Brain and Spine Injury Lawyer & Attorney : Titolo Law Firm : Las Vegas, Nevada

More attention has been paid to the mental health of American troops in Iraq and Afghanistan than in any previous war. Yet shame remains a significant barrier to military personnel and their families getting the psychiatric treatment they need, a report released Wednesday says.

Time Magazine reports today on the American Psychiatric Association's study that veterans are attaching a stigma to the psychiatric afftects of the war.  This is a function of educating the public and veterans about the reality of brain and mental injury.

The good news is nearly three-quarters of the 200 military men and women interviewed by the American Psychiatric Association (APA) said that it was very or somewhat easy for them to seek out mental health care. But 60% still feared that doing so could have negative consequences on their career. More than half reported they believe others would think less of them if they sought out counseling, and most surveyed said they have rarely or never spoken even to family and friends about mental health issues. These numbers show "there's still a long way to go towards reducing the stigma surrounding care," says APA board member Dr. Mary Helen Davis.

Click here to read the whole article.

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Book Title: Change Your Mind, Change Your Brain: How a New Science Reveals Our Extraordinary Potential to Transform Ourselves

Author: Sharon Begley

Contrary to what the title may suggest, this is not a training manual for the brain. The book is a fascinating and convincing account of recent discoveries in brain neuroplasticity (i.e. its `pliability') even into old age, and the amazing implications of such discoveries. Sharon Begley states, "Yes, the brain can change, and that means we can change." For those looking for a magic bullet, she adds that it is not easy. "Neuroplasticity is impossible without attention and mental effort."

Those who have worked in fields such as psychology, education, gerontology and various social services will no doubt have observed unexplained and seemingly miraculous events with their clients and students. This book gives answers to their questions. For example, working as an occupational therapist in gerontology a number of years ago, I was stunned when an elderly (and chronic) stroke victim suddenly raised her paralysed arm to bat a balloon in a lighter version of volley ball. There was an "aha" moment when I read the chapter "New neurons for old brains."

This book also gives credence to the Superlearning trend of a decade ago, which met with a great deal of scepticism at the time. There were those, like myself, who used it anyway, purely on instinct, and met with amazing outcomes we could not explain. Anecdotal, of course, but Begley's book gives the following example some weight: While in my sixties, I decided to test out on myself what I had successfully used on the children. I undertook papers at university after forty years break from education, but reducing the study time by two thirds (using the Superlearning protocol.) It worked far better than I had dared hope; the 'grandmother' amongst students a third her age achieving the 90th percentile. (I later helped 'learning disabled' adults achieve the same percentile.) I couldn't say how it worked; just that it did. Now Begley gives scientific reasons why.

I am sure that other readers will find similar places of déja vu in this book and be assured that they can repeat, again and again, what they previously thought was mere chance. Whether you are a parent seeking hope for a dyslexic child, or an older adult who does not want to end up in mental decline like your parents did, there is solid evidence that "we can change what we choose to change."

Intertwined in Begley's reports of neuroplasticity research (cataloguing the unbelievable intransigence of the 'hardwired brain' traditionalists) is the story of an interaction that has developed over the years between the Dalai Llama and a group of enlightened Western scientists. This is a beautiful account of an interrelationship that has, without doubt, benefited the world, albeit with little media attention.

My only surprise is that, although Begley refers repeatedly to the scientists' rejection of mind-brain dualism, she does not answer this with any of the impeccable research available on non-local mind - such as that of William Braud (whose research is documented meticulously in "Distant Mental Influence.") However, Begley's "Train Your Mind, Change YOur Brain" was published in the same week as Lynne McTaggart's "The Intention Experiment," to create what is essentially a dyad in consciousness literature: while McTaggart shows how we can influence our outer world, Begley shows how we can influence our inner world. One way or another, we can be empowered.

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Trial lawyers, civil litigators and criminal defense attorneys will find Dr. Robert Heilbronner’s latest book, “Neuropsychology in the Courtroom: Expert Analysis of Reports and Testimony” (Guilford Press, 2008), to be an informative legal guide for the evaluation of neuropsychological impairments in civil and criminal litigation.

