Brain Injury Lawyer - New York

Public Input Requested for the Brain Injury Summit

A Brain Injury Summit is scheduled for November 2-3, 2007 in Washington, DC jointly sponsored by the Brain Injury Association of America (BIAA) and the North American Brain Injury Society (NABIS).  You are invited to provide input into one or more of the focus areas listed below.  Your comments will be furnished to work group moderators who will write the final document. 

Acute Care
Sub-acute and Post-acute Care
Long-term, Community Integration & Case Management
Mild TBI & PTSD
Systems Issues
To provide input to the established work group questions, please click on this link.

The Summit will result in a white paper/position statement on improving the quality of care and long-term living for individuals with brain injury, including civilians, service members and veterans. Advocates at the federal and state levels and in the private sector will utilize the position paper for advocacy efforts. 

I encourage all those involved in the brain injury movement including persons with a brain injury, family members and professionals to participate in this important advocacy effort.

Diffusion Tensor Imaging Can Detect Brain Damage Even in Mild TBI

Researchers report that diffusion tensor imaging can identify structural changes in the white matter of the brain that correlates to cognitive deficits even in patients with mild traumatic brain injury.

The study is published in the October issue of the journal Brain.

"We studied patients with all severities of traumatic brain injury -- mild to severe -- and found that abnormalities in white matter existed on the spectrum," said Dr. Marilyn Kraus, associate professor of psychiatry and neurology at the University of Illinois at Chicago College of Medicine and lead author of the study. "Even in patients with mild TBI -- those identified as having minimal or no loss of consciousness -- there were structural deficits."

Diffusion tensor imaging uses magnetic resonance imaging technology to examine the integrity of white matter that is especially vulnerable to traumatic brain injury. This imaging modality allows researchers to quantify and qualify structural changes in white matter, particularly in chronic TBI patients.

Thirty-seven TBI patients (20 mild and 17 moderate to severe) and 18 healthy volunteers underwent diffusion tensor imaging and neuropsychological testing to evaluate memory, attention, and executive function. All subjects were at least six months post-injury, and the majority were high-functioning people who were employed or in school at the time of evaluation.

The researchers found that structural changes in the white matter correlate to observable cognitive deficits related to thinking, memory and attention. Patients with more severe injuries had greater white matter abnormalities, representing a permanent change in the brain.

"We know that discreet brain areas are important for specific types of functioning, such as thinking, memory, cognition and motor skills," said Kraus. "But what's also very important is that the white matter serves as the connection between these significant areas of the brain."

In some ways, the brain is similar to a computer, said Deborah Little, director of MRI research in the department of neurology and rehabilitation medicine at UIC and co-author of the study. "You have the CPU and the memory, but they are worthless unless they are connected to each other. The white matter of the brain has the same function as the cables of the computer."

When white matter is damaged, areas of the brain may appear healthy but they are actually "unplugged" and cannot function.

Patients who have a contusion, or bruising of the brain, can also suffer from subtle and diffuse damage to the white matter. The researchers believe that not only the focal lesion but the damage to the white matter is very important.

In the study, the researchers were also able to determine axonal damage (tearing of the axons that allow one neuron to communicate with another) in white matter versus abnormalities in the myelin (the protective sheath that, if damaged, can disrupt signals between the brain and other parts of the body.) If an axon is severed, the damage generally cannot be repaired.

New Shock Reducing Foorball Helmet May Prevent Concussions

A front page story in today's New York Times, Far From Grandpa's Leather, Helmet Absorbs Shock a New Way reports on a promising new technology to protect football players from concussions.

A newly designed football helmet has a radically different method of absorbing shock and the forces transmitted to the brain which may be a primary cause of concussions in football players.  Unlike traditional helmets which contain padding this new helmet is constructed with 18 thermoplastic shock absorbers which contain air.  These shock absorbers can protect the brain from a wide range of outside forces and also provide support to the head to prevent sudden movement within the helmet.  It is this movement of the head which causes damage to the brain as it strikes the interior sharp edges of the skull.

"Football helmets present the technological challenge of protecting against all manner of blows to the head and also doing so thousands of times. (Bicycle helmets, by contrast, are designed to withstand just one major, accidental impact.) Optimally, a helmet’s interior must be forgiving enough to cushion against a routine impact while also sturdy enough to withstand a potentially lethal one — each level of force requires a different response from the material."

