The University of New Mexico is engaged in a new program designed to scan the brains of all student-athletes engaged in contact sports.
The program will perform noninvasive MRI scans of the brains of men’s basketball, football, soccer, diving and baseball teams. Female athletes engaged in basketball, volleyball, soccer and diving will also be scanned. Additionally, anyone engaged in cheerleading will receive a baseline brain scan.
So far the program known as the Brain Safe Project has scanned the brain of more than 253 student athletes. The program is designed to study the long term effects of concussions sustained by student athletes.
The Premise of Baseline Brain Scans according to the Brain Safe Project:
“The Importance of Baseline Scans
Measuring structure, function, perfusion, and connectivity at two different times
One of the most difficult things in assessing the impact of any type of head injury — but concussions and mild traumatic brain injury in particular — is to identify what has changed in regard to brain structure and function. Having individuals’ baseline scan for comparison purposes may significantly add to the accuracy of the assessment of brain injury. This is the premise of the Brain Safe project.
The goal of the Brain Safe analysis methods— that will analyze what has changed at the level of the individual subject by measuring structure, function, perfusion, and connectivity at two different time points or before and after any event—is to be able to identify mild traumatic brain injuries that cannot be identified with traditional assessment methods such as neuropsychological tests or a single structural scan.”
You can get more information by visiting the brain safe project web site.
The Brain Injury Association of New York State is offering a free Webinar, A Parent's Guide to Concussions in the Classroom on Thursday, August 28, 2014 from 3:00-4:15 p.m. EST
Topics to include:
What to do when my child sustains a concussion?
What is the school district’s responsibility when a student is concussed?
Neurocognitive testing, what is it for?
Return to play protocols
Return to school protocols|
Available resources for managing a complex concussion
Click here to register
The following August federal brain injury legislative update was prepared by the Brain Injury Association of America (BIAA):
TBI Act Reauthorization
The United States Senate planned to pass TBI Act Reauthorization this week but further action on the bill will be taken in September. BIAA thanks Sens. Harkin (D-Iowa), Alexander (R-TN), Hatch (R-UT) and Casey (D-PA) for their continued leadership on passing this important legislation to the brain injury community.
Assisted Living TBI Pilot Program Extension
The U.S. Senate overwhelmingly passed a $16 billion overall to the Department of Veterans Affairs Thursday night which included a three year extension to the Assisted Living TBI Pilot Program. Sens. Corey Booker (D-NJ) and Dean Heller (R-NV) introduced the Assisted Living Pilot Program for Veterans with Traumatic Brain Injury Extension Act, S.2607. The AL-TBI Extension Act authorizes the continuation of a critical VA program that provides intensive care and rehabilitation to veterans with complex brain injuries. AL-TBI consists of community-based residential/transitional rehabilitation programs around the country in which veterans are immersed in therapies for movement, memory, speech, and gradual community reintegration. This model of care allows veterans facing similar challenges to live together while receiving 24/7 care, which has yielded impressive results and helped rehabilitate hundreds of veterans from severe injuries that are notoriously difficult to treat. BIAA thanks Sens. Booker and Heller for their leadership and to Congress on extending this vital program to our Veterans with TBI.
U.S. Department of Education
On Tuesday, BIAA staff attended a meeting with Michael Yudin, Assistant Secretary of Special Education and Rehabilitation Services and other senior leadership at the Department to discuss New York State's Elementary and Secondary Education Act (ESEA) waiver extension which included a provision to test students with disabilities two grades below their enrolled grade level. On Thursday, the Department approved New York's ESEA Waiver Extension without Amendment 1. Amendment 1 was the provision that would have allowed NY to test students with disabilities at two grades below their enrolled grade. BIAA could not be more pleased that this provision was not included in the waiver - its removal means that thousands of students with disabilities including brain injury won't be taken off the track to graduation.
SAFE PLAY Act Introduced
On Thursday, Rep. Bill Pascrell, Jr. (D-NJ-09), Senator Robert Menendez (D-NJ), and Rep. Lois Capps (D-CA-24) introduced the Supporting Athletes, Families and Educators to Protect the Lives of Athletic Youth (SAFE PLAY) Act, a bill that would promote youth safety in athletic activities.