Edited by Robert L. Heilbronner, this 2008 publication contains contributions from several authors including Erin Bigler, PhD, Ida Sue Baron, PhD, Brian Brooks, PhD, David Bush, PhD, Shane Bush, PhD, Jacobus Donders, PhD, Kevin Greve, PhD, James Holdnack, PhD, Grant Iverson, PhD, Michael McCrea, PhD, Wiley Mittenburg, PhD, Joel Morgan, PhD, Howard Oakes, PsyD, Wilfred van Gorp PhD, Karen Wills PhD.

The Preface identifies that the publication is directed primarily at neuropsychologists.  Obviously those in related professions are an anticipated audience as well.

The book is divided into 3 parts.  The first contains 7 contributions relating to Case Analysis. Part 2 is entitled "Forensic Analysis from Opposing Perspectives."  This portion gave me a illustration of how two neuropsychologists looking at the same case can hold very different opinions.  This is important in my representation of Brain Injured clients as well as those with suspected brain injury.

The third part contains 5 special topics.  Fixed versus Flexed Battery Approach by Dr. Bigler.  Pediatric Issues by Dr. Wills.  Issues about testimony and cross examination.  And finally Misdiagnosis issues.

This is definitely a book worth adding to your TBI literature library.  It is not cost restrictive and can me ordered through Amazon.

 Robert L. Heilbronner, Ph.D., ABPP-CN, is a board-certified neuropsychologist with over 20 years of professional experience. In addition to maintaining a private clinical practice, Dr. Heilbronner is a court-approved forensic expert who consults with plaintiff and defense attorneys in regard to the impact of brain injuries and various neurological disorders on civil and criminal cases.

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I heard John Grisham criticized for not being in a league with proven contemporary writers like Joyce Carol Oates. But come on, his books read so well. Sometimes we want the Big Mac over the filet and nothing else will do.

In addition, the messages Grisham comes up with…the timing. John Edwards could have used the David versus Goliath mantra in his campaign. All on the heels of Playing for Pizza and Innocent Man, a non-legal thriller and non-fiction work respectively.

The vile Krane Chemical Corporation, run by its rich and selfish CEO Carl Trudeau who spends multi millions buying art he detests just to appease his trophy wife, kills a town of water drinking folks by polluting the supply.

The juicy reading of the trial verdict opens the story at $41 million. The plaintiff lawyers – a husband and wife legal team - have put their lifeblood and souls into getting the case to trial and their banker is calling in the loans they have not been making payments on. Meanwhile Krane has set out to finance a campaign for a handpicked conservative Judge who will, presumably, uphold his “conservative” corporate special interest group and reject the appeal of the verdict on behalf of Krane.

Grisham gives us the brain injury of the purchased Judge Fisk just as he is about to make the appellate decision. His son is injured when hit with a baseball. Fisk agonizes in the hospital waiting to see the extent of damage to his son. He learns that the bat used by the league to hit the ball was taken off the market due to product defect and the ER doctor read the wrong MRI when initially and negligently misdiagnosing the damage: All potential lawsuits to recover for the permanent and significant damage to his son. However, will he be converted?

The methodical subversion of justice is all too familiar. Our contemporary presidential election, judicial elections and appointments, all strategically financed by the rich, could make us realize how small our own voices are in this so-called democracy. Grisham’s book is both entertaining and a public service announcement.

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Throughout the year, I read many things.  Of course much is related to my work.  However others are related to my interests and include biography and fiction.  To see my blog on the books I read other then brain injury go to http://timtitolo.spaces.live.com/lists/cns!8274E62551D682F0!309/.

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Trial lawyers, civil litigators and criminal defense attorneys will find Dr. Robert Heilbronner's latest book, "Neuropsychology in the Courtroom: Expert Analysis of Reports and Testimony" (Guilford Press, 2008), to be an informative legal guide for the evaluation of neuropsychological impairments in civil and criminal litigation.

