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

 We are almost through August and more than half way through Summer 2010. Parents, children and kids are preparing for the return to school in the next couple of weeks. In Nevada, public schools start August 30.

Meanwhile Nevada, and particularly Las Vegas, continues to muddle through the recession which for Southern Nevada has been a novel experience. The unemployment rate is close to 15% as I write.  The city many thought was immune from economic storms has seen itself hardest hit. Hopefully things will improve.

We face a heated election where the Tea Party candidate, Sharon Angle, accuses Democrat incumbent, Harry Reid, for the current state of plummeted home values while Reid criticizes Angle for not making job creation a part of her job!

The Station Casino’s recent resurface from Bankruptcy with owners, Frank and Lorenzo Fertitta, manning the helm, may be a boost. Of course some creditors had to write off $4,000,000,000 – four billion dollars! But maybe the massive adjustment will re establish the local casino group and have a positive impact on Las Vegas. 

Today’s report of the M Resort, opening just over a year ago, being put up for sale may result in an interesting bid; especially if Boyd gets back into the picture. Boyd’s recent failed effort to take over Station properties may be a prelude to an M resort bid.  Although my sources tell me that Station may make a bid to buy M resort now that they have shaken off 4 billion in debt.

I am reporting on 2 separate topics relating to Brain and Spine Injury issues. First is a look at the Cleveland Clinic’s Las Vegas Lou Ruvo Center. Second is the recent revelation concerning veterans. 

Lou Ruvo Brain Center

Nevada, and specifically Las Vegas, may be on its way to becoming the "go-to" place in the country for Brain Health.  The Cleveland Clinic Lou Ruvo Center for Brain Health (CCLRCBH) provides state-of-the-art care for cognitive disorders and for the family members of those who suffer from them.

 For persons with mild cognitive impairment such as early stage dementia and Alzheimer’s disease, the center offers the most up-to-date and technologically advanced diagnostic imaging services, including 3-Tesla MR, performed by one of the leading neuroimaging academic centers in the world. The CCLRCBH also offers a multimodal treatment program for persons with mild cognitive disorders, including physical exercise, cognitive rehabilitation, and cognitive enhancing medications.

Recently named to head up the Center, leading researcher and neurologist Jeffery L. Cummings, MD, will be the Director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

Prior to joining Cleveland Clinic, Dr. Cummings was the director of the Mary S. Easton Center for Alzheimer’s Disease Research and a professor of Neurology and Psychiatry and Biobehavioral Sciences at David Geffen School of Medicine at UCLA.

He is past president of the Behavioral Neurology Society and of the American Neuropsychiatric Association. Dr. Cummings has authored or edited 30 books and published more than 600 peer-reviewed papers.
 

Misdiagnosis Hurt U.S. Soldiers

We now know that during the height of the Iraq war, the Army routinely misdiagnosed hundreds of soldiers with “personality disorder.” In doing this, the Army was categorizing veterans being dismissed from duty, with a pre-existing condition. Pre existing conditions are not covered by the military health care for veterans.

Leaving wounded veterans ineligible for military health care and with a stigma attached to mental weakness, advocates for veterans, congress and the public actively pushed for re-evaluation of veterans conditions. The Nation, published an article exposing the practice and caused the Defense Department to change its policy. 

All soldiers diagnosed with Personality disorder prior to 2008 are being re-evaluated. Before 2008, over 1000 soldiers were dismissed based on personality disorder. In 2009 only 260 were dismissed for personality disorder.   By 2008, 14,000 soldiers were diagnosed with brain injury or post traumatic stress disorder.   The number of personality disorder cases dropped 75%. Watch this You Tube video.

The significance for those men and women that serve the country in the military is staggering. Could you imagine sacrificing life and limb only to have the U.S. government tell you that you suffered a pre-existing personality disorder? Why, you might ask, did the Army, for example, not make that determination until after my sacrifice of life and limb? How convenient for the Army to take advantage of the sacrifice and not pay the veteran when they can no longer make the sacrifice.

We now know about PTSD as it relates to war, something the Vietnam veterans did not benefit from. We also know, unlike Vietnam, that more soldiers stay alive after blast and concussion trauma due to the enhanced protective gear.

I really hope that the U.S. will be proactive in caring for its military. I think we should all support brain injury groups like the Brain Injury Association of America who are on the front lines, so to speak, in getting legislation for brain injured survivors.

