Brain Injury Lawyer - New York

New Developments in Sports-Related Concussion Conference

The University  of South Florida, College of Medicine has just announced their program for a sports-concussion conference entitled "New Developments in Sports-Related Concussion Conference" scheduled for July 24-25, 2008 at The Sheraton Station Square, Pittsburgh, Pennsylvania.

New knowledge on sport-related concussions has developed in recent years and athletic trainers and medical professional have had to rethink how they manage sport-related concussion. This conference features internationally recognized experts in concussion management and will focus specifically on new and innovative strategies for the evaluation and treatment of sports-related concussion. 

The conference planners list the following objectives for conference participants:

- Classify biomechanical, neurometabolic and neurobehavioral aspects of concussion.
- Explain appropriate on-field concussion diagnostic and return-to-play protocols.
- Compare and contrast new brain imaging diagnostic techniques for the management of concussion.
- Analyze the role of the computerized neuropsychological testing in making return-to-play decisions.
- Assess current treatment options for sports-related concussion and post-concussion syndrome.
- Implement a concussion management program at the professional, college or high school level.

Concussion conference registration information is available by clicking here.

Domestic Violence and Traumatic Brain Injury

On Tuesday morning, February 26, 2008, I will be making a presentation on Domestic Violence as a Cause of Traumatic Brain Injury to the Nassau County Coalition Against Domestic Violence. 

I will be educating social workers, attorneys and other agency personnel on the signs and symptoms of traumatic brain injury, concussion and the post concussion syndrome and explain the mechanism of how these devastating injuries take place in the context of domestic violence.

Many victims of domestic violence fail to get proper treatment for their brain damage because their symptoms are not appreciated.  Unfortunately, many individuals still fail to understand that this injury can take place even without the head being struck or if a person never loses consciousness.  In many cases the full extent of the brain damage is not apparent for days, weeks or even months after the assault took place.

I am pleased to provide some very important educational information on traumatic brain injury, its causes and repercussions to this dedicated group of professionals. For further information contact the Educational Coordinator of the Nassau County Coalition Against Domestic Violence 

If I can provide a complementary presentation to your group on this or some other topic surrounding traumatic brain injury, please do not hesitate to contact me.

At De Caro & Kaplen, LLP, we concentrate our practice on representing persons with traumatic brain injury.  What set's us apart from most personal injury law firms is our commitment and compassion to protect the rights of brain injury victims.

Traumatic Brain Injury and Senior Citizens: New CDC Publications

As you may know, falls are the leading cause of traumatic brain injury (TBI) and people ages 75 and older have the highest rates of TBI-related hospitalizations and death.  The Centers for Disease Control and Prevention (CDC) wants to improve the ability of children and other caregivers of older adults to prevent TBI from occurring and to recognize and respond appropriately should their loved one sustain a TBI.

Therefore, CDC has developed the "Help Seniors Live Better, Longer: Prevent Brain Injury" initiative, an exciting new communication campaign designed to raise awareness about ways to prevent, recognize, and respond to fall- related TBI in older adults.  CDC plans to launch the initiative in March
2008 during Brain Injury Awareness Month.  To support local activities surrounding the “Help Seniors Live Better Longer: Prevent Brain Injury” initiative, CDC has developed the “Event Planning” and “Media Access” guides, which are available online .

These guides are designed to assist with planning and hosting successful community events and working effectively with the media to raise awareness about this serious public health issue.  The 36-page “Event Planning Guide” includes suggestions and tools for planning and organizing a community event, for enlisting partners, and for promoting and evaluating an event.

The 64-page “Media Access Guide” includes tips and tools, such as talking points and templates for press releases and media advisories, to help you work with your local media to get valuable news coverage for the activities you plan in support of this national effort.

At De Caro & Kaplen, LLP, we concentrate our practice on representing persons with traumatic brain injury.  What set's us apart from most personal injury law firms is our commitment and compassion to protect the rights of brain injury victims.

Has the Senate Forgot About The Way The NFL Handles Traumatic Brain Injury Claims?

The Senate Judiciary Committee in addition to examining the destruction of tapes by the NFL, needs to look at how the NFL and their disability fund handles claims of traumatic brain injury.