According to the Centers for Disease Control, participation in organized sports is on the rise. Almost 30 million children participate in youth sports in the U.S. This increase in participation has also led to an increase in injuries - more than 3.5 million kids under age 14 receive medical treatment for sports injuries each year, 21 percent of all traumatic brain injuries among U.S. children are associated with sports participation, and children ages 5 to 14 account for nearly 40 percent of all sports-related injuries treated in hospitals.
To address this, the bill would take a multipronged approach of research, community education, and federal support for school district to adopt best practices to keep kids safe, focusing on several areas, including heat exposure, CPR and AED training, concussion response, and energy drink consumption, to ensure children's safety in athletics and on campus.
Specifically, the SAFEPLAY Act would direct the Center for Disease Control (CDC) and the Department of Health and Human Services (HHS) to:
• Develop recommended guidelines for the development of emergency actions plans for student athletes
• Develop information on the ingredients used in energy drinks and the potential side effects of energy drink consumption
• Recommend guidelines for the safe use of energy drink consumption by students
• Report to Congress on the number of sports related fatalities and catastrophic injuries and the cause
• Develop and disseminate information about the health risks associated with exposure to excessive heat and humidity, and how to avoid heat-related illness
• Assist schools in developing and implementing an excessive heat action plan to be used during all school-sponsored athletic activities that occur during periods of excessive heat and humidity
The bill would also help local education agencies develop and implement safer schools. The bill would provide assistance for school districts to develop and implement a standard plan for concussion safety and management and set up concussion management teams to respond to incidents on campus. It would also support schools by providing access to critical resources to teach students across the country the life-saving skills of cardiopulmonary resuscitation (CPR) and how to use automated external defibrillators (AED).
Congress is out of session for the month of August and will return to Washington D.C. on September 8, 2014. Policy Corner will resume on September 12, 2014.
Apparently, not all concussion apps that are currently available from I Tunes are up to date or provide comprehensive information according to a new article Comprehensive review of concussion screening apps for the sidelines which can be accessed by clicking here.
Concussion rates in young female soccer players are greater than those reported in older age groups, and most of those concussed report playing with symptoms according to a study on the prevalence of concussions in female soccer players reported in this week’s issue of Journal of the American Medical Association entitled, Concussion and Female Middle School Athletes, JAMA. Published online August 01, 2014
The study also found that heading the ball is a frequent precipitating event and that awareness of recommendations to not play and seek medical attention is lacking for this age group.
The study found that among the 351 soccer players, there were 59 concussions with 43 742 athletic exposure hours. Cumulative concussion incidence was 13.0% per season, and the incidence rate was 1.2 per 1000 athletic exposure hours (95% CI, 0.9-1.6). Symptoms lasted a median of 4.0 days (mean, 9.4 days). Heading the ball accounted for 30.5% of concussions. Players with the following symptoms had a longer recover time than players without these symptoms: light sensitivity (16.0 vs 3.0 days, P = .001), emotional lability (15.0 vs 3.5 days, P = .002), noise sensitivity (12.0 vs 3.0 days, P = .004), memory loss (9.0 vs 4.0 days, P = .04), nausea (9.0 vs 3.0 days, P = .02), and concentration problems (7.0 vs 2.0 days, P = .02). Most players (58.6%) continued to play with symptoms, with almost half (44.1%) seeking medical attention.
You can access the full study by clicking here.
Here is the most recent legislative update from the Brain Injury Association of America (BIAA) who deserves our thanks for all of their efforts on behalf of individuals with brain injury and their families
TBI Act Reauthorization
The Senate Committee on Health, Education, Labor, and Pensions (HELP), lead by Chairman Tom Harkin (D-Iowa) and Ranking Member Lamar Alexander (R-TN) approved the Traumatic Brain Injury (TBI) Reauthorization Act of 2014 as part of a package of bipartisan bills. S.2539 was introduced by Sens. Robert Casey, Jr. (D-PA) and Orrin Hatch (R-Utah).
First enacted in 1996, the TBI Act is the only federal law that authorizes agencies within the U.S. Department of Health and Human Services (HHS) to conduct research and public education programs and to administer grants to states and protection and advocacy organizations to improve service system access and coordination for the 2.4 million civilians who sustain traumatic brain injuries in the U.S. each year.
The authorization bill includes an increased focus on brain injury management in children and gives the HHS Secretary discretion to determine which agency within the department will administer the grant program for states and protection and advocacy organizations.