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What is a Brain Injury Case Worth? Episode 2

Brain injury comes in many shapes and sizes. The proverbial “one size fits all” does not apply. Although there are many similar characteristics with most brain injuries they are not all the same. For instance, brain injury often results in short term memory loss and difficulty processing information. How that emerges between individuals varies but often it is seen at work and in social situations. Often the difficulty requires more energy for processing information and results in fatigue.

Depression is common both from the injury itself and psychologically as a result of the affects of the injury. This is especially true in cases of mild and moderate traumatic brain injury when those around you simply have difficulty believing you are suffering when you look otherwise normal. This adds to the frustration, anxiety and irritability.

If you have been in a traumatic event that caused a concussion and brain injury, you may wonder about the value of the legal case. A legal case value depends on many things other than the injury and its affects. Many people do not understand this. Sometimes an injury can be worse in one case but valued lower than another case with a lesser injury. On the other hand, too often cases with a higher value are settled for less because the person making the evaluation does not understand brain injury. Since traumatic brain injury typically results in difficulty making decisions, it is a good idea to have someone you trust help you find a lawyer.
Finding the right lawyer is critical to getting a proper verdict or settlement. Lawyers have different interests and talents. Long ago lawyers could be general practitioners handling wills, business matters, divorce and criminal matters. Today the law is very specialized. That is, what a lawyer spends most of his time doing is what he is best at. If your lawyer handles one or two brain injury cases a year, he is not a good choice to handle your injury. If your lawyer’s practice is devoted to over 90% brain injury cases, you’ll have a much better outcome.

The first thing to understand is all lawyers are not made the same. And just like other folks, if a lawyer untrained in brain injury does not see an injury on standard diagnostic tests or by simple observation, they are not likely to believe it exists. On the other hand, if your lawyer is versed in how mild and moderate traumatic brain injury affects victims, they will know where to look and how to maximize the value.

Traumatic Brain Injury typically has medical costs associated with care in the past and in the future. Determining what the future costs are likely to be is important in valuing the case. Likewise, past lost earnings from being out of work are simple enough to calculate, but what about the loss of future earning capacity? This is very tricky since a person with brain injury may be able to do a job but staying consistently employed is an entirely different matter. Again, unless your lawyer has extensive experience on how and why a brain injury can cause loss of future earning capacity, she may sell your case short.

There are many other things to consider when hiring a lawyer and that is why you should seek out assistance from someone you trust; your spouse, parent, child, relative, or good friend. You should not simply take the advice of someone who tells you about a lawyer they used in a case. That lawyer may be a very talented divorce lawyer but that is not what you need. Your friend’s lawyer may even be personal injury lawyer, but that does not automatically qualify her as a brain injury specialist. Personal injury lawyers rarely limit their practice and research to traumatic brain injury. You are entitled to hire a lawyer that does.

I wrote an article entitled a Guide to Selecting a Lawyer in a Traumatic Brain Injury Case. I attempt to guide non-lawyers in choosing a qualified lawyer to handle their case. Much of what I propose are simple questions that you have a right to ask. Lawyers who profess skill in handling traumatic brain injury cases typically have blogs they publish. For instance my blog is entitled Brain and Spine Injury Law Blog. You may want to research your lawyer’s web site as well.

With the help of a trusted companion, look up organizations like the Brain Injury Association of America (BIAA), www.biaa.org. Visit their site on the internet or call them and ask for a referral to a lawyer in your particular state. There are organizations whose purpose is to assist victims of brain injury. Consult them rather than simply relying on the recommendation of a friend who may mean well but does not understand the nuances of brain injury.

These organizations will also assist you in getting the right care and treatment in your area. Most hospital emergency rooms do not treat or even diagnose mild or moderate traumatic brain injury, so you will benefit by talking to folks who understand. Other groups include individual State Brain Injury Associations, and the North American Brain Injury Society (NABIS), www.nabis.org.

Not only will these organizations assist you in getting help, they provide literature and videos to help explain what you are experiencing and how treatment can help.
If you or someone you know has suffered traumatic brain injury, please accept my best wishes and prayers for a maximized recovery. I hope something I have shared here will assist you in your journey.

Timothy Titolo copyright 2010
 

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TheAmerican Medical Association study links depression and traumatic brain injury. Survivors of concussions are almost eight times more likely to become clinically depressed, researchers report.

In the year following a traumatic brain injury, roughly half of survivors likely experience a bout of clinical depression -- a rate almost eight times higher than that found in the general population, says a study published  in the Journal of the American Medical Association. And those whose head trauma was followed by depression reported significantly more pain, greater mobility problems and more difficulty carrying out their usual responsibilities than those who were not plagued by post-injury depression.

