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

Here is the latest from Sarah D'Orsie at the Brain Injury Association of America

Health Care Reform Update

This week, The Senate released and began debate on their Health Care Reform leadership measure. As many of you may know, originally, rehabilitation was not included in the Senate Finance bill as a minimum benefit. Due to the lobbying efforts of BIAA, largely supported and funded by our Business and Professional Council, we have been able to ensure that rehabilitation is a part of the minimum benefits package of the final product now being debated in the Senate.

Specifically, the Patient Protection and Affordable Care Act being considered would:
(Democratic leadership summary)

- Include immediate changes to the way health insurance companies do business to protect consumers from discriminatory practices and provide Americans with better preventive coverage and the information they need to make informed decisions about their health insurance.

-Uninsured Americans with a pre-existing condition will have access to an immediate insurance program to help them avoid medical bankruptcy and retirees will have greater certainty due to reinsurance provisions to help maintain coverage.

-New health insurance Exchanges will make coverage affordable and accessible for individuals and small businesses.

-Insurance companies will be barred from discriminating based on pre-existing conditions, health status, and gender.

-Expand eligibility for Medicaid to include all non-elderly Americans with income below 133 percent of the Federal Poverty Level (FPL), with substantial assistance to States for the cost of covering these individuals.

- Make long-term supports and services more affordable for millions of Americans by providing a lifetime cash benefit that will help people with severe disabilities remain in their homes and communities.

- Eliminate lifetime insurance limits in all new individual and group plans for plan years beginning 6 months after enactment.

Today, as the Senate opened a two-day debate on the bill, Congressional Quarterly reported that Majority Leader, Harry Reid is closing in on the 60 votes needed to overcome an anticipated filibuster and bring the measure to the floor. Reid has filed cloture the bill and the vote on the motion to proceed to the bill is expected to occur on Saturday at 8:00 pm.

BIAA will continue to monitor the bill's progress closely as debate continues. Also, documents relating to the Senate leadership bill can be found on BIAA's website under the Health Care Reform Library section:

http://www.biausa.org/policyissues.htm#library
 

Veteran's Health Omnibus Bill

On Thursday, November 19, 2009, The Senate voted to pass a package of veteran's bills (S1963) that included both S. 801 and S. 252, both important Veteran's health care measures supported by BIAA.

The bill would expand services in rural areas and ensure that veterans who are catastrophically disabled or who need emergency care in the community are not charged for those services. It would also authorize VA hospitals to contract with non-VA providers to ensure that our returning service members have access to the care that they so desperately need and deserve.
 

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Here are the latest updates from the Brain Injury Association of America.

Health Care Reform Update

This week the Senate finance committee wrapped up debate on its version of a health care reform package.  The committee now has finished debating the more than one hundred amendments offered to the bill.  A final vote is possible next week, although the finance committee cautiously waits to hear the cost estimate of the measure from the congressional budget office.

BIAA will continue to monitor the situation as the legislation progresses.

Appropriations Update

Last week, Congress considered a measure, known as a continuing resolution (CR), that would keep the government funded into the 2010 fiscal year, which began on October 1, 2009.  TBI related programs will be funded at FY2009 levels until the spending bills for next year have been approved.

The full Senate has yet to consider the Fiscal Year 2010 Labor, Health and Human Services and Education spending bill that will provide the funding allocation for programs authorized through the TBI Act and for NIDRR's TBI-related research programs, including TBI Model Systems of Care.

BIAA will alert grassroots advocates when action is needed.

National Defense Authorization Update

As reported in a previous edition of Policy Corner, the Senate version of this year's National Defense Authorization bill includes an amendment that authorizes the Secretary of Defense to carry out a pilot program for providing cognitive rehabilitation therapy services under TRICARE. 

As the House and Senate meet to debate the differences in the two versions in order to craft a final bill, BIAA has increased awareness among House members serving on the Armed Services Committee of the amendment and its importance to returning service members sufferring from TBI.

This week, Congressman Bill Pascrell, Jr. and Congressman Todd Platts, co-chairs of the Congressional Brain Injury Task Force, sent a letter to members of both the House and Senate Armed Services Committee members urging their support in preserving this amendment in the final bill.  A copy of the letter can be viewed on our web site, or by clicking the link below:

http://www.biausa.org/elements/policy/cognitive_rehabilitation_ndaa_letter.pdf

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As we age, most of us will experience some wear and tear to the discs and vertebrae that make up the structural components of our spines.  Here are the most common things that can go wrong.

Joint and Nerve Problems

1.  Spinal Arthritis is inflammation of the facet joints between the vertebrae, which can cause stiffness and pain.

2.  Sciatica is characterized by pain that radiates down one or both legs.  It may be caused by compression of the sciatic nerve.

Disc Problems

3.  A Normal Disc consists of a soft, gelatinous interior surrounded by a tough, fibrous membrane, with no sign of trauma or illness.

4.  A Degenerative Disc is a disc that is gradually wearing down and thinning over time, most likely due to the natural aging process.

5.  A Bulging Disc is one that is shifting out of its normal radius, extending beyond the circumference of the vertebrae.

6.  A Herniated Disc occurs when the inner material of the disc pushes through its outer membrane into the spinal canal.

Vertebra Problems

7.  A Bone Spur occurs when the body builds more bone as a natural response to the age-related deterioration of vertebrae.

8.  Spinal Stenosis refers to a narrowing of the spinal canal, typically as a result of bone spurs or joint enlargement.

9.  Spondylolisthesis is a forward or backward slippage of one vertebrae relative to another, causing pressure on spinal nerves.

10.  Osteoporosis is a disease marked by progressively decreasing bone.  In the spine, this can lead to a compression fracture.

The people at Titolo Law Office represent only those injured in car accidents, truck accidents, Death accidents, falls and most all injury accidents. Please give us a call at 702.869.5100 and find out how we can help you.

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BIAA needs your help.  Take Action!

The Appropriations Subcommittee on Labor, Health and Human Services and Education begins consideration of the FY10 funding bill today!

Over the next few days, the House Appropriations Subcommittee on Labor, Health and Human Services and Education will be considering a bill which will provide the funding allocation for programs authorized through the TBI Act and for NIDRR's TBI-related research programs, including TBI Model Systems of Care.

Federal funding for these important TBI programs has remained stagnant over the last several years, as Congress has not provided increases sufficient to keep up with the increasing cost of doing business. The urgent need for increased federal support for a national TBI public health infrastructure and TBI research is further heightened by the recognition of TBI as the signature wound of the wars in Iraq and Afghanistan.