I am hopeful that the Senate committee and Senator Specter who has been getting a good deal of attention on his questioning of Commissioner Goodell on the missing tapes, spend as much time on looking at the issues of why brain injured players are not receiving the compensation they so justly deserve.  Senator Spector is quoted as saying, "We have the right to have honest football games."  We also have the right to have an honest assessment of a player's disability.

The committee needs to address the deference under ERISA laws that courts give to the paid experts for hire retained by the league to defeat the claims of players.  Despite overwhelming evidence of permanent traumatic brain injury, the league is permitted to seek paid experts to offer opinions that are flawed and based upon antiquated science.  Yet, because of the way ERISA is written, the league is given "unfettered discretion" to rely upon any expert of their choice.

This law and its interpretation defies principles of due process and needs to be changed to protect players and all injured workers.

Criticism of Proposed New Rules on Classifying Brain Damage

Formal comments criticizing regulations proposed by the Department of Veterans Affairs governing compensation of veterans with traumatic brain injury has been submitted by U.S. Sen. Daniel K. Akaka (D-HI), Chairman of the Veterans' Affairs Committee who was joined by Senators Rockfeller, Murray, Obama, Tester, Brown, and Sanders.

"The new rules must provide for a fair evaluation of the veteran's disabilities. Unfortunately, the proposed regulations do not," said Sen. Akaka.

Under current regulations, compensation for symptoms attributable to TBI, such as headaches, dizziness, or insomnia is limited to "10 percent and no more." While VA recognizes that this requirement is outdated, it remains in effect pending the release of new rules. Chairman Akaka and majority members asked that this outdated rule be withdrawn immediately.

Akaka also objected to a section of the proposed rule which would not consider the severity or frequency of TBI symptoms, only count the number of symptoms.

The proposed brain injury regulations and the formal comment letter sent by Chairman Akaka and majority members can be found  by clicking here .

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.

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.

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.

 

New Study Confirms Even Minor Impacts Can Cause Concussions and Traumatic Brain Injury

An important new study to be published in the December issue of the journal, Neurosurgery confirms that impacts considered to be minor can cause a concussion and a traumatic brain injury.

The study is based upon date obtained from sensors placed in football helmets.  Researchers at the University of North Carolina studied the amount of force that the player received on impact.

Using special accelerometers embedded in helmets, researchers were able to measure in real time the amount of g-force players' heads experienced at impact, where on the head the players were hit and the directional force of the hits -- linear (straight) or rotational (twisted). The system is called HITS, or Head Impact Telemetry System.

"People see massive hits and think, 'that's the one!' and ignore more trivial blows," said Kevin Guskiewicz, Ph.D., senior author on the papers and chair of the department of exercise and sport science in UNC's College of Arts & Sciences. "Now we know that these trivial hits may be just as serious as the harder ones."

Hopefully this information will cause those who believe that minor impacts cause no permanent injury to reevaluate their opinions.  There is no such thing as a minor head injury.  All head injury must be treated seriously.

British Medical Journal Reports Neuropsychological Testing Not Enough For Return To Play Decisions Following a Concussion

A article appearing in the British Journal of Sports Medicine, Recovery of cognitive and dynamic motor function following concussion, concludes that neuropsychological testing by itself is not a sufficient indicator of when a player should be allowed to return to play following a concussion.

The authors report that motor skill testing should be utilized in addition to neuropsychological testing in making important return to play decisions.

Here is the abstract of their results:

Dynamic motor tasks, such as walking under varying conditions of attention, are complex and demanding undertakings, which require a longer recovery time following a concussion than cognitive measures. Little statistical relationship was found between the neuropsychological and gait variables, and the recovery curves of neuropsychological and gait domains were observed to be independent.

You can access the full report by clicking here.

Concussions in High School Athethes Featured Tomorrow Morning on ESPN: Outside the Lines

This Sunday, ESPN's Outside the Lines 9:30 AM Eastern Standard Time, will focus on concussions in high school athletes.