"Neuropsychology in the Courtroom" is Dr. Heilbronner's most recent text in a series of books on litigation-related neuropsychology topics. Earlier books edited or co-edited by Dr. Heilbronner include "Forensic Neuropsychology Casebook" (Guilford Press, 2005) and "The Practice of Clinical Neuropsychology" (Swets & Zeitlinger, 2003).

This new 268-page hardcover book can be ordered from the publisher online at www.guilford.com, toll-free at 1-800-365-7006 or via fax to 1-212-966-6708. The ISBN is 978-1-59385-634-2.

Also released: Research and Markets (http://www.researchandmarkets.com/reports/c81056) has announced the addition of "Neuropsychology for Occupational Therapists: Cognition in Occupational Performance, 3rd Edition" to their offering

The third edition of this successful textbook is written primarily for undergraduate students of occupational therapy, and for practitioners working in the field of cognitive rehabilitation.

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While driving with his head lights off down a country highway, Chris Pratt (Joseph Gordon-Levitt), his girlfriend Kelly (Laura Vandervoort) and two friends crash into a stalled combine on the road, which results in Chris' brain damage affecting his short-term memory, and death of the two friends.

Four years later, Chris has to write things down to remember them. Chris works at the Noel State Bank & Trust as the night janitor. He aspires to work as a teller, but the bank manager, Mr. Tuttle (David Huband), does not think that Chris is capable. While cleaning the bank, Chris is watched by four men: Gary Spargo (Matthew Goode), Marty (Morgan Kelly), Cork (Aaron Berg), and Bone (Greg Dunham). Also, every time after his shift, a police officer Ted (Sergio Di Zio) comes by to chat with Chris and brings donuts. At home, Lewis (Jeff Daniels), Chris' blind best friend, makes Chris tell the story of Goldilocks and the Three Bears backwards to help him with his sequencing problems, and Chris writes down "start from the end." Later, as Chris is sitting alone at a bar, Gary walks in and introduces himself.

 Chris and Lewis go to visit Chris’ wealthy family for Thanksgiving. Lewis tells Chris' parents, Barbara Pratt (Alberta Watson) and Robert Pratt (Bruce McGill) about a gas station that he and Chris want to turn into a restaurant.

 The next time Chris is at the bar, Gary and two girls walk in, and one of them, Luvlee (Isla Fisher), starts talking to Chris. The four leave together to Luvlee’s apartment, where Chris ends up sleeping with her. Afterwards, Gary invites Chris to a farm to have a late Thanksgiving dinner. At home, Chris tells Lewis about his recent experience with Luvlee and Gary, which makes Lewis suspicious.

Chris goes to the farm, where Gary introduces Chris to his gang. In the basement, Chris notices a board, which Gary says is a plan still in progress. Chris sees pictures and notes of banks and Gary says he needs his help because he is going to rob the bank Chris works at. Gary tries to convince Chris that he is still dependent on his family and others, which Chris does not acknowledge initially. Gary tells Chris that he can have his old life back and reinforces this with the phrase "Whoever has the money has the power." Chris starts noticing that he is dependent and agrees to take part in the robbery. Chris is told that he is the lookout and has to call Gary when money arrives at the bank.

In Chris' apartment, Luvlee talks to Lewis, who tells her that he used to cook meth, which blinded him. Lewis makes it clear that he had known plenty of "Luvlees" and "Garys", and knows that they are going to hurt Chris. Chris hears the entire conversation, and when Chris and Lewis go to a restaurant to eat, Chris loses his temper and says that he’s going to move out. Chris also tells Ted to stop checking on him. The next day, Luvlee packs up and leaves despite seeing Chris coming to her house.

On the night of robbery, Mr. Tuttle tells Chris that he noticed his improvement, and that he will try him as a teller. Subsequently, Chris tells Gary and his team that he does not want to take part in the robbery and will not tell anyone about it. However, Gary attacks Chris and tells him to do his job. After the safe is opened, Gary makes Chris retrieve the money because of the cameras. When Ted comes, he notices a suspicious activity, and a gun fight breaks out. Ted kills Marty and shoots Cork and Gary as well. However, Bone shoots Ted. Chris runs out leaving in the getaway car with the money.