The time is now to urge Members of Congress to adequately fund TBI programs!


 

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It has been known that traumatic brain injury leads to increased risk of Alzheimer's. 

Neuroscientist, Mark Burns, who is assistant professor at Georgetown University Medical Center (GUMC) in Washington, DC. is presenting a paper on their work at the Alzheimer's Association 2009 International Conference on Alzheimer's Disease (ICAD 2009) which is taking place from 11 to 16 July in Vienna, Austria.
 

The Stop Silent Suffering Website reports the following:

Researchers in the US found that the destructive cellular pathways that occur following traumatic brain injury are the same as those activated in Alzheimer's Disease, suggesting that both conditions could be treated with new drugs that target these pathways. They said the findings "cement" the relationship beween traumatic brain injury and Alzheimer's Disease.

The brains of elderly patients who died from Alzheimer's Disease often show a build up of a toxic peptide called beta amyloid. The same substance is also found in the brains of around one third of people who have suffered traumatic brain injury, including children.

When a traumatic injury occurs to the brain, a mass of brain cells or neurons dies, and this is then followed by a second "wave" of beta amyloid build up. This secondary damage can last several months or even years and leaves big holes inside the brain.
 

The people at Titolo Law Office represent only those injured in car accidents, truck accidents, Death accidents, falls and most all injury accidents. Please give us a call at 702.869.5100 and find out how we can help you.

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Neal Farber PhD is on the Board of Governors for the International Brain Injury Association.  IBIA recently published this article authored by Dr. Farber:

 Developing drug treatments for traumatic brain injury (TBI) has been notoriously difficult. While most of the severe neural damage that accompanies acute TBI results from the initial impact, considerable additional damage occurs over the following hours and days by biochemical cascades triggering inflammation, cell death and disruption of neural pathways. It would be ideal to have a treatment that prevents this degeneration, but decades of clinical research have so far been unsuccessful. In addition, there are non-acute symptoms such as prolonged disorders of consciousness, long-term cognitive and physical impairments, for which treatments have not been developed. [full story]

The people at Titolo Law Office represent only those injured in car accidents, truck accidents, Death accidents, falls and most all injury accidents. Please give us a call at 702.869.5100 and find out how we can help you.

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Registration Now Open for the Eighth World Congress on Brain Injury

The International Brain Injury Association is pleased to announce the Eighth World Congress on Brain Injury will be held in Washington, DC, March 10-14, 2010. In addition to an excellent scientific program with world renowned experts in the field of brain injury, we are also including other special features such as scientific poster and paper presentations, candlelight sessions with experts, and IBIA’s various awards, including the Henry Stonnington Award for best review article in Brain Injury (IBIA’s officially endorsed organizational research journal), the Jennett & Plum Award for Clinical Achievement in the field of brain injury medicine, as well as The Safe Car of the Year Award. There will also be a post-conference symposium on disorders of consciousness in addition to workshops on neuropharmacology, neuroethics, controversies in neuropsychology, visual assessment and rehabilitation, community reintegration, educational reentry issues, as well as return to work. Those interested in submitting an abstract are encouraged to do so by visiting our on-line submission system. The abstract deadline is October 9, 2009. [full story] 

Founded in 1993, IBIA was created in response to the growing demand from professionals and advocates throughout the world for collaboration and more information on all aspects of brain injury, from prevention to long-term care issues. Benefits of membership include an annual subscription to the journal Brain Injury as well as quarterly issues of this publication, the International NeuroTrauma Letter. To receive a membership form, click here (pdf)
 

The people at Titolo Law Office represent only those injured in car accidents, truck accidents, Death accidents, falls and most all injury accidents. Please give us a call at 702.869.5100 and find out how we can help you.

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The CDC post the latest Brain Injury Facts:

TBIs contribute to a substantial number of deaths and cases of permanent disability annually.

Of the 1.4 million who sustain a TBI each year in the United States:

50,000 die;
235,000 are hospitalized; and
1.1 million are treated and released from an emergency department.1
Among children ages 0 to 14 years, TBI results in an estimated:

2,685 deaths;
37,000 hospitalizations; and
435,000 emergency department visits annually.1
The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths

Research Findings on Treatment Guidelines for Severe TBI

Facts about Concussion and Brain Injury and Where to Get Help

CDC Study Finds Traumatic Brain Injuries Can Result from Seniors Falls
 

To read more join Chis Levinson at Masry and Vititoe Law Offices.  Known throughout the country as the personal injury law firm that successfully handled the famous Hinkley case profiled in the movie "Erin Brockovich," Masry & Vititoe has gained national recognition as a leader in Environmental Tort cases.

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I am currently dealing with a client who sustained a head injury and whose doctors are trying to rule out Vertical Heterophoria Syndrome (VHS). 

This is an eye alignment condition. Those who suffer from VHS are over-working their eye muscles to maintain vertical eye alignment. This leads to eye muscle strain and fatigue, which causes many different symptoms, including:

Dizziness
Lightheadedness
Nausea
Unsteadiness
Drifting While Walking
Poor Coordination
Poor Depth Perception
Motion Sickness
Headaches
Neck Ache
Head Tilt
Anxiety From Dizziness
Feeling Overwhelmed or Anxious in Crowds or Large Spaces
Light Sensitivity / Glare
Double Vision
Shadowed/Overlapping Vision
Difficulty with Reading & Reading Comprehension 
 

Read more here.  View more on YouTube. 

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Dave Boran sent me this question based on a recent post.

I spent 23 years in the Canadian Forces. I have had this problem for over 20 years with no diagnoses. For they past 6 months I have been going to the gym, trying to get back into shape. I am 51 years old. I had 2 episodes at the gym. I will start to sweat, I'll get dizzy and I can't function or try and speak it will take me at least 15 minutes before I can get off the ground. Last week I wanted to try and run a mile and when I got to the highway it happened again. I almost got hit by a car. I should mention in
1986 i was involved in a motor vehicle accident and I rolled my truck. My truck was a refuelling truck. I was carring gas on the pod. Can you help.

Dave

Dave,
It sounds like you definitely have problems. I am not sure if you are in Canada or the U.S. but I would try contacting the Brain Injury Association of America at www.biaa.org and see if they can point you to some resources.

As to any legal case, and again I am not sure where your truck accident occurred, it seems that all statutes of limitation are long expired based on it happening 23 years ago. I hope you received compensation back then as deserved.

Good luck Dave.