From ESPN.com -
"On gridirons across America, young people are playing football -- and inevitably getting hurt. Football is a contact sport and injuries are commonplace, but recent studies show that the number of high school players who get concussions each season range from five percent to as much as 47-percent. Not only are many high school programs understaffed with medical personnel, but it's also common for high school football players keep their symptoms from their coaches or trainers for fear of losing playing time. Coming up on "Outside the Lines," with the long term impact of concussions on NFL players making headlines, we examine a far bigger problem. The concussion epidemic on the high school level"

My friend, Sports Legacy Institute President, Chris Nowinski will appear as a live guest after the piece airs.  Chris is the author of Head Games, a superb book on the crisis of concussions in sports.

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.

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.

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.

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.

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.   

More Double Talk Today at Senate Hearing Examining NFL Disability Plan

I was privileged to attend the United States Commerce Committee oversight hearing today on issues pertaining the National Football League's Disability Plan and a follow up press conference hosted by Gridirons Greats, an organization of retired players headed by Mike Ditka and dedicated to achieving fairness and fair dealing for disabled players..

Unfortunately, what I heard was a lot of double talk.  While I commend NFL Commissioner Roger Goodell for his willingness to discuss the issues surrounding the plan, take the heat and pledge reform,I really didn't hear anything that was new or different.  The true issue is how the plan gets the final say on whether or not the player has permanent brain damage.  At the conclusion of the hearing I had an opportunity to meet with Gene Upshaw, head of NFL Player's Association.  I offered to meet with him in New York or anywhere else to discuss the serious issues of traumatic brain injury and the devastating nature of this condition.  He seemed interested.  Let's hope he contacts me so we can have a serious discussion and open a dialog.

They can change all the definitions of disability they want, but when the league gets to pick its own medical consultants who have the final say and the player gets no opportunity to challenge the decision, no matter how arbitrary or capricious it is, that violates fundamental principals of fairness and due process.

I have sadly been asked to review files of former players whose have been turned down by the league despite overwhelming evidence of brain damage suffered while playing professional football.  The league will keep looking until it finds a doctor to disagree with the multiple medical experts who have already concluded that a disability exists.  They will then chose to follow the recommendation of their bought and paid for, so called medical expert.

As I have previously said, When it comes to concussions and legal determinations as to whether a player has sustained brain damage, the league's position is heads I win, tails you lose.  It is outrageous that the league has stacked the deck against its retired and disabled players. It's time for Congress to act and rectify the injustices that have deprived victim's of brain trauma their legal rights.    They must allow players access to Court's of Law to review these determinations and take away the unfettered discretion that the league now enjoys.

High School Football Players Fail to Recognize the Seriousness of Concussions

A fascinating story appeared in yesterday's New York Times. High School Players Shrug Off Concussions, Raising Risks. 

The lengthy story explored the troubling prevailing attitude and culture that permeates high school football.  Namely, high school players minimize their injuries, especially their concussions; they do not have any clear idea what the symptoms of a concussion are or the dangers of continuing to play while symptomatic following a concussion.

These players are not alone in failing to appreciate the serious and life long consequences of a concussion.  Not only must they be educated, their parents, trainers and coaches need to understand the issues surrounding concussions and the dangers of minimizing any type of brain injury. 

The article quotes players as saying some really dangerous things like, "It's not dangerous to play with a concussion. You've got to sacrifice for the sake of the team.  The only way I come out is on a stretcher" and "our coaches would take us out in a second. So why, would we tell them?" 

As Robert Sallis, president of the American College of Sport's Medicine said, "Poor management of high school player's concussions "isn't just a football issue.  It's a matter of public health"

Some states are beginning to require specific training for players and coaches regarding the dangers of concussions.  Sounds like a great idea that should be explored by all school districts and states.

You can read the full article by clicking here.

Virginia Faulted on Care to Brain Injured

A report issued by a Virginia legislative review commission concluded that tens of thousands of people in Virginia with traumatic-brain injuries lack adequate residential facilities, access to therapy, transportation or occupational help. 

Further jeopardizing the already taxed system of brain injury care in Virginia is the prospect of returning veterans with brain damage who will also require care with no plans on how to deal with this growing epidemic. 

Unfortunately, Virginia is not the only State that lacks the proper resources to adequately care for the thousands of individuals who must live with a traumatic brain injury on a daily basis. Most states do not maintain proper statistics on the number of individuals who sustain brain injury in a give year and lack proper support services for brain damaged individuals and their families.  Rehabilitative services in many places are fragmented and not easily accessible.  Most states have improper levels of funding to support brain injury services and most individuals do not receive the services they deserve.