One leading concussion expert, Dr. Robert Cantu, according to the Times story called the new helmet "the greatest advance in helmet design in at least 30 years"

Let's hope that  further testing confirms the superiority of these newly designed helmets and that schools and teams find the extra money in their sports budgets to switch to these new helmets.  Without question, the cost of a new helmet is considerably less the than life time costs associated with concussions and the post concussion syndrome.

You can read the full Times story by clicking here.

10-in-10 Project

I had the privilege this morning of having breakfast with Peter C. Kinney, the treasurer of a really good not for profit organization known as the 10 in 10 Project whose goal is to assist our brain injured troops and the civilian population who are living with brain injuries and are unable to afford or access the necessary assistance.

Through a fund raising program called Tickets of Hope they are raising funds to assist those in need and provide a kit known as the Brain Injury Recovery Kit produced by Day Timer which is a memory aid and planner for brain injured individuals.

Donations totaling $600 purchase one Ticket of Hope™

For each Ticket they sell the the 10 in 10 Project is able to provide:

• One Brain Injury Recovery Kit™ shipped to the individual's home,
• A support program for use of the Kit with the assistance of The Brain Injury Association of New Mexico, (BIANM)
• Membership to the Chartered Affiliate Brain Injury Association in the individual's state to be guided to additional resources.

I look forward to working with this dedicated group of individuals on this project.

You can get further information by visiting the 10 in 10 Project web site. You can also e mail them for further information and to request assistance.

Bacterial Meningitis Vaccine Approved for Children As Young As Two Years of Age

The US Food and Drug Administration has approved the vaccination of children for bacterial meningitis.

The FDA expanded the age range for the vaccine Menactra, made by Sanofi-Aventis, to as young as two years old. Previously, the age range was 11 to 55. 

About 2,600 people fall ill annually from bacterial meningitis, an inflammation of the lining surrounding the brain and spinal cord, with 10 percent dying from it, the FDA said. The US Centers for Disease Control and Prevention recommends vaccination for travellers to countries where the infection is a problem, those with damaged spleens, college students living in dorms and military recruits, among others. The infection can cause seizures, brain damage, memory loss and death in otherwise healthy people in less than 48 hours, with a 15% fatality rate if treated with antibiotics.

Marked by fever, headache, and stiff neck, the relatively rare disease is more serious than viral meningitis.

Bicycle Accidents: Significant Cause Of Brain And Other Injuries

Bicycle-related injuries among children and adolescents in the U.S. are a significant public health concern, costing nearly $200 million in annual in-patient hospital charges, according to a new study published in the October issue of Injury Prevention.

One-third of children hospitalized for bicycle-related injuries were diagnosed with traumatic brain injury.  Many of these injuries could have been prevented or have been minimized if a helmet was used.

The national study, conducted by researchers at the Center for Injury Research and Policy at Nationwide Children’s Hospital, estimates that approximately 10,700 children are hospitalized annually for a bicycle-related injury with an average length of stay of three days.

Concussion Educational DVD's To Become Available

The National Football League (NFL), National Hockey League (NHL) and the National Hockey League Player's Association (NHLPA) have agreed to sponsor an educational program on sports concussions developed by the National Academy of Neuropsychology (NAN) and the National Athletic Trainers' Association (NATA).   

Consisting of a series of educational DVDs, this program is targeted to amateur and professional players, parents, physicians and coaches, and will provide information on how to recognize concussive injuries, seek proper evaluation, and follow appropriate return to play guidelines.

The Centers for Disease Control estimate that 300,000 brain injuries occur in sports each year. Of these reported concussions, an estimated 63,000 occur among high school athletes.  Even though these numbers alone suggest that concussions represent a significant public health concern, it is likely that many athletes with concussions fail to report their symptoms to medical personnel. These educational DVDs will increase awareness of this injury while promoting scientifically sound management guidelines that will help minimize the negative effects of traumatic brain injury.

The DVD's are currently being developed and will be released in January, 2008. The DVD's will be widely distributed through leagues, sports organizations, medical organizations, NATA and NAN.  Organizations interested in obtaining copies of the DVD's should contact the NAN office at (303) 691-3694.

Congressional Committee Asks NFL Tough Questions on Concussion Injuries

Congress  is continuing to look at the difficulties that disabled football players are having in receiving disability benefits following a traumatic brain injury or other disabling medical condition.

The House Judiciary Committee sent letters to the NFL and the NFL Players Association last week seeking information about the health care and pension system. The information will be passed to the Congressional Research Service, which will conduct an independent study of football's benefits program.

