, shape, or position of an organ. An abnormal scan reveals areas in which the radiotracer has abnormally collected.

Risks
The amount of radiation used in a PET scan is low. It is about the same amount of radiation as in most CT scans. Also, the radiation doesn't last for very long in your body.

However, women who are pregnant or are breastfeeding should let their doctor know before having this test. Infants and fetuses are more sensitive to the effects of radiation because their organs are still growing.

It is possible, although very unlikely, to have an allergic reaction to the radioactive tracer. Some people have pain, redness, or swelling at the injection site.

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The National Guard is now being checked for signs and symptoms of brain injury with comparisons to base line data.

Beth Pearson, senior research associate at Dartmouth Medical School in New Hampshire and the principal investigator on the National Guard project, said Thursday that explosive devices used in the wars in Iraq and Afghanistan are causing traumatic brain injuries in many service members. But without a pre-deployment baseline, it's impossible to tell whether an individual's abnormal brain function predates deployment or is related to military service, she said.

"Now we'll have a baseline measure of the neurological functioning of each person, and they'll be retested on their return for any changes," she said. That will help doctors determine which areas of the brain have been injured and improve medical treatment. Veterans Affairs officials at Togus are supportive of the project, Pearson added.

Read the full article here.

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U.S. Rep. Harry E. Mitchell today joined members of an inter-organizational Military TBI Task Force by endorsing a paper highlighting the important role that neuropsychology plays in treating combat-related traumatic brain injury.

The paper, The Role of Neuropsychology and Rehabilitation Psychology in the Evaluation, Management and Research of Military Veterans with Traumatic Brain Injury, is currently in press and an executive summary will be released Nov. 13 at a press conference at the National Academy of Neuropsychology's 27th Annual Conference. The Military TBI Task Force, led by Drs. Neil Pliskin and Mike McCrea, were comprised of members from the American Psychological Association Divisions 40 (Neuropsychology) and 22 (Rehabilitation Psychology), the American Academy of Clinical Neuropsychology, and the National Academy Neuropsychology (NAN).

"Traumatic brain injury is one of the signature injuries of the current war," said Mitchell, who has held hearings on the trouble facing troops returning from war. "Better field medicine is bringing more of our troops home alive, but they are suffering from combat-related TBI or PTSD in greater numbers than in past wars. We owe it to them to invest in this kind of research that will help improve their quality of life in the years to come."

Frequently brain injury is not detected in emergency rooms.  Brain injury, especially mild brain injury, is undetected on MRI or CT.  The use of neuropsychological tests are often the best and only way to diagnose and treat brain injury.  It is only with hindsight of past war veteran's medical treatment that the horrifying realities thier wounds is now appreciated.  Bravo to the efforts being made now to alter past mistakes.

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The reality of disability from brain injury can be seen in cases where individuals lose their ability to retain employment or function competitively at their job.  In cases of professionals like doctors, lawyers, engineers and others, this disability is a sensitive issue.

Cognitive impairments can diminish important aspects of a career.  Straying from the cutting edge of ones practice can seriously alter the effectiveness of that practice.  Lack of Initiative, insight, and abstract thinking, to name a few of the impairments associated with brain injury, can make former employment impossible.

For instance, The Louisville Kentucky Courier-Journal and United Press International reported a case of a former lawyer suing a transportation provider in Kentucky for not taking action to prevent a bus crash that left him incapable of practicing law.

Kevin Halbe, a former managing partner for Wyatt Tarrant & Combs in Louisville is suing the Transit Authority of River City for a 2005 traffic accident that left him with a traumatic brain injury that changed his life.

Hable contends TARC officials should have acted to prevent bus driver, Terra Walter, a convicted drug user, from operating the vehicle that smashed into his car.

Walter was fired by the transportation group three times prior to the accident in Louisville for her questionable behavior and Hable's attorneys allege medical tests have shown she was likely high at the time of the accident.

To Hable, the traffic accident completely changed his life. His attempt to gain $6.4 million in lost income plus punitive damages will begin in Jefferson Circuit Court on Tuesday, November 13.

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More than 800 of them have lost an arm, a leg, fingers or toes. More than 100 are blind. Dozens need tubes and machines to keep them alive. Hundreds are disfigured by burns, and thousands have brain injuries and mangled minds.

Soldiers hit in the head or knocked out by blasts — "getting your bell rung" is the military euphemism — sometimes have no visible wounds but a fog of war in their minds. They can be addled, irritable, depressed and unaware they are impaired.

Only an estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries. Around the nation, a new effort is under way to check every returning man and woman for this possibility.

Continue Reading...

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Congress passed the Fiscal Year 2008 Labor-HHS-Education appropriations bill this week, including some important funding increases for TBI programs, including the HRSA Federal TBI program and the TBI Model Systems of Care program.

The Labor-HHS-Education spending measure will now be sent to President Bush, who has pledged to veto it, because it contains $9.8 billion more than he requested in his budget earlier this year.

BIAA has also been busy on Capitol Hill working on several other issues this past week, including pushing for the inclusion of important TBI provisions in the final defense authorization bill.

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Brain injury does not only occur in violent car crashes.  In fact, from cases I have been involved in, I know that brain injury can occur in single blows to the head.  Similar to the "Hollywood Myth" of recovery after a fight or being knocked unconcious - think common western bar room brawl, or Captain Kirk punching an an alien intruder in Star Trek - people do not generally associate serious brain injury with a single punch or smack in the head.  Those knocked unconcious in movies always return fully recovered in the next scene.  That is a myth.

For instance, The Boston Globe recently reported a group of teenagers was harassing a Mattapan man last spring, when one of the boys punched the man in the face, causing him to fall and hit his head on the pavement, police said yesterday.

About a week later, the man, 41-year-old Michael Hansbury, died of complications of a brain injury. Yesterday, a 15-year-old boy was arrested at William McKinley South End Academy on charges of manslaughter.

To read the full article click hear.

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