Chris drives to his apartment, where Gary and Bone are holding Lewis hostage, so he goes to his family’s house and comes up with a plan. He puts a shotgun into one of the duffel bags, calls Gary and arranges a meeting at the ice rink to exchange the money for Lewis. Chris then drives to where his car accident was and buries the money. At the ice rink, Chris says that he buried the money but forgot where. Gary, who is bleeding to death, finds the place in Chris' notebook and tell him to dig it up. Chris hands Bone one of the bags, and just before Bone shoots Lewis, Chris shoots him. Gary then dies on the ground.

Chris is cleared of all charges because he returns the money, confesses, and the camera footage shows that Gary forced Chris to participate. Chris and Lewis open their planned restaurant, although Chris' impairments make giving change difficult. Chris starts to ice skate again. Although he knows that his life is still limited, he has accepted it and is willing to move forward.

To get a closer look click here

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I suppose brain disease is fertile substance for novels; especially novels that cross into the supernatural.

I recently completed this almost 600 page debut work of author Daniel Hecht written in 1998. The book was referred to me by a psychiatric expert who assists me with traumatic brain injury cases I handle. It was a very fast read despite its length. I enjoyed it immensely.

I recently was in New York for a conference, which added to the experience since the book takes place in areas west of Manhattan. I could easily visualize the trees and Hudson River descriptions from my locale.

The characters are all excellently defined and believable real people with relatable issues and thoughts. The main character, Paul Skoglund, has Tourettes. He is medicated and it is a mild condition for him. However, it bears on the climatic ending of the book.

Mr. Hecht certainly stretches the imagination with how the brain condition can manifest itself. By the end of the book, the manifestation reveals the story might sit well alongside a Stephen King shelf in a bookstore. However, by that time I was so engrossed in the story, characters and mystery, the thriller part came naturally.

I plan to look at the prequel, which I understand includes the other main character, the detective, who is not lucky enough In Skull Session to appear in any sequels.

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I just finished Terminal Man written by Michael Crichton in 1972. The thing I like about Crichton is his ability to look into the future, so to speak, with his subject matter. Clearly, I am the late bloomer here since this book is close to 40 years old. Nevertheless, keeping the perspective of the time the book was written enchanted me. This was early Crichton.

Harry Benson is having seizures that cause violent outbursts injurious to those in the immediate area of their occurrence. This condition is rampant in the human condition and has previously been misdiagnosed. Finally, with scientific intervention, the brain can be wired to a computer that will control violent behavior using a neuro pacemaker similar to the one used for cardiac monitoring.

The problem begins when the rats start to over stimulate themselves to point of death. Similarly, Harry begins to enjoy the euphoria of stimulation, which is triggered by violent patterns in the brain. However, Harry, a computer genius, believes that machines are taking over the world. His psychiatrist thinks the concept of “mind control” is dangerous but the surgeons are convinced they are serving a greater good by using Harry as part of their ongoing research. The goal is to one day deliver the answers to diseases of the mind.

Crichton develops his knack for scientific information intertwined with fiction to create a plot that ends with the action and suspense characteristic of his future novels.

I am especially endeared to this story as it was so reaching in the area of brain science for its time. Moreover, of course, I am endeared to the subject of brain science. For those of you who are either brain science fans or Crichton fans, I recommend reading the book.

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Chapter 11 entitled "Disturbing Deviations" takes the reader through Dr. Firlik's experience and observations of Pediatric Neurology. As a resident and a practicing surgeon, Dr. Firlik grapples with clinical detachment, reality and horror of being unable to change the "randomness of nature."

In a case of "hydrancephaly," Dr. Firlik was forced to decide whether doing surgery to slow the abnormal growth of an infant's head was justified given the condition. Hydrancephaly occurs when the brain does not develop its cerebral portion and, instead, fills the void in the skull with cerebrospinal fluid. If the cerebrospinal fluid does not absorb properly the head will expand creating a weight the infant neck cannot support. Evacuating the fluid may decrease the head size but the lack of brain will not make the infant any more likely to survive.

