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

Brain Injuries often occur fast (in milliseconds) to small places in the brain (microscopic cells).   Speed and size require specific understanding in relation to forces.  This must be important to all of us since just a moment of inattention can result in significant forces being imposed on our heads.  Think of the truck or car crash you did not see coming.  Or the fall you took.  The resulting impacts can change our brains and cause a whole constellation of symptoms and consequences.

Biomechanical forces  (the research and analysis of the mechanics of living organisms and the application of engineering principles to and from biological systems) to the head and body are predictors of brain injury.  In cases of trauma, like car, motorcycle and truck collisions, in addition to sports trauma, like hockey, football and boxing (to name a few), the amount of pressure exerted on the head and the amount of time that elapses during the application of pressure, cause microscopic changes to the structure of the brain.  Microscopic because the damage occurs at the cellular level with axons and dendrites shearing. 

This, in turn, causes metabolic changes (biochemical processes) and other changes in chemistry that result in cognitive impairments, emotional impairments and physical impairments.

Head injury expert Kim Gorgens, a neuropsychologist at the University of Denver (DU), says that most concussions deliver 95 g's to the human body upon impact.

Concussions range in significance from minor to major, but they all share one common factor — they temporarily interfere with the way your brain works. They can affect memory, judgment, reflexes, speech, balance and coordination.

Usually caused by a blow to the head, concussions don't always involve a loss of consciousness. In fact, most people who have concussions never black out. Some people have had concussions and not even realized it.

Concussions are common, particularly if you play a contact sport such as football. But every concussion, no matter how mild, injures your brain. This injury needs time and rest to heal properly. Luckily, most concussions are mild and people usually recover fully.

G-force is a unit of force equal to the force exerted by gravity. In addition, the average football player receives 103 g's when hit during a game. In comparison, the average g-force experienced by military fighter pilots is nine g's. 

Let that sink in for perspective.
 

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Alcohol abuse by teenagers is similar to drug abuse on brain development.  There are two major periods of mental development: The first three years of life and adolescence.  Hopefully by the early 20s the brain is fully developed.

During adolescence the brain has difficulty handling emotions, seeks high excitement/low effort activities, and has poor planning and judgment skills. You can either think back to your own teenage angst or look at your kids or grandkids.  That combination leads to a cycle in which impulsive decisions to consume reduce inhibitions more and lead to increased impulsiveness and risk taking.

It’s also attractive to teens because consumption begins a short period of feeling good with no effort expended.  Unfortunately this many times sets the stage for adult behavior as well.

The AMA reports, additionly, adolescent females who drink alcohol have a greater risk of benign breast disease than do their non-drinking counterparts, according to new research.

The 2010 statement indicates that the brain's frontal lobes, essential for functions such as emotional regulation, planning and organization, continue to develop through adolescence and young adulthood. At this stage, the brain is more vulnerable to the toxic and addictive actions of alcohol and other drugs.  The developmental interruption is the concern.

Alcohol is the most commonly used and abused drug among youth in the U.S., according to the Centers for Disease Control and Prevention.

Nearly three-quarters of students (72%) consumed alcohol by the end of high school, according to the 2008 Monitoring the Future study, which is funded by the National Institute on Drug Abuse. Each year, the study surveys a total of about 50,000 students in eighth, 10th, and 12th grades. In 2008, 55% of 12th graders and 18% of eighth-graders reported having been drunk at least once.

 The American Academy of Pediatrics has published an updated policy statement on alcohol use by youth and adolescents. The AAP recommends that physicians take the following steps to help prevent and reduce underage drinking:

• Become knowledgeable about adolescent alcohol, tobacco and other substance use through training programs or continuing medical education.
• Obtain a complete family medical and social history at prenatal and child wellness visits to explore potential genetic and family influences regarding alcohol and other substance use.
• Recognize risk factors for adolescent alcohol use and be aware of mental health problems that might occur in this age group.
• Use validated methods to screen regularly for alcohol and other drug use.
• Assess patients whose screening results are positive for alcohol use to determine the appropriate level of intervention.
• Use brief intervention and motivational interviewing techniques to work with patients who use alcohol but do not meet criteria for immediate referral.
• Discuss the hazards of alcohol and other substance use with patients.
• Strongly advise teen patients against the use of alcohol, tobacco and other illicit drugs.
• Encourage parents to be good role models for healthy life choices.
• Be familiar with local resources to which young patients can be referred for treatment.
• Support continuation of 21 as the minimum legal drinking age.
• Support further research into prevention, evidence-based screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents.

Source: American Academy of Pediatrics, "Policy Statement Alcohol Use by Youth and Adolescents: A Pediatric Concern," Pediatrics, published online April 12 .

