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

The New England Journal of Medicine published a Perspective on Traumatic Brain Injury called "Traumatic Brain Injury - Football, Warfare, and Long-Term Effects."

In late July, the National Football League introduced a new poster to be hung in league locker rooms, warning players of possible long-term effects of concussions.  Public awareness of the pathological consequences of traumatic brain injury has been elevated not only by the recognition of the potential clinical significance of repetitive head injuries in such high-contact sports as American football and boxing, but also by the prevalence of vehicular crashes and efforts to improve passenger safety features, and by modern warfare, especially blast injuries.

The article, by Dekosky et al., N Engl J Med 2010; 363:1293-1296, Sept. 30, 2010, goes on to contrast immediate consequences of traumatic brain injury and how long they last with delayed consequences of traumatic brain injury.

Many complications of traumatic brain injury are evident immediately or soon after injury....Seemingly mild closed-head injuries (i.e., those without skull fracture) may lead to diverse and sometimes disabling symptoms, such as chronic headaches, dizziness and vertigo, difficulty concentrating, word-finding problems, depression, irritability, and impulsiveness. The duration of such symptoms varies but can be months. Post-traumatic stress disorder frequently accompanies traumatic brain injury, though the relationship is poorly understood.

However, "Causal relationships between traumatic brain injury and delayed sequelae have been less studied because of the variable latency period before overt neurologic dysfunction."  However that does not mean relationships do not exist.  We know of certain repetitive mild brain injury (boxers); pugilistic parkinsonism.

 "Neurocognitive effects of repetitive mild head injury were initially recognized in boxers, with a syndrome that was distinct from the clinical and pathological sequelae of single-incident severe traumatic brain injury." Now other contact sports and blast injuries are also known to impact the brain.  In severe cases, as soon as two hours after the injury, scientists have discovered a protein, also seen in Alzheimer's patients, that causes cellular degeneration in the brain.  However in "mild brain injuries" the protein plaque is not evident. 

Further studies will help us understand why.  Currently precursers of the protein are seen in "mild brain injury" studies.  And, repetitive injury is replete with evidence of pugilistic parkinsonism

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I recently blogged about the long term effects of traumatic brain injury and the article entitled Traumatic Brain Injury - Football, Warfare, and Long-Term Effects.

In September 2010, the New England Journal of Medicine revisited traumatic brain injury awareness.  Focusing on the increased awareness of traumatic brain injury in the lives of ordinary people and those close to them, The Journal mentions contact sports and combat blast injuries.  The article is written by medical doctors who are pointing out how public awareness is growing.  Blogger Beth Miller writes that even for "normal gals" like her, the facts of Traumatic Brain Injury are becoming real.

This is a problem when representing people with Traumatic Brain Injury.  Too often they look fine.  You need an established traumatic brain injury attorney on your side.  Your attorney must know th signs, symptoms and consequences of traumatic brain injury.

And it should be accountable.  For too long general brain injury knowledge has been underrated.  Now that our son's, daughters, fathers and mothers are returning from combat and blast injuries with traumatic brain injury.  Now that our athletes, young and not so young, are getting traumatic brain injury from football, boxing and other sports.  We also need to understand the ramifications and costs of traumatic brain injury.

Similar to the public's slow but eventual understanding that cigarette smoking causes cancer, people need to appreciate the personal costs of traumatic brain injury.  The costs to the public  of treating cancer - whether in the form of higher insurance rates or tax paid subsidies to hospitals giving out medical care to those who cannot afford it - needs to resonate.

The New England Journal of Medicine does a nice job revisiting the Long term effects of traumatic brain injury to all of us "normal" people.  Take a read.

The inside of the skull, the article reminds us, is made of boney ridges.  When the head is violently moved, it sends the brain on a collision course with the inside of the skull.  This, often non-impact, movement typically encountered in a car accident, blast injury or sport contact, bruises and injures the brain.  However reseach concerning lesions (injury) has been a historically controversial topic.

Long Term Consequences

Many complications of traumatic brain injury are evident immediately or soon after injury.  The long term effects not so much.  Attorney and Blogger, Micahel Kaplan, has lately taken up the cause of repeated trauma in cases of sporting contacts.  His latest blog talks about youth sport concussion law.  Bruce Stern, another blogger and attorney, discusses how brain injury can effect work and occupation.

Be sure your lawyer is not simply a "car wreck" lawyer.  Be sure he/she is a traumatic brain injury lawyer.

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I just saw the Hurt Locker directed and produced by Kathryn Bigelow.  A movie about the solitude of explosive munitions neutralizer soldiers.  The entire movie portrays disarming Improvised Explosive Devices (IED) sometimes successfully and sometimes not.  The movie is nominated for an Oscar.

An IED is a device fabricated or placed in an improvised manner, incorporating lethal, noxious, pyrotechnic, or incendiary materials designed to destroy, incapacitate, harass, or distract. It may incorporate military parts, but is normally constructed from nonmilitary components.

What the movie does not provide is the reality these repeated trauma have on soldiers. 

To study such biomechanics and injury, the North American Brain Injury Society (NABIS) formed one of the first committees.   Blast Injury and TBI by Ronald C. Savage, EdD Executive Vice President, NABIS, states:

During the Vietnam War and the Persian Gulf War, 76 percent of American troops survived combat wounds. But in this century, the U.S. military's surgical teams "have saved the lives of an unprecedented 90 percent of the soldiers wounded in battle…" (New England Journal of Medicine, December, 2006). Furthermore, Walter Reed Army Medical Center reported that nearly 30% of all patients with combat-related injuries seen at Walter Reed from 2003 to 2005 sustained a TBI and that blast injuries are a significant cause of TBIs In addition, they reported that TBI is often associated with severe multiple trauma, post traumatic stress disorder (PTSD) or undiagnosed concussions. Thus, screening soldiers who are at risk for a TBI is important in order to ensure that TBIs are identified and appropriately treated.

Diagnosis can be difficult even when TBI is apparent or the patient is able to describe a concussive head injury to their doctors. The more common mild brain injury often has more than mild consequences and can cause depression, reduced cognitive functioning, nausea,
sleep disturbance, erratic behavior, and mood swings. These impairments are exacerbated by misdiagnosis, lack of treatment and the public’s misperceptions about brain injury and mental illness. For veterans with brain injuries, the lack of physical signs and the diffuse nature of symptoms may be met with skepticism, considered to be psychological, or worse, malingering.

As professionals in the field know, the “walking wounded” do not disappear. And many more will be seen and heard in this decade. Thanks to improvements in protective gear and swift medical treatment, more of America's wounded are surviving - and returning home with serious, permanent injuries. How will these veterans fare in the routines of daily life? Will they be able to maintain employment? How will their injuries impact their families, friends, co-workers, and communities?

The North American Brain Injury Society has begun to address these important issues. We recently published a special edition of Brain Injury Professional that focused solely on blast injury and TBI. NABIS would like to extend our sincere appreciation and thanks to Representative Bill Pascrell, co-chair of the Congressional Brain Injury Task Force, who wrote a thoughtful introduction, and also to Dr. Tina Trudel who served as Guest Editor.

In addition, the Planning Committee of our 2007 conference has organized a number of sessions devoted to the topic of blast injury. NABIS will continue to explore additional ways that we can create positive change in this area and we look forward to sharing those ideas with our membership in the future. 
 

Susan Lance, a speech pathologist specializing in •developmental problems •strokes
•brain injuries and •other neurological disorders, states, 

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