The United States Senate is likely to vote on the bill next week before Congress breaks for August recess. The House of Representatives voted to reauthorize the TBI Act in a floor vote on June 24, 2014. BIAA thanks Sens. Harkin, Alexander, Casey and Hatch for their leadership in reauthorizing the TBI Act.
Assisted Living Pilot Program for Veteran with TBI Extension Act
Sens. Corey Booker (D-NJ) and Dean Heller (R-NV) introduced the Assisted Living Pilot Program for Veterans with Traumatic Brain Injury Extension Act, S.2607. The AL-TBI Extension Act authorizes the continuation of a critical VA program that provides intensive care and rehabilitation to veterans with complex brain injuries. AL-TBI consists of community-based residential/transitional rehabilitation programs around the country in which veterans are immersed in therapies for movement, memory, speech, and gradual community reintegration. This model of care allows veterans facing similar challenges to live together while receiving 24/7 care, which has yielded impressive results and helped rehabilitate hundreds of veterans from severe injuries that are notoriously difficult to treat.
AL-TBI began as a five-year pilot program established in the FY2008 National Defense Authorization Act. Although it took the Department of Veterans Affairs over two years to implement the pilot program, the program-which has been operational for only three years-will expire this year if Congress does not act. The VA has stopped admitting new veterans into the program. If the program is allowed to expire, the VA will have to discharge veterans in the program even if they have not had the full benefits of this model of care. In fact, the VA will begin discontinuing services for at least half of those in the program in mid-September. The VA has indicated it will carry out individual transition plans for veterans currently enrolled in the pilot, but it offers no alternatives that replicate the AL-TBI's model of residential, community-based treatment.
Congratulations to Shana De Caro -- New Chair Traumatic Brain Injury Litigation Group, American Association for Justice
Congratulations to my partner, Shana De Caro on her election as chair of the American Association For Justice, Traumatic Brain Injury Litigation Group at the association's annual conference held earlier this week in Baltimore, Maryland.
The traumatic brain injury litigation group provides the latest information to attorneys representing victims of traumatic brain injury on effective strategies to establish and prove the lifelong consequences of brain damage sustained; new advances in brain injury medicine including diagnosis, treatment and using imaging studies. Each year the group sponsors seminars to educate attorneys on cutting-edge developments in traumatic brain injury litigation. The group reviews the latest medical literature on traumatic brain injury, new diagnostic test methods, and recent court decisions pertaining to the traumatic brain injury litigation and the latest trial techniques to convey the full extent of the consequences of traumatic brain injury in court.
The group comprises attorneys from throughout the nation who represent clients with traumatic brain injury caused by automobile collisions, truck and bus accidents, head injuries sustained on construction sites, falls and medical malpractice.
Shana De Caro has been an active participant in the group since its inception in 1991 and has served on its executive board for the past ten years. In addition to her service on the traumatic brain injury litigation group, Shana also serves on the board of directors of the New York State Academy of Trial Lawyers, is a trustee and officer of the Civil Justice Foundation and an elected fellow of the Melvin Belli Society. Shana is also a member of the Advisory Board, Acquired Brain Injury Program, The George Washington University, Washington, D.C., Graduate School of Education, and Human Development and has been selected as a New York Super Lawyer.
The Veterans Administration has developed a new mobile app that provides information on concussion symptoms and the self-management of the common symptoms following a concussion.
The concussion app’s main goals are:
- To provide education about a concussion
- To provide a 22 question inventory about symptoms that may develop following a concussion including dizziness, balance problems, headaches, memory and concentration impairments,
- To provide tools to assist individuals properly manage the symptoms of mild traumatic brain injury when they develop
- To provide resources and support for professional care and web sites with information about traumatic brain injury.
- The app can be used by anyone and is not restricted to veterans.
More information is available by clicking here
New recommendations from the U.S. Department of Defense (DOD) advise that all patients with concussion symptoms should be screened for the presence of a sleep disorder and patients. Additionally, patients should be asked if they are experiencing frequent difficulty in falling or saying asleep, excessive daytime sleepiness or usual events during sleep.
These new recommendations were released this month by DOD along with support tools to assist in the identification and treatment of sleep disturbance in persons following mild traumatic brain injury, also known as a concussion.
Sleep disorders are a frequent symptom following a concussion and must be identified and treated as soon as possible. According to many medical experts, a good sleep cycle is critical to the brain’s ability to heal and recover following a concussion.