Other pediatric conditions include schizencephaly, pachygyria, holoprosencephaly, and tuberous sclerosis.  Apert syndrome is a congenital condition including multiple craniofacial abnormalities and syndacity (fusion of the fingers). Holoprosencephaly, also known as arhinencephaly, is a developmental defect of the midline brain structures which causes midline facial abnormalities.

All these rare pediatric conditions create disturbing features for the infant and their parents.

So if the brain makes it through the initial stages of life, Dr. Firlik comments, it is still amazing that it goes on to develop "normally." And is "normalcy" measured by IQ?

For centuries researchers have attempted to correlate brain volume and intelligence. Nevertheless, that simplistic general rule is peppered with exceptions. For instance, Einstein was said to have a below average sized brain.

Other research describes the correlation between gray matter and intelligence. Still, better technology points to the function of the brain as the best indicator of intelligence. Dr. Firlik observes,

"Clearly, in order for the fragmented community of brain injury specialists to come to any meaningful conclusions about the physical brain and intelligence, much more needs to happen: existing studies need to repeated or otherwise validated, the major questions need to be approached from multiple angles, and there needs to be communication across disciplines (the hard part)."

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I recently read the 2007 book called The Nine, by Jeffrey Toobin.  The author gives us glimpses into the people appointed by Presidents Clinton and Bush with some 1960s and 1970s appointments that made up the liberal court.  Surprises abound as Republican appointed Justices created a new kind of conservative court.

Two political ironies underscore Jeffrey Toobin's interesting new account of how personnel changes have changed the Supreme Court over the past two decades.

One is that, at the very time the Republican Party's four-decade ascendancy shows signs of abating, President Bush's appointments of Justices John Roberts and Samuel Alito have enabled conservatives to achieve their long-sought goal of a firm court majority.

Secondly, for all the GOP's advocacy of judicial restraint and its criticism of judges who legislate from the bench, the Republican-appointed majority represents what the author terms "a new kind of judicial activism" that threatens long-established rulings in crucial areas such as abortion and affirmative action.

O'Connor and Kennedy have maintained the swing vote on the court.  And, as Toobin points out, it all about how many votes you can muster that makes your opinion count.

As the Renquist court became the Roberts court the issues of abortion, Roe v Wade, still dominate the agenda.  With the most likely Justices to retire, Liberal Souter, Stevens and Ginsburg, the new conservative court will be an interesting observation in the coming years.

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Dr. Firlik confides in the tenth chapter that she is not immune from Emotion.

While reporting to a man who just had a brain tumor that was "not benign," and his wife and daughter, she broke down and cried. Nice to know that neurosurgeons have feelings.

Her comments remind me how physicians are able to block the misery of death and dying. Wouldn't be much good if they couldn't. Kind of like not being able to deal with the sight of blood.

When speaking with undergraduate students about the brain, Dr. Firlik remembers the absolute visceral reaction. The whole business of neurosurgery was too depressing to consider as a career.

What price had she paid to "not cry over every patient?" What had she gained? For her, it is an appreciation of the everydayness of life that her patients lose. She will one day lose it but that is what dealing with death has given her.

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In this chapter Dr. Firlik takes us through perceptions of Risk. Both from the neurosurgeon’s view and the patient.

She recalls a "warm hand-holding" surgeon who would “pepper” his remarks about the risks of brain surgery, while holding out the consent forms, with "religious-speak" like "We'll get you through this with God's grace."

On the other end are surgeons who personally remind me of Dr. Greg House. The ones who are "blunt" and say "You could have a stroke. (Pause) You could have permanent brain damage. (Pause) You could become a vegetable. (Pause) You could die. (Pause)"

Surgeons typically like dealing with their patients under anesthesia. Not weeping and asking a list of questions with other family members in their office. Unfortunately, this is where many doctors make mistakes. Appropriately, Dr. Firlik comments on the issue of malpractice and lawyers.

