Brain Injury Lawyer - New York

Concussions complicated by post traumatic stress disorder and depression

A new study published this week in the New England Journal of Medicine links the persistent problems following a concussion to the development of post traumatic stress disorder and depression.

According to a summary of the study reported in today's New York Times, the new report finds that soldiers who had concussions were more likely than those with other injuries to report a variety of symptoms in their first months back home, including headaches, poor sleep and balance problems. But they were also at higher risk for the stress disorder, known as PTSD, and that accounted for most of the difference in complaints. Symptoms of the disorder include irritability, sleep problems and flashbacks.

You can read the full Times story by clicking here.

80 percent of prisoner's found to have sustained brain injury

A fascinating story appears on the AP wire service today concerning a survey done of prisoner's by the Wyoming Brain Injury Association.  The Wyoming Brain Injury Association found that more than 80 percent of the state's inmates have a mild to high likelihood of having suffered brain injury.

The association worked with the Wyoming Department of Corrections to survey a sample population of 200 offenders in the Wyoming State Penitentiary in Rawlins and Wyoming Women's Center in Lusk.

The survey did not actually medically diagnose people with brain injuries but asked them a series of questions about their injuries, hospital stays and difficulties with daily life to determine the possibility of injury.

Considering the behavioral affects of brain damage, the fact that most prisoner's sustained a brain injury some time in their lives is no surprise to me.  Hopefully prisoner's who have sustained a brain injury will be identified so that they can obtain proper cognitive support and rehabilitation.  At the present time their is apparently no screening in place to determine mild and moderate brain damage in prisoner's. 

The Wyoming Brain Injury Association has also offered to institute support groups for brain injured prisoners and to provide educational assistance to correction department officials about traumatic brain injury.

You can read the full AP story by clicking here.

Brain Injury Association Legal Conference

I am pleased to have been selected to speak at the Brain Injury Association of America's legal conference to be held in Las Vegas, Nevado from April 3-April 4, 2008. The conference is entitled: Brain Injury Litigation Strategies 2008--Mastering the Science and Trial Strategies.  Some of the best brain injury attorneys in the country will be present at this conference. 

This will be a unique conference made up of both plaintiff's and defense attorneys designed to bring both sides together for an intelligent discussion and understanding of traumatic brain injury.

As a frequent speaker at brain injury legal conference's, I am extremely pleased to have been selected from attorney's throughout the country to speak at this meeting.  My topic will be: "turning defense tactics at trial to the plaintiff's advantage"

My presentation will focus on many of the "dirty" tricks utilized by insurance company lawyers in the courtroom that are designed to pursuade the jury that persons who have sustained brain injury really aren't injured or really did not sustain a brain damage at all.  I have confronted these tactics in the past and have been able to effectively deal with them. 

More information about this conference can be obtained from the Brain Injury Association of America web site.

Depression Following Concussion

Researchers at the Montreal Neurological Institute of McGill University have identified the neurological basis of depression in male athletes with persisting post-concussion symptoms. The study, published in this week's issue of Archives of General Psychiatry, has important clinical implications for the treatment of individuals who have suffered a cerebral concussion.

Although neuropsychological testing in these individuals was reported to be normal, many of these athletes reported significant symptoms of depression.  The researchers utilized funtional MRI studies which showed reduced brain activity in areas of the brain that are seen in patients suffering from major depression.

GW Graduate Program in Acquired Brain Injury Tuition Assistance Announced

The George Washington University (GW) Department of Teacher Preparation and Special Education (DTPSE) has announced that they have received a Personnel Training Grant from the US Department of Education’s Office of Special Education Programs (OSEP) for the “Master’s of Education Degree (MA) in Transition Special Education: Emphasis in Acquired Brain Injury.”

The grant will provide tuition support (80%) for all accepted students and also includes direct stipends to assist students with class related expenses, travel for internships, and travel to professional conferences.  The grant also supports the training of teachers for initial licensure with a specialization in serving students with traumatic brain injuries (TBI) and includes a combination of on-campus and distance education coursework.  A specialized brain injury internship and a one semester student teaching experience are also required.