The new Management of Sleep Disturbances following Acute Concussion/Mild TBI Recommendations suite is composed of clinical recommendations, a clinical support tool, a provider education slide deck and a patient education fact sheet. More information can be obtained by clicking here.
On Sunday, July 27th, I will be the lead off speakier at the annual conference of the American Association for Justice, Traumatic Brain Injury Litigation Group’s annual program to be held this year in Baltimore, Maryland.
My topic this year is entitled, From Concussion to the Classroom and Playing Field. I will explore the many legal issues in recently enacted concussion management legislation, public health issues and additional steps that must be taken to protect our nation’s youth from the epidemic of traumatic brain injury in all sports.
Recent evidence points to over 250 million of our nation’s youth sustain some type of a traumatic brain injury each year while participating in athletic competition all athletic training. Brain injury in sports is a public health crisis that must be approached from many different areas including education, prevention, return to play guidelines and legal liability when a preventable brain injury takes place.
The legal conference is a part of the four day conference sponsored each year by the nation’s largest trial lawyer association, the American Association for Justice. The conference each year is attended by over 2,000 attorneys from across the nation. The conference provides educational skills to attorneys on how to more effectively represent their clients following a personal injury.
The traumatic brain injury litigation group is comprised of attorneys who have a special interest in the area of traumatic brain injury litigation. I have been honored to have been a chair of this group and continue to serve on the group’s executive board.
The Brain Injury Association of America has just issued the following Action Alert:
Protect Access to Care for Veterans
Call Congress Today!
As a member of the large and growing community that understands the importance of thoughtful, comprehensive care for individuals living with brain injury, we wanted to inform you of an important program for America's veterans that is in danger of shutting down if Congress does not act soon.
Established by Congress in 2008, the Assisted Living TBI Pilot Program has made it possible for hundreds of wounded warriors to receive specialized, post-acute brain injury rehabilitation in the community.The program provides critical, real-life skills to help veterans return to their homes and communities. It has been a lifeline for dozens and dozens of veterans.
Unfortunately, the Department of Veterans Affairs has announced that it will end the pilot program on September 30, 2014 unless Congress takes action to extend it. This means that the VA will soon begin to discharge veterans from the program.The Wall Street Journal recently highlighted the importance of the program and the challenges faced by many if Congress doesn't act soon.
We need your help to make sure the Assisted Living Pilot Program for Veterans with TBI continues to make a meaningful difference for America's heroes.
Please call your Member of Congress and make sure they know how important the program is to veterans and urge them to support extending the pilot program. You can reach your Representatives and Senators by calling the U.S. Capitol Switchboard at (202) 224-3121 where you will be transferred directly to their offices. Thank you for your crucial contribution to this effort.
Brain Injury and Concussion Awareness Day at Citi Field Sponsored by Brain Injury Association of New York State
The Brain Injury Association of New York State (BIANYS) will again be hosting Brain Injury and Concussion Awareness Day at Citi Field with the New York Mets on September 28, 2014.
BIANYS is selling field level tickets to see the Mets take on the Houston Astros at the last regular season home game of the year. You can obtain more information and purchase your tickets by clicking here.
The following brain injury conferences scheduled for August and September 2014 may be of interest to my readers:
Brain Injury: The Family's Journey
Sioux City, IA
855 444-6443. click here
Brain Injury Association of Michigan Annual Conference
810 229-5880 click here
Brain Injury Association of Canada Annual Conference
Gatineau, QC, Canada
613 762-1222 click here
Congressional Brain Injury Task Force Urges FIFA To Take a Hard Look at its Concussion Management Protocol
In a letter to FIFA, the co-chairs of the Congressional Brain Injury Task Force, urged that the world soccer organization take immediate steps to address their “inadequate approach toward traumatic brain injury.”
Here are some excerpts from the congressional correspondence raising questions about FIFA’s concussion management protocol:
“This threat was on full display during the World Cup, where several players were left in obvious pain after receiving blows to the head. Of note, Álvaro Pereira, Javier Mascherano, and Christoph Kramer all endured brutal head injuries during play. Unfortunately, their pain wasn’t the only thing that these players had in common: each of them returned to the field almost immediately after a brief, sideline evaluation by a team doctor. In the case of Mr. Pereira, the team doctor even signaled to the manager that a substitution was necessary; however, the player insisted that he continue and he was reintroduced to the game. While Messrs. Periera and Mascherano continued to play for the remainder of their matches, Mr. Kramer collapsed on the field after fifteen minutes and was finally substituted out. He stated the next morning that he had little memory of the game.”
