Episode 5 - The Hollywood Myth

Las Vegas Brain Injury Law Blog

THE HOLLYWOOD MYTH

We all accept the things we see in movies and on television.  That is the hope and intent of their creators.  However reality and fantasy, or at least make-believe, are not the same.  We need to be reminded that fact and fiction are not the same!

Traumatic Brain Injury

Traumatic brain injury will occur when the soft tissues of the brain are pushed against the boney structures of the skull in whiplash type, acceleration/deceleration movements. The inside of the skull is riddled with sharp ridges especially around the eyes.

The problem with most of us is we are desensitized to the impact of trauma and brain injury due to what we watch every day on television or in the movies. This is called the Hollywood Myth.

Most people’s knowledge and experience with the result of mild head injuries is largely the product of movie magic. Some of the funniest scenes in slap stick comedies and cartoons depict the character sustaining a single or multiple head injuries, looking dazed and then recovering immediately. In cowboy movies, detective and action stories, and boxing and kung fu films, seemingly serious head trauma is often inflicted by blows from guns and heavy objects, falls, motor vehicle injuries, fists, and kicks, all without lasting injury.

Our Experience

Our experience is minuscule compared to the thousands of simulated head injuries witnessed in the movies and on television. Because of the compelling mythology, the lawyers and physicians have a difficult job educating patients, their families, and others in the realities of mild head injuries. However, when one looks at examples of two successful boxers, Joe Lewis and Muhammad Ali, they have witnessed powerful punches resulting in dazed, disorientated boxers or knock outs. Memory loss and dementia have been a frequent finding in ex fighters.

Boxing and other Repetitive Injury

“Mild head injury typified by momentary amnesia, brief loss of consciousness, and persistent headache or mild neurological signs is more difficult to document than severe or moderate head injuries. In an analysis of 1,165 bouts: researchers found that 79% of boxers had momentary neurological signs, whereas 21% demonstrated deficits for at least 24 hours.”

And our favorite sports, football, hockey, baseball all involve serious, repetitive head injury which take their toll on athletes both now and later in life.

Television & Movies

Recall Laurel and Hardy, Abbott and Costello and the Three Stooges, all slapping each other and making us laugh. We laughed because we knew the injuries were fake; But not so in real life.

We all cheered James T. Kirk when he engaged in hand to hand combat either knocking his opponent out or being knocked out himself, only to return apparently healed and well in the next scene.

Today’s movies continue the tradition of distorting the truth about head and brain injury. And we are all caught up in it. We are conditioned to believe a little punch or two cannot really do any permanent damage. Then we see Natasha Richardson suffer a seemingly minor head injury while skiing, go on about her day, and die hours later from brain injury.

Education

Education is the key.  Occasionally, a documentary or science channel special runs a series or show on brain injury, but it is our responsibility as parents, and engagers of everyday risk to know the difference between fact and fiction.
 

Football, War and Traumatic Brain Injury

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

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

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

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

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

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

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

 

Traumatic Brain Injury Awareness and the New England Journal of Medicine

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

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

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

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

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

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

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

Long Term Consequences

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

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

 

Brain Injury Settlement

The fact of repeated impacts to the brain causing brain damage made news.  A private university will pay $7.5 million to provide lifetime care to a former football player who suffered a severe brain injury in a 2005 game after an earlier concussion went untreated.

The family of Preston Plevretes, 23, of New Jersey, settled their lawsuit against La Salle University.

The settlement came as the NFL, the NCAA and other governing bodies review rules about when athletes should return to play following concussions, amid research that suggests returning too soon can lead to brain damage.

 

Read more: http://sportsillustrated.cnn.com/2009/football/ncaa/wires/11/30/2060.ap.fbc.football.concussion.lawsuit.3rd.ld.writethru.0664/#ixzz0Z1OZ8nRV
 

Redskin's Taylor possible Brain Damage

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

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

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

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

Read the full article here.

Football: The Great American Danger?

We have all noticed the attention of late on sports and war related brain injury. I came across another article in People magazine ( October 8,2007) about the increasing number of concussions in high school football.


…while other serious injuries have declined in the past 10 years, the percentage of injuries that are concussions has nearly doubled, according to a July study by the Center for Injury Research and Policy in Columbus, which notes the numbers might be higher. “It’s a very underreported injury, so we’re pretty sure this is just the tip of the iceberg,” says Dawn Comstock, the study’s lead researcher and an assistant professor at Ohio State University School of Medicine. “Kids, coaches, parents, all of us have to take this injury much more seriously.”


Of course, no one is advocating a ban on the great American sport (which has more injuries than any other high school sport), the attention is creating increased safety. Several hundred high schools now use neurocognitive tests to help determine whether a player has healed.  High schools already have injury guidelines stressing that players shouldn’t be sent back into a game after a concussion – and definitely not until they’re examined by a physician.

 
Safety advocates received support when the NFL adopted stricter guidelines for when a player can return to play after a head injury. The NFL recently came under attack when three retired players who died were found to have suffered severe brain damage in their 40’s and 50’s. “As the NFL goes, so goes everyone else,” said Dr. Robert Cantu, co-director of the Neurological Sports Injury Center at Brigham and Women’s Hospital in Boston. “If the NFL says this is wrong, then colleges and high schools will say the same.”

Sports and Brain Injury

Injury on the fieldThe 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