Tim Titolo
 

The people at Titolo Law Office represent only those injured in car accidents, truck accidents, Death accidents, falls and most all injury accidents.  Please give us a call and find out how we can help you.

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Many victims of traumatic brain injury develop Post Traumatic Stress Disorder.  I recently came across a great article on the symtoms, causes and other information of PTSD.

PTSD (Post-Traumatic Stress Disorder) is triggered by a traumatic event - it is a kind of anxiety. The sufferer of PTSD may have experienced or seen an event that caused extreme fear, shock and/or a feeling of helplessness. Most of us experience a brief period of difficulty adjusting and coping with traumatic events. However, we gradually get better with time and healthy coping methods. On the other hand, there are times when symptoms get worse and may last for several months, or years. This study explains how PTSD can surface two years after a traumatic event. Another study found that one in eight Lower Manhattan residents likely had PTSD two to three years after the 9/11 attacks.
 

Read the full article here.

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Sarah D'Orsie of the Brain Injury Association of America provides the following update:

Brain Injury Association of America
Policy Corner E-Newsletter -- July 10, 2009
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________

In This Issue:
Appropriations Update
Health Care Reform Update
Fiscal Year 2010 Defense Authorization
_____________________________________________________________________

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.
_____________________________________________________________________
Appropriations Update

Today, July 10, 2009, the House Appropriations Subcommittee on Labor, Health and Human Services and Education will begin considering the Fiscal Year 2010 spending bill that will provide the funding allocation for programs authorized through the TBI Act and for NIDRR's TBI-related research programs, including TBI Model Systems of Care.

BIAA and other stakeholders authored a letter that was circulated today on Capitol Hill urging increased funding for TBI programs. Specifically:

• $11 million for the Centers for Disease Control and Prevention TBI Registries and Surveillance, Prevention and National Public Education/Awareness
• $20 million for the Health Resources and Services Administration (HRSA) Federal TBI State Grant Program
• $6 million for the HRSA Federal TBI Protection & Advocacy (P&A) Systems Grant Program
• 13.3 million for NIDRR's TBI Model Systems of Care Program
For further reading, a copy of the letter can be found on our web site by clicking on the following link:

http://www.biausa.org/elements/policy/2009/tbi_act_appropriations_2010_support_letter.pdf

If you would like to take action and encourage your Congressman to support increased funding for TBI programs, click on the link below to be directed to our legislative action center!

http://capwiz.com/bia/home/

BIAA will continue to monitor the Appropriations proceedings and alert grassroots advocates to take action when needed.
Health Care Reform Update

This week the Senate Health, Education, Labor and Pensions Committee has been continuing to consider its version of the health care overhaul, while the Finance Committee has yet to begin formal markups, but continues to discuss policy behind closed doors.

In the House, The chairmen of the Energy and Commerce, Education and Labor, and Ways and Means Committees are working on a final draft of a bill that could be released at any time. The House committees plan to mark up the legislation next week.

On July 2, 2009, BIAA circulated comments to the House Committees of Jurisdiction applauding their "efforts to design health care reform that will improve the accessibility, quality, effectiveness, and efficiency of patient care."

More specifically, the comments expressed BIAA's support of the protections and standards for qualified health plans included in the draft, such as no imposition of pre-existing condition exclusions, guaranteed access to essential benefits (including rehabilitation services), guaranteed issue and renewal, adequacy of provider networks, limits on cost sharing, no annual or lifetime limits on coverage, and consumer protections.

To see a full copy of the comments, click on the following link:

http://www.biausa.org/elements/policy/2009/biaa_house_tri_committee_health_reform_comments.pdf

BIAA will continue to follow the health care reform considerations carefully and advocate on behalf of the brain injury community.
Fiscal Year 2010 Defense Authorization

Next week the 2010 Defense Authorization bill is expected to dominate debate on the Senate floor. The bill was reported as an original bill by the Senate Armed Services Committee on June 2, 2009.

It is important to note that BIAA's cognitive rehabilitation position paper (http://www.biausa.org/elements/media/biaa_cog_rehab_position_statement_2007.pdf) was referenced in the official Committee Report that was released last week as saying, "The committee notes that the Brain Injury Association of America has recognized the benefits of cognitive rehabilitation therapy for brain injuries, and that there is a growing body of scientific evidence to support its efficacy."

BIAA will continue to watch the bill as it is considered next week and advocate for the inclusion of cognitive rehabilitation within TRICARE coverage for returning service members.

 

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The New York Times reported:

Patients who received a bioengineered protein during spinal fusion procedures to correct neck pain had far more complications than patients who did not get it, according to a study released Tuesday.

The study, published Tuesday in The Journal of the American Medical Association, reinforces previous concerns about the use of the proteins in fusion procedures to treat upper spine, or cervical, pain.
 

Read more by clicking here.

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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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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.

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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I had the opportunity to hold a brain during my trip to the morgue a few years ago. It was an amazing experience. The brain is soft and infirm. It looks relatively symmetrical with each half held together at the corpus callosum.  

But each half is not perfectly symmetrical and that goes against the pop psychological “left-right brain” theories. Actually each half is not a mirror image of the other which enables us to perform different tasks at the same time.

“In the 1990s psychologist Michael Corballis of the University of Auckland in New Zealand argued that the asymmetry of the brain – known as lateralization - was a key step in the evolution of our species, giving us language and additional mental powers that other animals lack.

“Today Corballis readily admits he was wrong. Lateralized brains are not unique to humans. Parrots prefer picking up things with their left foot. Toads tend to attack other toads from the right but go after prey from the left. Zebra fish are likely to look at new things with their right eye and familiar things with their left….”

The May 2009 edition of Discover Magazine published an article by Carl Zimmer who frequently publishes on brain issues. He says, “One hypothesis is that a lateralized brain is more powerful than one that works like a mirror image. Instead of two matching parts of the brain performing an identical task, one can take charge, leaving the other free to do something else.”

It seems that our ability to multitask is owed largely to our not so symmetrical brain halves. Zimmer’s article is fascinating and can be read by clicking here.

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When Army Col. (Dr.) Kenneth Lee began evaluating more than 3,000 Wisconsin Army National Guardsmen called to duty last fall in the state's largest operational deployment since World War II to ensure their medical readiness, he approached the task with unique and personal insights.  Soldiers are not willing to reveal their injuries.

Between their initial alert last year and early this year, when they moved to their mobilization station at Fort Bliss, Texas, Lee had to put these Soldiers into one of two categories: "green" if they were deployable or "red" for they weren't.