" Unlike in many other professional sports, following a player injury, the decisions of team doctors, who are rarely neurologists, can be overruled by coaches or the players themselves. This flies in the face of everything we know about TBIs, inadequate diagnosis and treatment, and the severity of this condition. Even after his team’s doctor advised him to leave the field, Mr. Pereira refused. This strategy is not sufficient in adequately diagnosing and treating players who have sustained head injuries. In the National Football League, for example, an independent doctor, unaffiliated with the team, must be present to evaluate all potential head injuries and make final decisions about whether it is safe for a player to return to the field."
A 20 minute conversation with a social worker has the potential to reduce the functional decline of persons diagnosed with mild traumatic brain injury according to a recent study published in May in the Journal, Brain Injury: The emergency department social work intervention for mild traumatic brain injury. A pilot study. Brain Injury, 2014; 28 (4): 448
Mild traumatic brain injury is often difficult to detect and may go undiagnosed in the emergency department of a hospital. Common symptoms of a concussion or mild traumatic brain include headache, nausea, vomiting, dizziness, blurred vision, fatigue and sleep disturbances. According to the Centers for Disease Control (CDC) not everyone gets all of these symptoms and not all symptoms appear at once. Some individuals do not develop some or all of these symptoms for days or even weeks after the initial brain injury.
If a patient does go to the emergency room to be evaluated, he or she may go home thinking they’re OK, but then begin to develop these physical symptoms including problems with memory, concentration and multi-tasking when doing routine tasks.
That’s why it is important that all individual with seen in the emergency department receive a consultation with a social worker before they are discharged. The social worker can provide patients with information about what may happen to them over the next several days or weeks. The social worker can suggest potential coping strategies, provide resources in case these symptoms develop for proper follow up care and ease the mind of the individual.
The following legislative summary was prepared by the Brain Injury Association of America (BIAA):
BIAA Presents at Congressional Briefing Highlighting Study on Outcomes for People with TBI:
Brain Injury Association of America (BIAA) president and CEO Susan Connors presented at a Congressional briefing hosted by Sens. Tim Johnson (D-S.D.) and Mark Kirk (R-Ill.) on Thursday, July 10. The briefing was held to announce the results of a study on outcomes for people with traumatic brain injury (TBI) and stroke conducted by Dobson DaVanzo & Associates, LLC.
The study, Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities and After Discharge, is the most comprehensive national analysis to date examining the long-term outcomes of clinically similar patient populations treated in inpatient rehabilitation settings and skilled nursing facilities. The research shows that people with TBI and stroke who were treated in inpatient rehabilitation settings had better long-term outcomes than those who received care in a skilled nursing facility.
The Workforce Innovation and Opportunity Act
The Workforce Innovation and Opportunity Act (WIOA) passed the House of Representatives this week. WIOA will provide better employment opportunities for individuals with disabilities. The Senate passed the bill with a 95-3 vote. It is expected the President will sign the WIOA bill into law soon. This legislation is considered the most important disability legislation passed since the groundbreaking Americans with Disabilities Act which was passed in 1990. BIAA applauds Congress for working together to pass this important legislation that will improve the lives for individuals living with disabilities caused by brain injury.
Congress Introduces the IMPACT Act
On June 26, Senators Ron Wyden (D-OR) and Orrin Hatch (R-UT), as well as Congressmen Dave Camp (R-MI) and Sandy Levin (D-MI) introduced the Improving Medicare Post-Acute Care Transformation (IMPACT) Act. They introduced the bill almost three months after releasing a bipartisan discussion draft. During the past few months, Senate and House committee staff have been meeting with a series of stakeholders on the bill including the Brain Injury Association of America.
The IMPACT Act lays out a framework for collecting standardized assessment data across post acute care (PAC) settings, which could then be used to transition Medicare's current silos of PAC payments from a fee for service payment structure to a pay for performance reimbursement structure. This payment structure would be prospective, unified across settings, and based on patient assessment data, as opposed to being dependent on the PAC setting in which the patient is treated.
TBI Act included in Mid-Year Committee Report
This week, U.S. House Energy and Commerce Committee Chairman Fred Upton (R-MI) released a report on the accomplishments of the committee in the first six months of 2014. The TBI Act, HR 1098, which was passed by the House of Representatives in June 2014, was included in the report.