According to an article in the Daily News, "Several members of the committee have suggested that Congress should intervene to fix what has been described as a broken system of delivering disability benefits to former NFL players," committee chairman John Conyers (D-Mich.) and Rep. Lamar Smith (R-Tex.) wrote to NFL commissioner Roger Goodell and NFLPA executive director Gene Upshaw. "The CRS study will provide the essential facts to help us consider what steps, if any, Congress could take on this issue."

The NFL and the Players Association have until Oct. 26 to provide the information to the committee. to retired players and their families."

In hearings conducted before the House Judiciary Committee and the Senate Commerce, Science and Transportation Committee, retired players set forth the unfairness of the plan in it's determination of disability benefits, especially when it comes to brain damage.  Although players presented the disability plan with substantial evidence of traumatic brain damage and permanent disability, the disability plan chose instead to rely on it's own paid hired guns to conclude that injured players either did not have an injury or were not permanently disabled. 

In reviewing the reports of some of these hired guns, I have been shocked at their cursory review of the medical evidence, their inadequate testing protocols and their reliance on outdated medical opinions regarding the diagnosis of concussions and the pervasive cognitive, behavioral, emotional and physical consequences which follow.  Equally disturbing was to see that plan physicians have even chosen to ignore the positive findings in their own test instruments.

• How is it that only 4 players have ever been deemed to be disabled following a concussion and a traumatic brain injury? 
• How can the plan continue to insist that before a diagnosis of a traumatic brain injury can be made their must be a positive CT scan or MRI scan when these notions have long been abandoned by the American Congress of Neurosurgeons and other medical groups? 
• How can plan doctors honestly say that a player did not sustain a concussion because there was no loss of consciousness when the CDC unequivocally had stated that a concussion can occur with resultant brain damage even without loss of consciousness? 
• How can league medical providers claim that a player's psychological problems cannot be caused by a traumatic brain injury when the National Institute of Health consensus statement on traumatic brain injury clearly spells out the behavioral, emotional and psychological consequences of brain damage?

The plan must be compelled to answer these questions and many more.

Stroke Warnings Often Ignored

Despite much effort to educate the public to the warning signs of stroke, a new study released by the American College of Emergency Physicians concludes that the elderly either fail to recognize the signs of an impending stroke or fail to follow up with immediate emergency care. 

The study found that patients were afraid to go to the emergency room because they feared dying alone.  Other's didn't want to inconvenience family or friends by asking to go to the hospital.  Many didn't believe that they were actually having a stroke despite being knowledgeable about stroke symptoms. 

The researchers studied 344 stroke patients in emergency rooms.  All were over 65 years of age and 41 percent were over 80.  On average, patients delays seeking treatment three hours from the onset of symptoms.  Some patients waited over a week.  Only half the patients believed that they were having a stroke or a TIA, a transient ischemic attack that is ofter a precursor to a stroke.

It's important that we get the word out that it is important that individuals who are experiencing the signs and symptoms of a stroke, seek immediate medical attention.  The first three hours after a stroke are critical.  Often clot-busting medication can be administered that will prevent a full blown stroke from taking place.

Stroke symptoms include slurred words, inability to formulate words, numbness and weakness on one side of the body, severe headache, trouble seeing in one or both eyes, confusion and trouble understanding speech, facial droop and difficulty in walking including loss of balance and coordination.

TIA's which are temporary blockages of the arteries that feed the brain are often precursors to a stroke.  The symptoms of the same as a stroke but disappear after 10 or 15 minutes.  Immediate emergency care following a TIA is essential to prevent a stroke from occuring.

 

Connecticut Brain Injury Association Fund Raising Event

The Brain Injury Association of Connecticut will host its third annual BIAC-United Steel Walk for Thought on Saturday, October 20, along the Connecticut River.

The rain or shine event will open at 11 a.m. at Great River Park in East Hartford. The walk will begin at 12:30 p.m. with a ribbon cutting ceremony.   There is a walk fee of $25 per person. Brain injury survivors and children under 12 years of age are invited to walk free.

The Brain Injury Association of Connecticut is accepting sponsorships for the walk and encourages team registrations on behalf of companies and faith-based organizations.  Those seeking additional information may call Nancy Wuennemann at the Brain Injury Association of Connecticut office, 860-721-8111, or register online.

New Injury Control Research Center for Traumatic Brain Injury Established at New York's Mount Sinai School of Medicine

Congratulations to New York City's Mount Sinai School of Medicine for being designated by the Centers for Disease Control and Prevention (CDC)  as its newest Injury Control Research Center (ICRC). The new center will conduct research on persons with traumatic brain injuries in order to better understand the consequences of their injury and to help enhance the quality of their lives.