It was a tough call, he admits, because many of the Soldiers didn't want to confess to issues that might keep them from deploying with their units. Some hid musculoskeletal or other injuries for fear they'd be forced out of the military if deemed nondeployable. Others acknowledged they had medical issues, but hadn't addressed them because they had no health insurance or couldn't spare time away from their civilian jobs to get treated.

But the bigger challenge, Lee said, was identifying troops with mental-health issues, including post-traumatic stress and traumatic brain injuries. Lee calls these "the invisible wounds" of war - issues that don't mean a Soldier can't deploy, but that have to be weighed when making that determination.
 

This problem has come up more and more as physicans and VET medical staff have dealt with returning vets.

I am currently handling a case for a man who underwent moderate to severe brain damage, surgery and near fatal seizures.  Yet when given the chance to return to Iraq for a tour of duty, he opts to go since his working ability as a civilian has plummeted. It is my hope that the military will identify the problems this man has and not let him go into harms way.  He is currently receiving training for preparedness to return to Iraq.

I have sent the medical records documenting the seizures and injury but find it difficult to get the attention of the military decision makers.  Therefore I advocate procedures like those taken by Army Col. (Dr.) Kenneth Lee.

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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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The American Association of Justice published the following in response to President Obama's Seech to the American Medical Association on June 15, 2009:

“It’s clear America’s health care system is in crisis. Over 40 million people are without health insurance and costs are skyrocketing. President Obama is right that health care reform is needed now and patient safety should be the top priority.

“Empirically-based practice guidelines, developed by independent experts, is an idea we can support, as long as it does not lower quality or standards of care. Instead, these guidelines should lead to greater patient safety.

“According to the Institute of Medicine, 98,000 people die every year because of medical errors. Eliminating these errors, not further hurting the victims of negligence, is where lawmakers should focus their attention. By taking away the rights of people to hold wrongdoers accountable, the quality of health care will suffer tremendously.

“However, the notion that ‘defensive medicine’ is leading to higher health care costs is not supported by empirical data or academic literature. Recent news reports, CBO and GAO analyses, and statements from administration officials have shown that physicians will over-test and over-treat purely for financial reasons, unrelated to liability concerns.

“Limiting the legal rights of injured patients will do nothing to lower health care costs or aid the uninsured. We will work over the coming weeks and months to educate members of Congress and the administration on how to best protect victims of medical negligence.”
 

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The New York Times advises that movie theaters are about to show anti consumer ads as part of a campaign by  www.facesoflawsuitabuse.org.

INSTEAD of the latest on Hollywood stars, moviegoers may get a dose of advocacy this month when they settle into their seats for the feature presentation.

Coming to theaters are commercials that are intended to spell out the perils of frivolous lawsuits as told by “everyday Americans,” including small-business owners who have been hit with costly lawsuits they believed were arbitrary and abusive.

This is the wrong message.  When the one who feels injured is the business owner, then retribution is appropriate.  But not if it is a consumer who is injured.  This makes no sense. 

Frivolous lawsuits are not a way of life for the vast majority of lawyers.  The news media simply portrays that myth.  And if any one believes the news media does not impact the masses then I have a frivolous lawsuit to sell them.

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Although the A.M.A.’s highest legislative priority is capping jury awards, highly unlikely under the Obama administration, it does favor legislation like that proposed by Senators Obama and Clinton. Dr. Rohack said the group’s legislative experts were also working over the weekend to draft a bill that would set out a way to protect doctors who are sued if they have followed professional practice guidelines.

The New York Times reports that while President Obama spoke to doctors yesterday assuring them that he favors limiting malpractice suits, he definitely does not favor limiting malpractice awards.  He believes that limiting recovery for clear errors is bad for the victims of those medical errors.

His position on limiting malpractice suits with such things as the "Sorry" apology might be what it takes to bring Republicans to the table.

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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 Ruvo Center anchors the Medical Office District of downtown Las Vegas' Symphony Park.  It will provide breaking research and treatments for brain disorders such as Alzheimer's and Lou Gehrig's Disease.  I will keep my eye on this great addition to the Las Vegas medical community.

Marshall Allan at the Las Vegas Sun is also keeping an eye on the Center.

As the vision for the Ruvo Center for Brain Health evolved in the past decade, its most fantastic ambition became the curing of Alzheimer’s and other degenerative brain disorders.

But from the get-go, the founders knew they first had to provide emotional and logistical support for the patients, families and friends who deal with the repercussions of the grueling diseases.

Today, the Ruvo Center is moving aggressively on its quest to cure and treat the diseases, in partnership with the renowned Cleveland Clinic as the more expansive Cleveland Clinic Lou Ruvo Center for Brain Health. It will begin seeing patients in July at a facility that, for now, is best known for its daring Frank Gehry design.

Last week, the clinic turned its focus to the emotional and logistical needs of patients and caregivers.

Two dozen experts gathered as a sort of brain trust to help the Ruvo Center address the oft-forgotten social needs of caregivers and patients living with Alzheimer’s, Huntington’s, Parkinson’s and Amyotrophic Lateral Sclerosis (ALS).

The people who attended say the assembly was unprecedented, drawing experts from the likes of the Cleveland Clinic, Duke University, the Alzheimer’s Association. They came at the invitation of the Ruvo Center.

Read the full article here.

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The American Assocation of Justice has released this and I have contacted my senator.  Please consider doing likewise.

I’m writing to alert each of you that on this coming Monday (at a time still to be determined) President Obama will be speaking to the American Medical Association. Please see the story below.

We are extremely concerned that once again he will advocate for some kind of medical malpractice “reform” in the health care bill. In fact, it is our present understanding that it is likely he will do so. We do not expect the speech to be long on specifics. We are on top of this situation, working with our Congressional allies on this urgently. We will inform all of you as to details as soon as we can. Stay tuned!

In the meantime, we need your help. Please contact your Senators and Representative and tell them that medical malpractice tort reform should not be included in the health care bill. The notion that Americans should have to relinquish one right in order to gain another is unacceptable.

Sincerely,
Linda A. Lipsen
Senior Vice President for Public Affairs
 

Obama to address AMA Delegates in Chicago
By Bruce Japsen
Tribune reporter
12:39 PM CDT, June 10, 2009
Amid the push in Washington for health care reform, President Barack Obama will on Monday address delegates to the American Medical Association, the Chicago-based national doctor group confirmed today.

The AMA's policy-making House of Delegates meets in Chicago beginning this weekend through next Wednesday. The national doctors group represents about a quarter of a million doctors across the country and its support of any effort to cover the more than 46 million uninsured Americans is seen as critical.