Congressional Brain Injury Task Force Hosts Crash Reel Screening
The Congressional Brain Injury Task Force, co-chaired by Reps. Bill Pascrell Jr. (D-NJ) and Tom Rooney (R-FL), will host a Congressional screening of the film Crash Reel on Tuesday, July 15, 2014 from 6:00-8:00 p.m. in the Rayburn House Office Building, Room 2103. BIAA is sponsoring the screening of Crash Reel. The film features Kevin Pearce, a professional snowboarder, who sustained a TBI at the height of his career. This event will feature a discussion with Kevin Pearce who is now retired from professional snowboarding.
Doctors have an ethical obligation to educate and protect athletes from sports concussion and clear them to play only when the athlete is medically ready, standing firm against objections from players, parents or coaches according to a new position paper of the American Academy of Neurology (AAN), released yesterday in their medical journal, Neurology.
An AAN press release issued in connection with this announcement stated, “With nearly four million sports-related concussions in the US each year, it is imperative doctors are educated and protect these athletes who may have sustained a concussion,” said lead author Matthew P. Kirschen, MD, PhD, a neurologist with The Children's Hospital of Philadelphia and a member of the American Academy of Neurology. “Concussions can have devastating effects such as short-term impairments in athletes’ cognitive and athletic performance. Repeat concussions have been linked to long-term impairments in brain function, such as problems with learning, memory and behavior.”
The AAN statement also:
- Supports wider use of baseline cognitive testing
- Recommends that concussion evaluation and management training be added to neurology residency programs
- Suggests the development of a national concussion registry with mandatory reporting, which may help to document more rigorously the incidence and recurrence of concussion at all levels of play
The statement concludes that physicians caring for athletes during and after a sports-related concussion should have adequate training and experience in the recognition and evaluation of both the existence and severity of potential brain injury.
My comments on the cavalier conduct of World Cup soccer in allowing players with head injuries to prematurely return to play before proper clearance were published last evening by the New York Daily News. Click here to read the article.
In a study investigating traumatic brain injury (TBI) in the homeless population of Toronto, it was determined that almost half of all homeless men who took part in the study had suffered at least one traumatic brain injury in their life and 87 percent occurred before these men lost their homes. The study is published in the journal CMAJ Open. "Traumatic brain injury among men in an urban homeless shelter"
Another study published by Dr. Stephan Hwang in the Journal of Head Trauma Rehabilitation found that the number of individuals who are homeless or vulnerably housed and who have suffered a traumatic brain injury may be as high as 61 percent-seven times higher than the general population. Almost half of homeless men had traumatic brain injury in their lifetime
The important question raised by these studies: Is TBI a risk factor for homelessness?
A few moments ago I learned of the shocking decision by officals at the World Cup Soccer tournament allowing Javier Mascherano to return to play after sustained what appeared to be a potential concussion. What's wrong with these people? Haven't they learned their lesson from the serious injuries sustained by so many athletes who were allowed to return to play following a concussion? Haven't they heard of the tragic death of Natasha Richardonson or the condition known as second impact syndrome. World Cup soccer is playing russian roulette with the health and lives of their playrs. Don't they know, WHEN IN DOUBT, KEEP THEM OUT.
Click here for more on this tragic story Javier Mascherano plays through apparent concussion during Arentiana-Holland Wordup semifinal
Even Phineas Gage would be denied benefits under the NFL class action settlement if received his injury while playing football!
Illustrative of the inadequacy of the NFL class action settlement are the injuries sustained by Phineas Gage and how he would fair under this agreement.
Perhaps the most famous traumatic brain injury patient in the history of medicine was Phineas Gage. In 1848, Gage was a 25-year-old railway construction foreman, working with explosive powder and a packing rod. A spark caused an explosion that propelled the three-foot long pointed rod through his head. It penetrated his skull at the top, passed through his brain, and exited through his temple. Before the accident Gage was a quiet, mild-mannered man; after his injuries he became an obscene, obstinate, self-absorbed man. His personality and behavioral problems persisted until his death in 1861.
Had Phineas Gage sustained these injuries while playing professional football, he would not be entitled to any benefit under the proposed settlement agreement.
It is unfortunate that the U.S. District Court Brody granted preliminary approval to the proposed settlement of the NFL class action lawsuit without first holding a hearing to examine significant issues affecting the ability of players to obtain the compensation they deserve.