Applications are currently being accepted for Spring 2008 Semester and Summer 2008 Semester.

For further information, you can contact Zavolia Willis (Zee)  or at 202-973-1082.

For more information about the Graduate Certificate Program in Brain Injury, inquiries may be directed to Monija Amani or 202- 973-1032.

For information for applying to either of these programs, you can visit the Graduate School of Education and Human Development (GSEHD) web site

Full Military Traumatic Brain Injury Task Force Report

My earlier post today concerned the Military Traumatic Brain Injury Task Force Report.

The full report can be read by clicking here.

Army Study Reports One In Five Brain Injuries Go Unrecognized

In a study released yesterday, the Army has confirmed that Up to 20 percent of U.S. troops returning from Iraq and Afghanistan may have suffered mild concussions but were unaware of them and did not get treatment.

The study reports that the Army has a hard time identifying and treating affected troops because the soldiers and Marines don't recognize the symptoms and don't report them.

"The Army is challenged to understand, diagnose and treat military personnel who suffer with mild TBI," said Brig. Gen. Donald Bradshaw, who leads the Army's TBI task force.

In addition to recognizing the common symptoms of a concussion such as headaches, dizziness, sleep disorders, nausea or memory problems, the Army is now alerting soldiers and their families to the psychological consequences of closed head injury such as irritability, anxiety and depression.

The earlier that these soldiers recognize and report their symptoms, the earlier that they can get treatment.  Just as important, soldiers who are still on active duty need to know that these symptoms are important to report so that they are not exposed to a second head injury before they fully recover from the initial injury they received.

 

Brain Injury Webcast: "Veterans with TBI"

A web cast which will  provide an overview of the Veterans Health System and address the structure and services available for veterans with TBI and their families by the  Program Manage of the Department Veterans Affairs will take place on Friday, February 1, 2008, from 2:00 pm to 3:30 pm  "Veterans with TBI - The Veterans Health System." 

According to the Department of Veteran Affairs, this Web cast will be useful as a first step in understanding the VA system.  As service members with TBI are identified in State and community systems, it will provide an idea on where to refer them so that appropriate benefits are received.  Ideas for outreach and potential partnerships might also be a potential outcome.

The web-cast REQUIRES PRIOR on-line registration to ensure that your computer meets all technical requirements.  To register click here   You should register well in advance of February 1st to resolve any potential technical issues before the web-cast.  Should you experience any technical difficulties while registering, please submit a question to them by clicking here .   On February 1st, be sure to use the same computer to view the Web cast that you used to register. Connect 20 minutes in advance of the web-cast to ensure your connection and to download the Power Point slides.

For anyone who can't be present for the February 1st web-cast, there will be an archived copy available about one week after the event by clicking here .

Rehabilitation Following Severe Traumatic Brain Injury

The hardships, frustrations and rewards associated with rehabilitation following a severe traumatic brain injury are discussed in an article in today's New York Times, Coaching the Comeback.

The article describes rehabilitation efforts at Keller Institute of Rehabilitation in New Jersey and the difficulties and rewards of this work intensive and heart breaking endeavor.  The dedication of professionals involved in the rehabilitation of survivor's of a traumatic brain injury should never be forgotten. They deserve our thanks.  They also deserve salaries that reflect their skills and efforts.

Insurance carriers need to be compelled to provide reimbursement for these essential services without arbitrary limits on the number of days that a person is entitled to services, the types of services that an individual can receive or ignorant assertions that they have reached maximum levels of improvement.

Long Island Brain Injury Symposium

The Brain Injury Association of New York State is holding a symposium for brain injury professionals, survivors, families, caregivers and community advocates hosted by Transitions of Long Island.

The symposium is scheduled for Saturday March 8, 2008 from 9:00 AM to 3:00 PM at Rust Auditorium, North Shore University Hospital in Manhasset.  Lunch and refreshments will be provided.

Scheduled topics include: New Technologies, Maintaining Health and Wellness, Work Integration, Special Issues faced by Men and Women, the TBI Medicaid Waiver Program, Guardianship and Trust Issues.

