New York Times: Derek Boogaard's Brain Injury

 Derek Boogaard's brain was preserved.  Although the Hockey player was dead, a request came to the family to not cremate Boogaard until they could carve his brain out of his skull to study it.  That was May 2011.  The results came in October.

Boogaard had chronic traumatic encephalopathy, commonly known as C.T.E., a close relative of Alzheimer’s disease. It is believed to be caused by repeated blows to the head. It can be diagnosed only posthumously, but scientists say it shows itself in symptoms like memory loss, impulsiveness, mood swings, even addiction.

More than 20 dead former N.F.L. players and many boxers have had C.T.E. diagnosed.  Typically they are left in a permanently scarred state in later life.

The issue of repeated trauma is explained in a video.  To read more about this particular case you can read the New York Times Article.

The Center for the Study of Chronic Traumatic Encephalopathy states the following:

Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head. CTE has been known to affect boxers since the 1920s. However, recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma. This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.

 A new paper published in the Journal of Neuropathology and Experimental Neurology suggests head trauma may also lead to a neurodegenerative disorder mimicking ALS.  This paper adds to literature suggesting an elevated risk of ALS in veterans and professional soccer players who have suffered head injuries, and is certain to contribute to the controversy regarding the link between head trauma and ALS. A recent article in the New York Times points out that Lou Gehrig himself may have had this entity rather than ALS.

Researchers at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, the University Hospital and academic medical center for Einstein, used diffusion tensor imaging, an advanced type of MRI-based imaging technique, as well as cognitive tests, to assess brain function in amateur football players. Their findings indicate the possibility of brain injury from frequently heading the ball.

Gabrielle Giffords Getting Care Not Typically Offered By Insurance

One of the most disconcerting realities of Traumatic Brain Injury is getting the care covered by most insurance.  What we as a nation are seeing for Congresswoman Gabrielle Giffords is not what normally occurs.

ABC did a piece on how insurance companies deny coverage for treatiment of traumatic brain injury.  Check it out here.

While Giffords is getting top-flight care at a facility that specializes in rehabilitation after major brain injuries, many patients get nothing close to it. The fine print in many health plans -- including Medicare and Tricare, which serves U.S. military members -- excludes coverage of certain types or even complete rehabilitation for thousands of patients with traumatic brain injuries, or TBIs.

...the Brain Injury Association of America, a non-profit group that advocates on behalf of people with brain injuries, says studies have shown that cognitive rehab is very effective.

BRAIN INJURY CONFERENCES AND EVENTS IN 2011

Brain Injury Conferences and Events in 2011

For those of us interested in upcoming truamatic brain injury conferences, I obtained this information.

  • Brain Injury Association of America

The Brain Injury Association of America launches its new web site at http://www.biausa.org/. Check out the latest information on developments and advancements in the brain injury field.

Visit the site today to find information on available support services, upcoming training and education opportunities, participate in new online forums and much more!

  • International Brain Injury Association

The International Brain Injury Association is pleased to announce that the Ninth World Congress on Brain Injury will be held March 21-25, 2012, in Edinburgh, Scotland.

  •  Interagency Conference on Traumatic Brain Injury (TBI)

The Third Interagency Conference on Traumatic Brain Injury (TBI) will be held on June 13-15, 2011, in Washington DC at the Washington Hilton.

The first Federal Interagency Conference was held in 1999, and the second in 2006. Attendance at these conferences far exceeded expectations of the planning committee and was way beyond the capacity of the hotel. Feedback from attendees indicated that the conferences were highly successful educational events for the attendees and many requested that the conference continue to be offered in the future. As a result of this enthusiasm, the continued focus of TBI in the media and the need for researchers, clinicians and policy makers to “get out” the “latest and greatest” advances in TBI research and clinical care, a third conference is to be sponsored by a consortium of Federal Agencies. For the first time, this consortium brings together civilian and military research efforts.

Click here for more Brain Injury related conferences and events.



Scientists Find New Research On The Brain And Fear That Could Help Victims Of Post Traumatic Stress Disorder

University of Missouri research indicates there may be new hope in dealing with Post traumatic stress disorder commonly referred to as PTSD.

The brain is a complex system made of billions of neurons and thousands of connections that relate to every human feeling, including one of the strongest emotions, fear. Most neurological fear studies have been rooted in fear-conditioning experiments. Now, University of Missouri researchers have started using computational models of the brain, making it easier to study the brain's connections. Guoshi Li, an electrical and computer engineering doctoral student, has discovered new evidence on how the brain reacts to fear, including important findings that could help victims of post-traumatic stress disorder (PTSD).
 

Read more here.

Post Traumatic Stress Disorder

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.

Mild & Minor Traumatic Brain Injury: An Unfortunate Oxymoron

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.

 

DoD Gets 35M to Study "Mild" Traumatic Brain Injury

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.