I am hopeful that hearing scheduled for November 19th, will explore the obstacles, roadblocks, and hurdles that players in all classes of injury must overcome before receiving compensation under this settlement proposal. The majority of players suffering with brain injuries are not embraced within the settlement and will receive no compensation.
The revised settlement is flawed in many respects. The proposal neither recognizes nor compensates the majority of players who suffer the long-term consequences of brain trauma, but merely carves out certain, small and discrete groups. The majority of players who have physical, cognitive, emotional, and behavioral impairments will remain uncompensated under this settlement.
Though this settlement proposal purports to generously provide financial stability for the futures of thousands of players who suffer from traumatic brain injury and its consequences, closer scrutiny reveals something entirely different. An examination of the terms and conditions of the settlement reveals a design to systematically exclude players from participation and reduce payments to the small group who meet the arbitrary criteria. It imposes unfair and illogical restrictions on the categories of compensable injuries and requires players to have participated in NFL play for excessively long periods, implicitly denying that a player can sustain a life-altering concussion after only a short NFL career. The plan is replete with complex, arbitrary, and overlapping omissions in its unwieldy and overly intricate criteria, which are then further reduced by offset for liens.
The revised NFL brain injuy settlement agreement is fatally flawed. Judge Brody should hold a hearing before she even considers granting preliminary approval to the settlement.
Here are some preliminary observations that were published yesterday by my partner, Shana De Caro and myself on the Huffington Post:
The revised proposed settlement of the class action lawsuit against the NFL remains fundamentally flawed. The settlement neither recognizes nor compensates the majority of players who suffer the long-term consequences of repeated concussive injury.
The foundation of the lawsuit was the deliberate and longstanding misrepresentations by the NFL and its committee on traumatic brain injury, concerning the known health risks that players confronted from repetitive brain trauma so ingrained in the game. For years, the NFL has staunchly refused to acknowledge the accumulating body of objective medical evidence revealing the risk of permanent brain damage from repeated head trauma. The NFL remained shrouded by inaccurate statements propagated by its own Committee on Mild Head Injury, including false declarations that "mild TBIs in football are not serious injuries" and that "many NFL players can be safely allowed to return to play on the day of the injury after sustaining a mild TBI." This deception imperiled professional football players and was calculated to mislead players and the public.
Today's proposed revised settlement persists in disregarding the issues that are essential to the vast majority of players that are affected. A concussion is a brain injury. A mild brain injury is only mild if it is someone else's brain. The silent majority of players who have cognitive, emotional, and behavioral impairments because of their reliance on the fraudulent conduct by the NFL will remain uncompensated under this settlement.
The court has an obligation to protect all players who are part of this class action lawsuit. Any settlement that fails to address the claims and interests of the majority of players should be rejected as imprudent and contrary to the best interests of the majority of class members.
The claims of the preponderance of players must be allowed to continue in order to expose the reprehensible pattern of deception and intentional misconduct committed by the league, whose control of the negotiations of this settlement, elevates profits over player safety.
Traumatic brain injury and risk of dementia in older veterans
An important study was published today, Traumatic brain injury and risk of dementia in older veterans in the Journal Neurology. The study has important implications for all those who have suffered a traumatic brain injury, but most importantly for individuals including athletes who have sustained repetitive head trauma.
Traumatic brain injury (TBI) is common in military personnel, and there is growing concern about the long-term effects of TBI on the brain; however, few studies have examined the association between TBI and risk of dementia in veterans.
The study concludes: “TBI in older veterans was associated with a 60% increase in the risk of developing dementia over 9 years after accounting for competing risks and potential confounders. Our results suggest that TBI in older veterans may predispose toward development of symptomatic dementia and raise concern about the potential long-term consequences of TBI in younger veterans and civilians.”
You can read more by clicking here.
The increased attention this week on the World Cup has also focused renewed questions on the safety of heading the ball in soccer. The New York Times on line edition has published an interesting debate today on this issue. When to Use Your Head
Late last evening the United States House of Representatives unanimously approved passage of H.R. 1098, the Traumatic Brain Injury Reauthorization (TBI) Act of 2013.
Approximately 2.5 million Americans experience TBI each year and an estimated 5.3 million Americans are living with long-term, severe disabilities as a result of brain injury.
The Brain Injury Association of America (BIAA) and its executive director, Susan Connors as well as the leaders of the Congressional Brain Injury Task Force, Representatives Bill Pascrell, Jr. and Tom Rooney all need to be thanked for their hard work in passing this important legislation.