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Pediatric traumatic brain injury (TBI) is a major public health concern and challenge to critical care practitioners. The prevention of secondary injury is key to improving morbidity and mortality outcomes. Interventions are targeted at maintaining adequate cerebral blood flow and minimizing oxygen consumption by the brain. The anticipation and prevention of systemic complications are also of vital importance.

A new book focuses on evaluating what is currently known about childhood TBI and the challenges faced by researchers and clinicians in this arena. The book is entitled "Pediatric Traumatic Brain Injury: New Frontiers in Clinical and Translational Research," edited by Vicki Anderson and Keith Owen Yeates and published by Cambridge University Press. 

The following is an Introduction I ran across:

Traumatic brain injury (TBI) is a major public health problem among children and
adolescents. Surveillance data reveal that 1 in every 20 emergency department presentations at pediatric hospitals is for a TBI, making TBI more common than burns or
poisonings. For children, such injuries represent a common interruption to normal
development, with population estimates ranging from 200 to over 500 per 100 000 a year,
and with well-established variations across age and gender (Crowe et al., in press; Langlois et al., 2006).

The majority of TBI in children and adolescents are mild, typically with few
long-term consequences; however, a significant proportion of children will suffer more
serious injuries and will experience a range of residual physical, cognitive, educational,
functional, and social and emotional consequences, requiring the lifelong involvement of
health professionals across a range of disciplines and leading to a significant social
and economic burden for the children’s families and for the community more broadly
(Cassidy et al., 2004).

This book, New Frontiers in Pediatric Traumatic Brain Injury, aims to evaluate what we
have learned about TBI in childhood to date and, perhaps more importantly, to articulate
the challenges we face and how we should go forward in the future. Over the past two or
three decades, researchers and clinicians working with children with TBI have become
aware that injuries to the developing brain cannot be understood or treated in exactly the
same manner as those occurring in adulthood. Although we may be guided by science and
practice in adult TBI, unique developmental and contextual issues need to be taken into
account at all stages of recovery and treatment in children. Thus, a separate knowledge base is needed for pediatric TBI. As a consequence, until recently our understanding of recovery and outcomes in pediatric TBI has lagged behind that for adults. This is changing. Research in pediatric TBI now has more solid foundations. A number of principles have been established, some consistent with the adult literature, such as the predictive value of injury severity (Anderson et al., 2004; Taylor et al., 2008).

Others are specific to early brain injury, such as the unique mechanics and characteristic pathology of inflicted injury in children (Coats & Margulies, 2006; Prange & Margulies, 2002), or reflect the importance of developmental and contextual factors, such as the age at injury, developmental stage of brain development, and functional maturation (Anderson et al., 2005; Taylor & Alden, 1997), the key role of the family, and implications of life tasks specific to children (Yeates et al., 1997). 

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Recall the recent post I made raising the issue of whether antidepressants were properly relied on by patients and physicians.  That post can be accessed here. http://brainandspine.titololawoffice.com/2009/12/articles/psychiartric-psychological-iss/antidepressant-may-change-personality/

 A new study appears in the December issue of The Annals of Pharmacotherapy.  (Published Online, November 24, 2009. www.theannals.com, DOI 10.1345/aph.1M326) Suicidal adolescents who were prescribed an antidepressant medication during inpatient psychiatric hospital treatment were 85 percent less likely than others to be readmitted within a month after discharge.

The results provide additional evidence that antidepressants may play a key role in helping improve the mental health of suicidal youth. Cynthia Fontanella, co-author of the study and assistant professor of social work at Ohio State University, points out that the the findings are especially important now, because antidepressant use dropped in 2003 after the Food and Drug Administration issued a black box warning that some antidepressants may increase the risk of suicidal behavior for pediatric patients. A black-box warning is the most serious type of warning in prescription drug labeling.

Despite considerable recent attention and wide-scale interventionsby regulatory authorities that have changed drug usage patterns,the possible relationship between psychotropic pharmacotherapy and suicidal behavior among children and adolescents remainsunclear. Confounding by diagnosis adds to confusion in the interpretationof the relationship between antidepressant use and suicidal behavior among young people. Cynthia Fontanella's recent research suggests that antidepressants may be protective against early readmission after hospitalization for suicide attempts or ideation, but that psychotropic polypharmacy (although common) may be associated with increased risk of rehospitalization.There remains an urgent need for high-quality, ongoing research into these clinical dilemmas.

Once again, I invite your input and thoughts on this issue by posting a comment.
 

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Reporting their results in the Journal of Neuroscience, Scientists show that Inhibiting an enzyme in the brains of newborns suffering from oxygen and blood flow deprivation stops a type of brain damage that is a leading cause of cerebral palsy, mental retardation and death, according to researchers at Cincinnati Children's Hospital Medical Center.

This is a breakthrough which will save lives and promote healthy delivery of newborns.  Although it is still experimental.

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