For further information e mail Dr. Deborah Benson

Brain Injury--Legislative Update

The following legislative update has been provided by the Brain Injury Association of America

Update on FY2008 Defense Authorization Bill Status

House Democratic leaders have scheduled an override vote on President Bush’s recent veto of the National Defense Authorization Act for Fiscal Year 2008 (H.R. 1585) to take place when the House of Representatives returns to session on Tuesday, January 15.

Late last month, President Bush unexpectedly vetoed the defense authorization bill over provisions in the bill that would allow plaintiffs in the United States to sue foreign governments, including Iraq.

Congressional passage of this bill in December represented a major legislative victory for improving TBI care for returning service members and veterans.  BIAA lobbied actively this past year on many of the TBI care provisions included in the bill and grassroots activity on the part of BIAA advocates, as well as support from the Congressional Brain Injury Task Force, helped ensure that these TBI provisions were included in the final bill.

There is a good chance that the override vote scheduled to occur on Tuesday will fail in the face of unified Republican opposition.  If this occurs, it seems likely that Democratic leaders would then bring a new bill directly to the House floor that would closely resemble the vetoed defense bill, but with a fix that is currently being negotiated.  Similar Senate action seems likely to follow. 

According to an article published in CQ Today earlier this week, “While leaders of the Armed Services committees are taking the lead in the substantive negotiations, a new defense bill likely would go straight to the House and Senate floors to minimize opportunities for members to amend the measure.”

The widespread hope is that this new, slightly revised defense authorization bill will be signed into law before the end of January.

BIAA continues to hold off on organizing grassroots activity at this time, pending further legislative developments this week and next.

President Bush To Release Contingency Funds for Veterans

The White House announced this week that President Bush plans to approve $3.7 billion in "contingency” funding for veterans’ health programs sometime next week.

This welcome development marks the end of speculation over whether the president would block release of the funding, which was included as “emergency” funding in the FY2008 omnibus appropriations bill which passed last month.

During end-of-the-year appropriations negotiations in December, Congressional leaders designated this $3.7 billion in spending as “emergency” funding in order to keep it from counting against discretionary spending caps.  This left the ultimate decision on whether to release the funding up to President Bush.

Veterans groups and Democrats have been advocating for the release of this additional funding, which the president has until Jan. 18 to approve.

According to a Dec. 21 letter from Senate Veterans’ Affairs Committee Democrats, this funding “will ensure, among other things, that the Department will be able to provide timely access to services, furnish improved mental health services and develop the needed capacity to handle the massive claims backlog.”

Note: The House of Representatives returns from recess this Tuesday, January 15; the Senate reconvenes next Tuesday, January 22.

Brain Injury Disability Rating System For Vets: New Proposals

The department of veterans affairs has proposed a new rating schedule for the evaluation of traumatic brain injury.  The proposal appears in the Federal Register, Vol 73 no 2, 38 CFR Part 4.

The proposal is a far reaching analysis of the consequences of traumatic brain injury.  Significantly, the veterans administration has recognized that there is nothing mild about mild traumatic brain injury. However, after making some very important statements about traumatic brain injury, its  diagnosis, symptoms and consequences, the VA then fails to classify these disabilities as rendering the individual 100 percent disabled.  The proposed disability rating ranges from 10 percent to 40 percent.

It is important that all advocates for individuals with a traumatic brain injury including neuropsychologists, neuropsychiatrists, social workers and others involved in the brain injury rehabilitation process make their opinions heard and oppose these limited ratings.

This proposed disability rating for a traumatic brain injury is just wrong and needs to be changed.  What the VA fails to understand is that a brain injury affects every aspect of a person's life.  To rate a brain injury as only a ten percent disability fails to take into account the day to day disabilities suffered by a person following brain damage.   

Here is what the proposal states:

We propose to include the information that mild, moderate and severe  refer to a classification of TBI at, or close to, the time of injury rather than to the current level of functioning in the regulation itself to make it clear to raters that these designations that may appear in the medical records refer only to the initial evaluation and not to current functioning.

The proposal also  acknowledges that mental disorders are common consequences of a traumatic brain injury.  The VA states that the most common co existing mental disorder is depression, which may occur in up to 60 percent of those with TBI, but anxiety and post traumatic stress disorder also commonly occur.