Originally passed in 1996 and reauthorized in 2000 and 2008, the TBI Act represents a foundation for coordinated and balanced public policy in prevention, education, research, and community living for people with TBI. The TBI Act specifically allocates federal funds for programs supporting individuals with brain injury to federal agencies including the Centers for Disease Control (CDC), the National Institute for Health (NIH) and the Health Resources Administration (HRSA).
BIAA and other TBI Act stakeholders are continuing to work with the United States Senate to introduce a companion bill.
How much rehabilitation should adults with moderate to severe traumatic brain injury (TBI) receive, in what setting, and at what time?
The Brain Injury Association of America (BIAA) has partnered with the Brain Injury Research Center at the Icahn School of Medicine at Mount Sinai to answer these questions. Clinicians with expertise in post-acute rehabilitation are needed to participate in a three-year investigation beginning July 1, 2014.
Individuals who sustain TBIs rarely have access to rehabilitation of sufficient timing, scope, duration, and intensity that would allow them to recover to the maximum extent possible. That's because treatment decisions are controlled by payers - insurance companies and public policymakers - instead of by doctors, patients, and family caregivers. When a person's care is delayed, discontinued, or denied altogether, the result is often increased re-hospitalization rates and greater levels of disability. This creates a cycle of joblessness, homelessness, and dependence on public programs.
BIAA and Mount Sinai are addressing this problem through the development and widespread distribution of Guidelines for the Rehabilitation and Disease Management of Adults with Moderate to Severe TBI. The goals of this project are to:
1.Identify and fully describe the continuum of care available following TBI;
2.Determine the evidence for various rehabilitative treatments and, based on that evidence and/or expert opinion, make recommendations for treatment and management in various settings;
3.Produce a document that supports improvements in the quality and consistency of rehabilitation treatment; and
4.Broadly disseminate the recommendations to payer, provider, patient and advocacy communities in an effort to increase access to and quality of care.
Fifty of the nation's top researchers and clinicians are needed to review and assess evidence in functional, medical, cognitive, behavioral, and social domains. If you have expertise in any one of these subject areas and are interested in serving on one of the panels, you can send your CV to Marianna Abashian, BIAA Director of Professional Services. Indicate which panel interests you. Panels have limited membership.
The HRSA Traumatic Brain Injury Technical Assistance Center has scheduled a Webinar: Children & Youth with TBI: Diversion Programs and Proper Identification and Treatment After Entering the Juvenile Justice System
June 17, 2014 at 2:30 to 4:00 p.m. ET
The webinar will address the following questions:
How do you help a child with an undetected TBI who has entered the juvenile justice system because of behavioral problems? What do juvenile justice personnel, courts, schools, and others need to know to be able to detect a TBI and refer them for appropriate treatment? What are the legal implications?
The webinar will focus on the following topics:
• National efforts to address the school to prison pipeline
• Barriers and challenges for youth with TBI in the juvenile justice system, including what happens when they are misidentified or improperly evaluated
• What HRSA’s Protection and Advocacy (P&A) grantees are doing across various states to divert children from the juvenile justice system and make sure that youth with TBI get referred for appropriate screening and treatment
• Individual justice planning tools that P&As and others can use to divert children and youth from the juvenile justice system and alternative sentencing options
RSVP by clicking here
I have been invited to share my thoughts following my participation at the White House Healthy Kids and Safe Sports Concussion Summit Sports
This afternoon, at 12:30 PM (eastern time), I will be a gues of Ed Berliner on his internet news show, "Mid Point"-NewsMax TV to discuss the crisis of sports concussions. you can access the show by clicking here.
President Obma's inaugural concussion summit presented a watershed moment in valdiating and tackling the public health crisis of the long-term hazards posed by concussions in sports and its ramifications.
Now, we need to seize upon the president's iniative and move forward with a national plan to address the crisis of concussion in sports and take all the steps necessary to prevent, preventable brain injuries from occuring and provide the needed support and care to children and adults once a brain injury does take place
CDC's Heads Up app helps parents and others learn how to spot the signs and symptoms of a concussion and explains what to do if they think their child or teen has a concussion or other serious brain injury. The app also includes information on selecting the right helmet for an activity and other detailed helmet safety information.
Download the CDC Heads Up Concussion App by clicking here