It is sad that many lawyers approach any bad outcome with the cynicism of a malpractice lawsuit. It is also sad that too many doctors get annoyed when their obligations to their patients interfere with their golf tee times.

I personally believe that it is hard being a doctor and a surgeon. I believe that sometimes the body responds differently than hoped or expected. I sympathize with a lot of what doctors fear from malpractice lawsuits. However, even those worrisome physicians should appreciate that some doctors are mis-motivated and simply practice bad medicine. Hence, the real need for lawyers, courts, and jury verdicts.

Dr. Firlik states she has never been sued although she expects to at some point. I hope that it will be the result of a mis-motivated lawyer and patient and she will be vindicated professionally and monetarily. That could well depend on the motivation of the insurance company underwriting her and the lawyers it chooses to defend her.

Good luck Dr. Firlik with that.

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I am reading Another Day in the Frontal Lobe by Katrina Firlik. Dr. Firlik is a neurosurgeon. She was the first woman admitted to the neurosurgery residency program at the University of Pittsburg Medical Center; the largest and one the most prestigious neurosurgery programs in the country. She currently teaches at Yale University and lives in Connecticut.

Dr. Firlik’s book, published in 2006, is 20 chapters of her neurosurgical observations offered to non-neurosurgeons. 20 chapters and glimpses into the mundane an d exciting drama of the operating room and brain surgery.

 
As a neurolawyer, I have a keen interest in the neurosciences. Although neurosurgery is not always present in the cases I handle, I find it very interesting to hear a neurosurgeon’s thoughts on everything from medical school anxiety to the fear doctor’s have of being sued for malpractice. With obligatory forays into operating room procedure, detailed descriptions of what drilling into the skull feels like, and other amazing insider information, I find this book a quick read. Maybe not for everyone, I am enjoying this book.

 
I want to share some of my thoughts about the chapters here. This will be an ongoing effort and I will post more as I go through the book.

 
I am at chapter 8 entitled, “Tools.” Here we find that neurosurgeons harbor great affection for the instruments they use in the acts of surgery. And they actually ascribe nicknames to these items. So “Adson forceps” are referred to as “bunnies.” The scrub nurse had better know the particular nomenclature for the particular surgeon or suffer his or her wrath when she fails to place the right instrument into his hand.

 
One surgeon asked his scrub nurse for “my little nipper,” his particular nickname for a tool properly called a “rongeur.” This tool is used to bite off pieces of bone. Fortunately of all the surgical tools before her, she was able to quickly deduce which one looked like one that nips.

 
The “sound of surgery,” I learned, is the sound of the neurosurgeons most commonly used tool – the suction device. Similar to the suction device used by dental hygienists, brain and spine surgeons use it throughout surgery to remove fluids that accumulate; namely blood and cerebrospinal fluid. Sometimes suction is interrupted due to pieces of tissue or clotted blood clogging the tube. A similar interruption occurs when an observing medical student unknowingly has her foot on the tubing. A mistake she will make only once.

Every intern’s rite of passage is to claim to have placed the first “bur hole” into a patient’s skull. Neurosurgeons use drills to carve out skull bone to expose the brain. These technologically advanced drills automatically stop once the bone is drilled through preventing further drilling into the brain. This was previously done manually and drills sometimes went too far! Interestingly, one cannot stop drilling half way into the skull and stop. If one does, the drill will not restart. I personally cannot imagine bearing down on a drill as it drives its way through a skull trusting it will stop once the bone is cut.

 
Finally “bone dust” from what I have gleaned does not smell very good. And you apparently get it on you when doing brain surgery!

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“We have at present no basis for a scientific explanation of the brain-mind relationship. We can only continue to study the brain without philosophical prejudice. And if the day should ever dawn when scientific analysis of body and brain solves the “mystery,” all men who have sought the truth in all sincerity will rejoice alike: the professing materialist and the dualist, the scientist and the philosopher, the agnostic and the convinced worshipper. Surely none need fear the truth.” (Wilder Penfield, Speech and Brain Mechanisms, 1959)

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