In discussing post concussion syndrome, the proposal acknowledges the this condition may become permanent in a proportion of the population and lists the symptoms of the post concussion syndrome as headache, dizziness or vertigo, fatigue, malaise, sleep disturbance, cognitive impairment, difficulty concentrating, delayed reaction time, behavioral changes (such as irritability, restlessness, apathy, inappropriate social behavior, aggression, impulsivity), emotional changes (such as mood swings, anxiety, depression), tinnitus or hypersensitivity to sound, hypersensitivity to light, blurred vision, double vision, decreased sense of smell and taste, and difficulty hearing in noisy situations or competing sounds in the absence of objective hearing loss.

Comments regarding the VA proposal must be submitted on or before February 4, 2008.  Written comments can be submitted by clicking here. Comments should indicate that they are submitted in response to RIN 2900-AM75-"Schedule for Rating Disabilities: Evaluation of Residuals of Traumatic Brain Injury (TBI). Comments can also be sent by mail to the Director, Regulations Management, (00REG), Department of Veterans Affairs, 810 Vermont Avenue, NW., Rm 1068, Washington, DC 20420.

For further information on these proposed regulations you can contact, Maya Ferrandino, Regulations Staff (211D), Compensation and Pension Service, Veterans Benefits Administration, Department of Veterans Benefits Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW Washington, DC 20420. (727) 319 5847

Maureen Campbell-Korves Passes Away

It is with sadness that I must report the passing of Maureen Campbell Korves, a past president of the Brain Injury Association of New York Sate following a lengthy illness. 

Maureen assumed the presidency of the Brain Injury Association in some very troubling times for the association and helped guide it back to its true mission.  Maureen, became involved with the brain injury and disability advocacy movement following her own traumatic brain injury sustained as a result of striking her head while a passenger in a taxi cab.  Maureen learned that their was little respect shown for victims of brain injury and few options for treatment.  She took it upon herself to improve the quality of life for persons with a brain injury and their families and became actively involved with the Brain Injury Association of New York State, then known as the New York Head Injury Association.

Her advocacy skills and commitment soon came to the attention of New York State and she was appointed to the Governors Commission on Disabilities. 

Maureen will be sorely missed by all who knew her and all whose lives were bettered by her commitment to improve life for persons with a brain injury and their families.

A wake has been scheduled to be held at the Frank E. Campbell Funeral Home, 1076 Madison Avenue, New York City today (Wednesday) from 7 PM to 9 PM and tomorrow from 2 PM to 4 PM and 7 PM to 9 PM.

Funeral services are scheduled for Friday at 11:15 AM at St. Ignatius Loyola Church, Park Avenue & 84th street, New York City.

More Powerful MRI Approved To View Brain Pathology

The power of MRI machines keeps increasing at amazing speed.  While most hospitals are still using Tesla 1.5 strength MRI machines, many have now switched over to the Tesla 3.O which enables physicians to see brain pathology including diffuse axonal injury previously missed.  However, much brain injury still is not capable of being seen on the Tesla 3.0 MRI leading to frustrating absence of objective proof of traumatic brain injury.  This is especially frustrating in court cases. While absensce of proof of brain injury does not mean that no brain injury occurred as it is now accepted by the medical community that brain injury can occur even in the absense of positive MRI or CT confirmation, none the less, the failure to be able to document the TBI using objective measures still causes problems in legal cases involving brain damage.

Now, however an MRI that is much stronger than any before has successfully completed safety trials at the University of Chicago.  This new MRI machine is rated at 9.4 Tesla and is capable of revealing the brain in a detail never before seen and which will allow the observer to view biological processes in the human brain.

The safety study was published in the November Journal of Magnetic Resonance Imaging in an issue focused on MRI safety.

Researchers and physicians hope that the 9.4T will usher in a new era of brain imaging in which they will be able to observe metabolic processes and customize health care.

You can read more by clicking here.