It's unusual for a president, let alone a non-physician, to address an AMA House of Delegates meeting. The AMA said the last president to do so was Ronald Reagan in 1983.

It will be only the second time Obama has been to Chicago since he became president. His previous visit, a three-night stay in mid-February, included a dinner out with his wife, a basketball game at the University of Chicago Laboratory Schools, morning workouts, visits with friends and a haircut. The White House has not yet said whether the president will spend part of his weekend in the city, before the AMA appearance on Monday.

On Thursday, Obama is scheduled to appear at a town hall style event in Green Bay, where he will also push for health care reform.
 

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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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The Brain Injury Association of America continues its legislative efforts:

Brain Injury Association of America
Policy Corner E-Newsletter -- June 12, 2009
A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________

In This Issue:
Cognitive Rehabilitation Coverage
Health Care Reform Update
NIDRR Grant Forecast
Coalition for Regenerative Stem Cell Medicine update

________________________________________

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.

________________________________________

Cognitive Rehabilitation Coverage

This week BIAA learned of two important victories centered around cognitive rehabilitation services. Anthem Insurance Companies (Anthem BC/BS, Anthem Health Plans) revised its cognitive rehabilitation coverage policy in December 2008 and cited BIAA's position paper among the authoritative sources consulted. Last month, United Health Care followed suit by publishing a coverage change in its May 2009 Network Bulletin .

Also this week, BIAA sent a letter to President Obama urging TRICARE coverage for service members. This is a follow up to the summit hosted by the Defense Centers of Excellence in April 2009, which was prompted by Congressional inquiries BIAA initiated last summer.

http://www.biausa.org/elements/policy/president_obama_letter_tricare_cog_rehab.pdf

Insurance coverage of cognitive rehabilitation has been a centerpiece of BIAA's policy efforts for the past three years. The Anthem and United Health Care coverage policies are important victories for people with brain injury as they provide fuel for our TRICARE advocacy and health care reform fight.

BIAA will continue to fight for TRICARE to cover cognitive rehabilitation services to ensure that our returning service members have access to the best health care available.

Health Care Reform Update

On June 9, 2009, the Senate Health, Education, Labor and Pensions (HELP) Committee released a draft health care reform bill. In summary, the draft would expand Medicaid eligibility to those with incomes up to 150 percent of the federal poverty level, impose federal tax penalties on most individuals failing to purchase coverage, mandate a public plan option, require employers to provide coverage or pay into a pool, and stiffen regulation of private health insurance plans.

Importantly, the plan eliminates life-time insurance caps as well as provides for the establishment of a medical advisory council that will submit a report to the Secretary of Health and Human Services including recommendations on essential health care benefits eligible for credits which includes rehabilitative services. In issuing the report, the council will ensure that the recommendations take into account the needs of diverse segments of the population including persons with disability.

The HELP committee plans to begin considering this bill on June 16, 2009. BIAA will continue to monitor the situation carefully.

NIDRR Grant Forecast

This week, The National Institute on Disability and Rehabilitation Research (NIDRR) announced it will include two TBI grant programs in its forecast for 2009. http://www.ed.gov/fund/grant/find/edlite-forecast.html#chart7

The first grant application notice, rehabilitation research and training centers (RRTC) on traumatic brain injury interventions, will be available on June 30, 2009, while the second, RRTC on developing strategies to foster community integration and participation for individuals with traumatic brain injury will be available on July 24, 2009.

BIAA will report on the details of these applications when they are released.

Coalition for Regenerative Stem Cell Medicine update

As part of the Coalition for Regenerative Stem Cell Medicine, BIAA enthusiastically endorses two important pieces of legislation aimed at advancing the therapeutic potential of newborn stem cells, the unique stem cells that can be collected immediately following birth from umbilical cord blood and the cord itself, as well as helping to advance the use of one's own newborn stem cells in regenerative medicine.

HR 1718 - The "Family Cord Blood Banking Act" amends Section 213(d) of the IRS Code to add cord blood banking services as a qualified medical expense. This change will allow individuals and couples to use tax advantaged dollars to pay for umbilical cord blood banking services through flexible spending accounts (FSAs), health savings accounts (HSAs) health reimbursement arrangements (HRAs) or the medical expenses tax deduction.

The "Family Cord Blood Banking Act" will make cord blood banking more affordable for American families and provides incentives to ensure that this valuable health resource is never thrown away.

HR. 2107 - The "Cord Blood Education and Awareness Act of 2009" will provide expectant mothers with straightforward, accurate and easy to understand information about the value of their child's umbilical cord blood stem cells. It will offer a government stamp of approval on all available cord blood banking options and will give expectant parents confidence in the information they are reviewing.

 

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I found this article entitled  Building a Better Brain in The April issue of Discover Magazine and thought I would share this excerpt with my readers.

The Attention Edge
Pay attention to this paragraph and you are selectively concentrating on a task or idea while ignoring distractions like that dog barking down the street or your cell phone ringing. In a world of information overload and increasing multi-multitasking, you do not have to suffer from ADHD to have trouble focusing. You need no diagnosis to benefit from drugs that cut through the chaos and help you get things done.

Attention-focusing drugs, of course, have been here for years: Amphetamines, nicknamed “go pills,” were discovered in the late 19th century. By the 1940s these central nervous system stimulants were widely used to treat asthma and had become popular as “pep” and diet pills. They were embraced by members of the armed forces, especially pilots, who had to remain attentive to myriad tasks despite constant danger and fatigue. Rife with serious side effects, including hallucinations, anorexia, and heart problems, dextroamphetamine (trade name Dexedrine, better known as speed) is rarely used today by civilians. But the amphetamine mix Adderall and the amphetamine-related drug methylphenidate (Ritalin, Methylin, Concerta, among others) are commonly prescribed.

Exactly how these drugs work their magic remains unknown, but stimulants like Ritalin and modafinil influence the neurotransmitters dopamine and norepinephrine, which are essential for attention and memory skills. Both drugs inhibit reuptake, or reabsorption, of these neurotransmitters by neurons, thus prolonging their action. Modafinil also indirectly alters the action of glutamate, the main neurotransmitter used by neurons in the brain to send signals down the line. The center of action for all these drugs, says University of California at Davis psychiatrist Michael Minzenberg, is the prefrontal cortex, the part of the brain that is responsible for executive functions like sorting out conflicting thoughts, making choices, predicting events, and exerting social control.

Read the whole thing by clicking here.