CDC’s Injury Control Research Centers (ICRC) are located at 13 universities throughout the United States. At each ICRC, scientists from a wide spectrum of disciplines focus upon discovering how to prevent and control injuries more effectively. They also work to identify critical knowledge gaps in injury risk and protection and also conduct research to address these gaps.

This network of ICRCs also provide technical assistance to injury prevention and control programs within their geographic region. At the Mount Sinai ICRC the focus will be only TBI, including concussion, while other centers focus on other disabilities.

Mount Sinai’s new Center will evaluate promising treatments that address many of the consequences of brain injury, such as impaired cognitive functioning, mood disturbances, and emotional difficulties. The Center will help better identify people with brain injury, and their needs and problems. Lastly, it will look at improving community integration and functioning, and will help educate those most affected by TBI.

New Report Calls for Improved Disability Benefits for War Veterans

A report issued on Wednesday by the Veterans’ Disability Benefits Commission recommended revising the disability-rating schedule to better take into account neurological disabilities, including TBI. Specifically, the Commission recommended tackling “post-traumatic stress disorder, other mental disorders and traumatic brain injury expeditiously” when revising the disability-rating schedule.

The report called for completing a revision of the current disability rating system within the next five years. In addition, the Commission found that, overall, the current disability benefits structure does not take into account the full impact of service-connected disabilities on veterans’ quality of life, and recommended that Congress provide a 25 percent increase in benefits until a new system is put into place.

Can Football Helmets Detect Concussions?

According to an article published in Scientific American,  some high school teams are now testing a new helmet sensor that promises to alert coaches when players have been hit hard enough to cause a concussion, potentially averting further brain injury.

The helmets—made by sports equipment maker Riddell Sports Group—use sensor technology developed by New Hampshire–based Simbex, LLC. The system consists of six battery-powered sensors in the helmet's padding that record the location, magnitude, duration and direction of up to 100 impacts and wirelessly send this information to a PC (within 150 yards) running data collection software. The sensors work by measuring both linear and rotational acceleration of the helmet after a player has been struck.

The costs for the concussion detection equipment reportedly are $30,000 for the computer system and $1,000 for each helmet.

This technology is still in the developmental stages and I still believe that teams need to be extremely cautious when it comes to concussions and always take the conservative approach of keeping players out of play any time a concussion is suspected to have occurred.  While this equipment may be able to record forces, there are many types of forces that the system may not be able to detect which are responsible for concussions.  Further, the individual sensitivity of each player to concussive forces makes me wonder if this product can really do what it's developers claim.

You can read the full story by clicking here.

Assistance Needed to Insure Funding Of Needed TBI Programs For Brain Injured Veterans

The Brain Injury Association of America has requested that I post this urgent request.

Earlier this week, the Senate passed its version of the defense authorization bill, including the text of the Dignified Treatment of Wounded Warriors Act, which contains critically important provisions to improve TBI care for returning service members.  The House of Representatives passed its defense authorization bill, which does not contain these critical TBI provisions, in May.  Conferees have now been appointed, as the House and Senate will work in conference to produce a final version of the legislation to send to President Bush.

Action Requested: Please contact your Representative today and urge them to sign on to the Congressional Brain Injury Task Force letter urging conferees to retain the Senate’s Dignified Treatment of Wounded Warriors Act provisions in the final version of the defense authorization bill. 

Click here to contact you representative.

Girls At Higher Risk for Sport Concussion Injuries

I am back from the North American Brain Injury Association (NABIS) conference on traumatic brain injury where I gave a talk to the lawyer's section on how to deliver an effective opening statement in a brain injury law suit and look forward to resuming my brain injury blog posts. 

Today's New York Times carries an important article entitled, Girls Are Often Neglected Victims of Concussions. The article reports on a study conducted at Ohio State University to be published in the Journal of Athletic Training which that concluded that girls take longer for their sports concussion symptoms to resolve and are more susceptible to concussions than boys are in the same sports.

The study found that girls playing high school soccer sustained concussions 68 percent more often than boys did and that female concussion rates in high school basketball were almost three times higher among girls than boys.  The study also found that girls consistently took longer for their post concussion symptoms to resolve.

While doctors are uncertain as to why the rates of concussions and the severity of symptoms are higher in girls than in boys, the primary theory is that girls may be more honest in reporting their symptoms and injuries than boys are.  Others also point to the fact that the neck muscles in girls are not as strong as boys so that the head is more prone to move upon impact. 

You can read the entire story by clicking here.