Traumatic brain injury, or TBI, is sometimes called concussion. Often called the "silent epidemic," it affects some 1.5 million Americans yearly. Its symptoms are often subtle -- including personality changes, problems of memory and concentration, headaches and mood disturbances. While for most, the effects of a head trauma will clear within a year, many have more lasting effects. For at least 80,000 people a year, major disability will follow.  

The 559 participants in this study had all come to a trauma center in the Seattle area with a head injury, signs of brain trauma that could be detected by a CT scan, and at least a few complications -- including loss of consciousness, disorientation or other factors that qualified them as scoring at most a 13 on the 15-point Glasgow Coma scale. Over the next six months, and then again at eight, 10 and 12 months after the participant's injury, researchers conducted a detailed telephone interview to gauge his or her mood state and ability to function. The result, said the researchers, was likely to yield a conservative picture of how many suffered from depression.

LA Times reporter Melissa Healy interviewed Dr. Hovda, a UCLA biologist who said, "the study made clear what clinicians had long suspected: "Major depressive disorder can have severe consequences for recovery from TBI."

But the study didn't explore some important distinctions, said Hovda, who was not involved in the research. Among those are whether repeated concussions — like those suffered by some U.S. troops and athletes — might make depression more likely than a single, severe brain trauma.

Other factors were also correlated with depression after Traumatic Brain injury including being African-Amreican, being involved in litigation, not completing high school, or when the injury was caused by violence (as opposed to a vehicular crash, fall or recreational injury).

It is still questionable whether depression is related to organicity of the injury or psyhological affects of the injury.  The latter being more susceptible to treatment.  But the myth that depression is "all in your head" (seriously - no pun intended) continues to dispelled.  It a serious consequence of traumatic brain injury that can severly affect a persons ability to function.

To learn more about TBI and its sometimes-persistent effects, this comprehensive website can't be beat. To learn about local support groups and national and state efforts to improve life for those with TBI, check this website out.  

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One of the problems associated with TBI is the person's ability to drive and lack of insight as to that ability.  I came across this interesting article on the topic of evaluating driving following a TBI.  Keep in mind that statistics tell us that 10% of TBI's are severe or moderate.  80% are mild.  The following is a summary of the study.

 OBJECTIVE. We conducted a literature review of assessment tools predicting driving performance for people with traumatic brain injury (TBI).

METHOD. Data sources were Web of Science, EBSCOhost, PubMed, and recently published literature from experts and team members not yet catalogued in the databases. We used the American Academy of Neurology's classification criteria to extract data from 13 studies, and we assigned a class (I-IV, with I being the highest level of evidence) to each study. We grouped primary studies into categories of driving assessment (neuropsychological; simulator; off-road; self-report, other report, and postinjury disability status; and comprehensive driving evaluation) and synthesized the predictability of these tools as it relates to driving performance for people with TBI.

CONCLUSIONS. To assist clinicians and researchers in making decisions regarding testing the driving performance of people with TBI, we provide recommendations for neuropsychological tests; off-road tests; self-report, other report, and postinjury disability status; and comprehensive driving evaluation.
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Read the entire article with references here:  C; Charles Levy; Dennis McCarthy; William C Mann; Desiree Lanford; J Kay Waid-Ebbs. "Traumatic Brain Injury and Driving Assessment: An Evidence-Based Literature Review." The American Journal of Occupational Therapy. The American Occupational Therapy Assn, Inc. 2009. HighBeam Research. 29 Sep. 2009 <http://www.highbeam.com>.

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Biotech Week reported on May 23, 2009:

Remembering what's most important is central to daily life. For example, if you went to the grocery store but left your shopping list at home, you'd at least want to remember the milk and bread, if not the jam. Or, when packing for a trip, you'd want to remember your wallet and tickets more than your slippers or belt.

Even very early in Alzheimer's disease, people become less efficient at separating important from less important information, a new study has found (see also American Psychological Association).

 Knowing this, clinicians may be able to train people in the early stages of Alzheimer's to remember high-value information better, according to a report in the May issue of Neuropsychology, published by the American Psychological Association.

Neuropsychology is the area of neuroscience that studies relationships between brain function and behavior, with a central focus on human brain-behavior relationships. Neuropsychological research attempts to map the brain structures and functions that are critical for particular mental/cognitive, emotional, and behavioral capacities.

As my father approaches 70 and my grandmother 87, early onset of Alzheimers is a reality for me.  Making sure they get proper diagnosis and treatment is paramount should signs and symptoms appear.  We should all be mindful of those we love as they age.

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