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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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The Associated Press reports

A federal jury has determined that Ford Motor Co. should pay a 38-year-old Oakland man $18.3 million after he was paralyzed in a crash in a Ford van.

Jurors Wednesday awarded Dax Pierson $12.3 million for medical expenses and lost earnings and $6 million for pain and suffering for the injuries he suffered when the Ford E-350 he was riding in rolled over on an icy freeway in 2005.

At the time of the crash, Pierson was the founder of musical group that was traveling through Iowa on a U.S. tour.

Pierson was belted into his seat, but still suffered multiple fractures of his spine.

In his suit, Pierson claimed that van was defectively designed. Though Ford claimed the driver was going to fast, jurors found that Ford's design of the van had caused Pierson's injuries.

___

Information from: San Francisco Chronicle, http://www.sfgate.com/chronicle
 

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Timothy R. Titolo resides in Las Vegas. His practice is exclusively personal injury cases. He holds specific interest in cases involving traumatic brain injury (TBI), spine and spinal cord injury (SCI) and auto, motorcycle and truck accidents. He is a member of the Million Dollar Advocates Forum.

Because of his experience handling brain, spine and other  injury cases, Tim has been invited to lecture at over 50 attorney & medical conferences around the country. He has lectured for:

American Association of Justice
North American Brain Injury Society
Brain Injury Association of America
International Brain Injury Association
National Business Institute
Pacific Northwest Brain Injury Association
Oregon Brain Injury Association
Washington Brain Injury Association
Los Angeles County Bar Association
Utah Trial Lawyers Assocation
Utah Brain Injury Association
Nevada Brain Injury Association
Michigan Brain Injury Association
other brain injury affiliated groups
Tim Is a Fellow with AAJ's National College of Advocacy and is recognized for completion of the Advanced Studies of Trial Advocacy Program.
 

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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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I will never forgot the experience of deposing the coroner in a brain injury case.  The deposition was at the morgue.  Afterward, we, the attorneys for all parties and the court reporter, were treated to a tour.  What amazed me most was how numbed the folks working there were to the noxious fumes that pushed their way into your olfactory center.

Then as a personal favor to me, I was permitted to hold brains that had been removed from bodies.  I was able to get a never before view of the brain's structure, texture and size. 

I recently came across an interesting article from someone having a similar experience. Discover Magazine contributor, Carl Zimmer, published "The Brain The Big Similarities & Quirky Differences Between Our Left and Right Brains," in the May 2009 issue.  Brain lateralization is the cooperation of right and left brain.  He states:

No matter how lateralized the brain can get, though, the two sides still work together. The pop psychology notion of a left brain and a right brain doesn’t capture their intimate working relationship. The left hemisphere specializes in picking out the sounds that form words and working out the syntax of the words, for example, but it does not have a monopoly on language processing. The right hemisphere is actually more sensitive to the emotional features of language, tuning in to the slow rhythms of speech that carry intonation and stress.

Neuroscientists know that the hemispheres work together and that they do so by communicating through the corpus callosum. But exactly how the hemispheres cooperate is not so clear. Perhaps paired regions take turns being dominant. That is known to happen in some animals. For instance, dolphins use this strategy to sleep and swim at the same time: One hemisphere remains active for hours, then fades while the other takes over. Bird brains switch as well. In order to sing, a songbird makes the two sides of its lungs open and close. The two hemispheres of the bird’s brain take turns controlling the song, each dominating for a hundredth of a second.

The intimate cooperation between the two hemispheres makes it all the more remarkable that a person can survive with just one—a sign that the brain is far more malleable than we once thought. After a hemisphere is forced to manage on its own, it can rewire itself to handle all the tasks of a full brain. In fact, two hemispheres can cause more trouble than one if they cannot talk clearly to each other. Neuro­scientists have linked some mental disorders, including dyslexia and Alzheimer’s, with a breakdown in left-right communication.

The two sides of the brain may be a legacy that we inherited from our wormlike ancestors. But their delicate balance of symmetry and specialization is now woven into the very essence of human nature.

Read the full article here.

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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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The Diagnsotic and Statistical Manual IV (DSM IV) serves as the psychiatric source book for diagnosing disorders.    The manual is used in worker's compensation cases, personal injury cases, including brain injury, and in clinical and forensic psychiatric practice.

Now the Diagnsotic and Statistical Manual V (DSM V) is being created.  Shari Roan of the LA Times writes:

Psychiatrists are debating what is normal and what constitutes an illness. When that edition of the book often referred to as the “bible of psychiatry” is released in 18 months, most agree it will contain significant revisions based on information gathered from newer imaging techniques and genetic studies. Mental health advocates hope that the new edition will include information to help with diagnoses of those with mild versions of disorders, as well as those suffering from multiple disorders.

Leaders from the APA, the World Health Organization (WHO) and World Psychiatric Association (WPA) determined that additional information and research planning was needed related to specific diagnostic areas. The manual is being updated to deal with things obesity, gambling, sex addiction and Internet addiction -- formerly dismissed as harmful habits that could be defeated with willpower -- may also be labeled illnesses.
 

Read more on DSM V by clicking here.

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The Brain Injury Association of America updates us on the legislative activities.

Health Care Reform Update

This week the Senate Finance Committee engaged in three daylong sessions to discuss various policy options that may be included in a Health Care Reform bill later this year.

As reported by Congressional Quarterly, Senator Baucus, the Chairman of the Senate Finance Committee, was not very enthusiastic when asked whether committee members had reached consensus on any issues. However, he did say that he sensed some common ground on broader issues and believes his committee is moving towards a "convergence" on these issues that are expected to be debated next month.

As always, BIAA will continue to monitor any health care reform related progress. If you have not yet taken action and emailed your Senators and Representatives regarding the brain injury guiding principles, you may still do so by clicking the following link:

http://capwiz.com/bia/home

Senate Finance Committee Health Care Delivery System Comments

On Friday, May 15, 2009, BIAA submitted comments to the Senate Finance Committee in response to their proposed set of recommendations regarding health care delivery system reform.

BIAA expressed support for several recommendations with respect to the coordination of chronic conditions but also made clear within the submission that the organization is strongly opposed to the bundling of post-acute care as it applies to persons with brain injury.

To view the full document, click on the link below:

http://www.biausa.org/elements/policy/2009/biaa_finance_committee_response.pdf

DCoE Launches Real Warriors Anti-Stigma Campaign

On Thursday May 21, 2009, The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) launched a public awareness campaign focused on combating the stigma associated with seeking care and treatment for psychological health and Traumatic Brain Injury (TBI).