CDC Traumatic Brain Injury Webcast

The Center for Injury Research and Control at the University of Pittsburgh has announced a  live webcast event entitled  “TBI Outcomes: Overview and Implications for Returning Military Personnel” to be presented by Jean A. Langlois, ScD, MPH,  Senior Epidemiologist at the Centers for Disease Control and Prevention National Center for Injury Prevention and Control Atlanta, Georgia.

The broadcast is scheduled to take place on Wednesday, January 16th, 2008 at 2:00 p.m. Eastern Time.  You will need to register in advance to participate.  Since seats are limited, you are urged to register without delay.  You can obtain full information by clicking here.

Hospital's Slow Response to Cardiac Arrest Leads to Hypoxic Brain Injury

Hypoxia (diminished oxygen) and anoxia (absence of oxygen) are leading causes of brain damage.  These events are often precipitated by cardiac arrest which causes the heart to stop pumping needed blood supply to the brain.  It is the blood that supplies needed oxygen to the brain.  The brain utilizes the majority of the bodies oxygen supply.

An article on the front page of today's New York Times, Hospitals Seen as Slow to Halt Cardiac Arrest reports the findings of a study published today in the New England Journal of Medicine where it was found that in nearly a third of cases of sudden cardiac arrest in the hospital, the staff takes too long to respond, thereby increasing the risk of brain damage and death.

In nearly 30 percent of the cases studied, it took longer than the national standard of two minutes to shock the heart and bring it back to normal function. This increased time leads to increased oxygen deprivation and increased brain damage.

The study and an accompanying editorial clearly find that these injuries are preventable and good hospital care would prevent this needless brain damage from occurring. 

Delays were more likely in patients whose hearts stopped at night or on the weekend, who were admitted for non cardiac illnesses, in hospitals with fewer than 250 beds and in units without heart monitors.

The lead author of the study, Dr. Paul S. Chan of St. Luke's Mid America Heart Institute in Kansas City,  MO is quoted as saying, "We know what works, what save lives. We have the technology available, and certainly the knowledge and skilled personnel in the hospital to shock patients back to normal rhythm. But it will take political will for hospitals to put those resources to better use."

Dr. Leslie A. Saxon, chief of cardiology at the University of Southern California in an accompanying New England of Medicine editorial is quoted as saying, "This is the kind of date we need to say, Let's make sure these preventable things never happen on our watch"

One thing the study recommends is that all hospitals have sufficient automatic defibrillators (which cost less than $500 a piece)  in place to shock the heart back to life along with better monitoring of all patients to alert staff to cardiac arrests.

Hopefully these recommendations will be implemented in hospitals throughout the country without delay to reduce these needless brain injuries.

Brain Mapping Site From National Geographic Magazine

I've just come across an interesting visual demonstration of how the brain processes information produced by National Geographic.  The site is a visual map of the brain with some excellent graphics which can be very useful for teaching and understanding traumatic brain injury.  The site is from the November 2007 edition of National Geographic and is entitled mapping memory.

Boxer in Coma Passes Away From Head Injuries

Sadly, World Boxing Organization intercontinental champion Choi Yo-sam was officially declared dead following head injuries received in a title bout in Korea. 

Choi's death came after eight days in an injury-induced coma and following him being certified brain dead Wednesday afternoon.

Choi Yo-sam was repeatedly struck in the head during this boxing match.  Although he was knocked to the ground, he was able to recover and continue to fight.  He managed to finish the bout.  He collapsed after returning to his corner. He was taken to the hospital where a cerebral hemorrhage (bleeding in the brain) was discovered and he underwent neurosurgery to reduce the pressure in his brain and stop the bleeding. Unfortunately, he never regained consciousness.

His family has donated many of his organs to assist others.

This is not the first fighter who has tragically died following head trauma.  Many of these individuals have not been knocked unconscious during the bout and have been allowed by ring doctors to continue to fight despite having sustained numerous violent blows to the head.  Perhaps, changes need to be made requiring that fights be halted following a certain number of head blows in any given round or during the entire fight.

By this time, it should be apparent that the ringside examination is not sufficient to determine if the fighter has sustained life threatening brain damage.  Unfortunately, this cannot be determined until the fight is over and steps need to be taken to protect the lives and future health of these fighters.