For more information, visit http://www.realwarriors.net/ . The Real Warriors Web site features articles and resources as well as video interviews with service members, their families and others dealing with psychological health and/or TBI.

BIAA has been an active partner in this campaign and will continue to work towards its success with the DCoE.
 

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Researchers conducting a study on Whiplash, neck injury, and forces conclude The [DELTA]V value as measured in trauma impact does not represent a conclusive predictor for cervical spine injury in real-life motor vehicle accidents.

The article states Whiplash injuries remain a barely understood phenomenon. Biomechanical considerations have been based on the assumption that damage to a given material only occurs when the energy that acts on this material is high enough. Thus, energy doses below a defined threshold have been considered harmless. In this context, the parameter delta v ([DELTA]V), which describes the velocity change of a motor vehicle during a collision with another vehicle, has become a widely accepted criterion for the energy that acts on the vehicle during a collision.

The scientific community has not yet reached consensus regarding the threshold value for cervical spine injuries after whiplash. Nonetheless, [DELTA]V threshold values were adopted very early in the history of insurance law as a criterion to accept or deny the claim settlement for whiplash-associated disorders (WADs)

Variability of  factors makes it unclear how easily the results from laboratory crash tests can be transferred to real-life accident situations. In order to elucidate these issues, this study analyzes the correlation between [DELTA]V and cervical spine injuries in real-life accidents and questions whether [DELTA]V is a valid predictor for cervical spine injuries following whiplash.

Read the study at Elbel, Martin; Michael Kramer,; Markus Huber-Lang,; Erich Hartwig,; Christoph Dehner,. "Deceleration during 'real life' motor vehicle collisions - a sensitive predictor for the risk of sustaining a cervical spine injury?(Research)(Report)." Patient Safety in Surgery. BioMed Central Ltd. 2009. HighBeam Research. 19 May. 2009 http://www.highbeam.com/doc/1G1-193106338.html

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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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Senator Kennedy suffers from a specific cancer of the brain.  It had been more than 10 years since a new treatment for glioblastoma was approved, but the U.S. Food and Drug Administration has now granted accelerated approval for the cancer drug Avastin for use against the aggressive brain cancer tumors, Business Week reports.

The FDA (Food and Drug Administration, USA) approved Avastin (bevacizumab) for patients with GBM (glioblastoma multiforme) whose cancer carries on progressing after standard therapy. GBM is a rapidly progressing cancer - it invades brain tissue and can may have a significant effect on a patient´s mental abilities and physical activities. Approximately 6,700 people each year in the USA are affected by GBM.

Unfortunately, the cancer nearly always comes back, even when treated with surgery, radiation and/or chemotherapy.

Richard Pazdur, M.D., director of the Office of Oncology Drug Products in the FDA's Center for Drug Evaluation and Research, said "This type of cancer is very resistant to therapy and thus challenging to treat. Avastin provides a therapy for patients with progressive GBM who have not responded to other medications."
 

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The cells, tissues, and organs that compose the skeletal system provide a supportive yet flexible framework that allows vertebrates to withstand earth's gravity yet remain mobile. Current knowledge about the vertebrate skeleton, especially recent research on skeletal development from embryo to adult, is summarized in a new monograph, The Skeletal System. Recently released by Cold Spring Harbor Laboratory Press, this book will serve as a reference for both scientists and clinicians.
The editor, Olivier Pourquié, states in the preface. "The goal of this book is to provide a comprehensive and up-to-date summary of the field." Each of the 13 chapters in the book was written by an expert on a specific topic. 

The Skeletal System (Cold Spring Harbor Monograph Series 53) was edited by Olivier Pourquié (Stowers Institute for Medical Research) and published by Cold Spring Harbor Laboratory Press (ISBN 978-0-87969-825-6; © 2009). It is available in hardcover and is 365 pp. in length (illus., index). For a complete table of contents and additional information about the book, please see http://www.cshlpress.com/link/skelsys.htm. 

 

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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 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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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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Timothy R. Titolo resides in Las Vegas, Nevada.  He represents plaintiffs in personal injury cases.  His specific interest is in cases involving traumatic brain injury (TBI), spinal cord injury (SCI) (including back and neck injury) and car, motorcycle and truck accidents.  

Tim is a member of the Million Dollar Advocates Forum.  He serves on the Board of Directors of the American Association of Justice Traumatic Brain Injury Litigation Group.  He is an active member of AAJ's Interstate Trucking Litigation Group, Motorcycle Litigation Group and Inadequate Security Litigation Group.  Tim is recognized as a Fellow of the National College of Advocacy.

Because of his experience handling brain, spine and other catastrophic injury cases, Tim has been invited to lecture at over 50 legal & medical conferences around the country.  He has lectured for:

• American Association of Justice
• North American Brain Injury Society
• Brain Injury Association of America
• International Brain Injury Association
• National Business Institute
• Pacific Northwest Brain Injury Association
• Oregon Brain Injury Association
• Washington Brain Injury Association
• Los Angeles County Bar Association
• Utah Trial Lawyers Assocation
• Utah Brain Injury Association
• Nevada Brain Injury Association
• Michigan Brain Injury Association
• other brain injury affiliated groups

When not practicing law, Tim enjoys spending time with his family, reading, writing, watching movies, traveling and exercising.

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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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Researchers Try to Predict Epilepsy

WASHINGTON (AP) -- Survivors of traumatic brain injuries - from car-crash victims to soldiers wounded in Iraq - face an extra hurdle as they recover: Thousands of them will develop epilepsy months or years later. The risk is especially high for certain kinds of war injuries. Studies of Vietnam veterans suggest up to 50 percent, says Dr. Nancy Temkin of the University of Washington.

Major new research is beginning into ways to predict exactly who is most at risk and how to protect their vulnerable brains.

Among the efforts: pilot studies to see if the newer seizure-treating drugs Topamax or Keppra might actually prevent epilepsy if they're taken immediately after a serious brain injury.
"It is among the most frustrating things in medicine to know that someone's at risk ... and be unable to do anything about it," says Dr. Marc Dichter of the University of Pennsylvania, who is leading the Topamax study and pushing for better recognition of such patients.

Adding to their struggle: Epilepsy may not begin with the classic jerking seizures, but instead with memory loss, attention problems or other more subtle symptoms that doctors can mistakenly attribute to the original brain injury, post-traumatic stress or some other factor.

 
Almost 3 million Americans have epilepsy, a condition in which the brain essentially suffers periodic electrical storms. When its circuits misfire fast enough, a seizure results.
Epilepsy has multiple causes. Some people are born with it.

But about 5 percent of the nation's epilepsy was caused by traumatic brain injury, or TBI. What's the risk? Roughly 25 percent of survivors of moderate to severe brain injury will develop epilepsy. Even more, perhaps, for certain types of war injuries.

Injuries that cause bleeding inside the brain are the riskiest.

The population at risk is huge: Some 1.4 million children and adults suffer serious brain injuries every year from car or bike crashes, falls, gunshot wounds and other trauma.

After the initial injury, inflammation and treatment comes a "silent period" during which survivors work to recover. It can last months or even years before epilepsy appears.

 
"This silent period is not really silent," Dr. Shlomo Shinnar of the Albert Einstein College of Medicine told a meeting of epilepsy specialists at the National Institutes of Health last week.
Instead, as the damaged brain tries to rewire itself - a crucial process called plasticity - misfiring circuitry can form. Injured neurons can make new connections in wrong places, or overly excitable connections. Even the brain's genes change the way they work after head injury.

"You need the plasticity for recovery. You don't want to stop it. You just want to structure it in a way that it aids recovery without causing seizures," Temkin explains.

 
It's not clear yet how to do that, so scientists instead are testing what's available - seizure-controlling drugs - as possible epilepsy preventers. Three old medications have failed. New pilot studies funded by the NIH and Defense Department are checking Topamax and Keppra, which work differently from older competitors.

 
"It's a bit of a shot in the dark," acknowledges Dr. Pavel Klein, who is running the Keppra study at Washington Hospital Center and Children's National Medical Center in the nation's capitol.
But there are some hints that these newer drugs might work, perhaps by inhibiting cell-harming chemicals wrought by post-injury inflammation, he says.

 
Each study is enrolling about 90 patients, a first step to ensure the drugs won't harm overall recovery before larger trials begin. Participants get the drug within hours of arriving at the emergency room, and take it for one to three months. Klein has treated 60 patients so far with no serious side effects; Dichter's study at Penn begins enrolling soon.

Until some protection is found, Dichter wants a bigger effort at warning about the epilepsy risk so that patients can recognize subtle symptoms. At his urging, the American Epilepsy Society is creating a task force to target brain-injured soldiers, work that Dichter says may eventually translate to the far bigger population of injured civilians.

Consider Denise Pease, an assistant comptroller for New York City. Months after what was initially deemed a minor head injury in a 1995 taxi crash, she began experiencing lost periods of time, increasing confusion and cognitive problems.

"This woman who dealt with the titans of industry ... was unable to make change at the corner store," Pease told the NIH meeting.

Only when a nephew witnessed a muscle-jerking seizure well over a year later did she get the right diagnosis and begin her recovery. Today, after years of trying different medications, she has good epilepsy control, and warns that "my experience ... is not unique."
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Our brains are wired to improve the odds of survival. We crave what looks rewarding and avoid what looks risky.   Similar to Malcolm Gladwell’s, Blink: the Power of Thinking without Thinking, emotions like hope, surprise, regret, fear and greed – as a matter of biology – affect our decision making.

Neuroscientist, Brian Knutson, at Stanford University, concluded that the brain fires neurons more when it anticipates reward then when it gets it. Dr. Knutson’s mentor, Jaak Panskepp of Bowling Green State University in Ohio, calls that function “the seeking system.”

Paul Slovic, a psychologist at the University of Oregon, says our anticipation wiring acts as a “beacon of incentive” that helps us pursue rewards that require patience and commitment. Hence we work hard for imagined wealth in the future and forego smaller gains in our present.

To test whether memory improves when anticipating financial rewards researchers used fMRI to view brain activity. It was revealed that looking at potentially rewarding pictures set off more intense activity in the hippocampus. The hippocampus is the part of the brain that houses long term memory. Emrah Duzel, neurologist, says “The anticipation of reward is more important for memory formation then is the receipt of reward.”

The amygdala is the reflexive part of the brain that acts like an alarm system. Neuroscientist, Gregory Berns, led a study of brain activity when following what others did versus going it alone. When people went against the consensus they showed heightened activity. Berns called it “the emotional load associated with standing up for one’s belief.” The same areas of the brain that trigger physical pain are activated by social isolation. In other words, you go along with others because it hurts not to.

Neurologists, Antonio Damasio and Antoine Bechara, conclude from research tests on persons with damaged amygdalas that decisions are driven by fear even though they do register in the thinking part of the brain and the mind has no idea of being afraid. Just like Gladwell’s Blink: the Power of Thinking without Thinking reveals, Damasio finds that without fear the human brain keeps trying to beat the odds regardless of logic. “The process of deciding advantageously is not just logical but also emotional.”

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The New York Times published a great article about the dangers associated with not recognizing the signs and warnings associated with Football injury.  Too often sporting goals prompt those who could make a difference dealing with injuries to fail players and themselves.  The issues of multiple impacts and multiple concussions seen in many contact sports like football and boxing are getting more and more attention.

The National Football League has recently faced questions about its handling of concussions after four former players were found to have significant brain damage as early as their mid-30s. But teenagers are more susceptible to immediate harm from such injuries because, studies show, their brain tissue is less developed than adults’ and more easily damaged. High school players also typically receive less capable medical care, or none at all.

At least 50 high school or younger football players in more than 20 states since 1997 have been killed or have sustained serious head injuries on the field, according to research by The New York Times.

Read the full article click here

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The Epidemic of Brain Injury care is far reaching. A recent study shows that brain injury survivors are not cared for. In terms of representing these people’s legal interests, convincing insurance companies and defense lawyers of this reality is imposing. Additionally, the future for these people, as found in the study, makes them victims again.

The report for the State of Virginia reveals what is true in many, if not all states:  veterans returning from the war will face difficult hurdles receiving care for brain injuries.  To read more about the situation click here.

Here are a few of the findings of the Joint Legislative Audit and Review Commission study:

The numbers: Up to 6,650 people with brain injuries are in nursing homes, and about 600 others are in state hospitals or in long-term care facilities, including psychiatric units.

Available care: Outside of institutionalization, only about 20 beds exist in Virginia to provide the intensive and costly treatment needed for tens of thousands of brain-injury survivors with complex neurobehavioral problems that can result in violent outbursts and other unmanageable behavior. "There is virtually no system of care in the community for people with behavioral problems who do not have the financial resources to pay for private care."

Tragic consequences: Brain-injured people often become homeless after their caregivers die; many end up in jails or seek divorce to qualify for care.

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