In Virginia, most if not all facilities will not accept Medicaid to pay for residential care.  In fact, the only facility in the state that does accept Medicaid payments for residential care for traumatic brain injury victims will stop accepting these patients later this month.

But, Medicaid funding is not the only issue.  Issues of private insurance and why these health insurers are not paying for brain injury rehabilitation services needs to be addressed.

You can read more about this 130 page report by clicking here.

Learn more about Chris Benoit's Brain Injury Tonight on Geraldo At Large

Just learned that tonight at 8 PM and 11 PM EST, Sports Legacy Institute founding members will discuss their neuropathology findings and opinions concerning Chris Benoit brain damage.

Brain Autopsy of WWE Wrestler Benoit Shows Extensive Brain Damage

In a Manhattan press conference today, physicians associated with the Sports Legacy Institute announced their findings today concerning the examination of the brain of pro wrestler Chris Benoit who killed his wife, son and then himself.

Not surprisingly, the examination of his brain showed extensive areas of brain damage.  All four lobes of his brain showed extensive cell death which is consistent with the multiple concussions he sustained while engaged in professional wrestling.

Benoit's brain was examined by the research team which included noted neurosurgeons Julian Bailes and Robert Cantu who along with retired pro wrestler, Chris Nowinski, author of Head Games, established the Sports Legacy Institute to look at the mounting evidence of permanent brain damage caused by concussions sustained by athletes.  Head Games is an excellent source of information on the dangers and long term effects of concussions

The brain experts had not problem concluding that the brain damage they found were due to the multiple concussions that Benoit sustained. But, the physicians could not say with absolute certainty that this brain damage was the cause of Benoit's erratic behavior on the night of the murders. They did say however, that the this type of brain damage can cause depression and irrational behavior in an individual.  Similar brain abnormalities were also found on autopsy of the brains of other athletes who committed suicide including pro football player, Andre Walters.

A full report of the press conference can be found at ABC News. 

VA Offers On Line Traumatic Brain Injury Course

The United States Department of Veterans Affairs (VA) offers an on-line Traumatic Brain Injury (TBI) Independent Study Course.  This curriculum presents an overview of TBI issues that primary care practitioners may encounter when providing care to veterans and active duty military personnel.  While it is primarily designed for medical personnel and other practitioners interested in traumatic brain injury care, the course contains useful information for everyone.

You may access the on-line independent study course directly by establishing a username and password by clicking here.  When you go to the site you can also download a pdf version of the course without registering. 

Madden NFL 08 Criticized For Violent Content

Today's Houston Chronicle contains an interesting article, In games, it's all about the big hit.  The article discusses the mounting criticism of the new Madden video football game and its emphasis on violence.

I am honored to have been extensively quoted in the article about the myths perpetuated by the NFL in licensing this product.  This new version of Madden is reportedly the most violent version ever produced.  It's emphasis on the big hit sends the message to all who view this game, that the big hit doesn't cause any head injury or brain damage. 

If the NFL is serious in their concern over concussions, they ought to rethink the image they are creating in the minds of young fans when they allow these video games to be produced under their license. The NFL should learn that the best cure for brain injuries is prevention! 

More NFL Double Talk on Concussions

Just when I thought that maybe the NFL is getting it when it comes to concussions and preventing brain damage, comes an article in today's New York Times, New Advice by NFL in Handling Concussions.

According to the news report, the NFL has finally adapted a policy prohibiting players who have been knocked unconscious to return to play during the game in which they were injured.

Not bad, but what about players who were not knocked unconscious, but sustained a concussion anyway?  Don't they need the same protection.  It's been over twenty years now that we know that serious brain damage and concussions can happen even without loss of consciousness.  Come on NFL, read the medical literature!

And their is more.  The league says that their policy is only that of erring on the side of caution.  Not that they really believe that that it is necessary to keep players who have been knocked out from returning to play.  You've got to be kidding. 

The statements made by the league in this article are truly troubling.  It's time that this league not only talk the talk. It's time that they really get serious about concussions.

New web site for Sports Legacy Institute

My good friend Chris Nowinski, author of Head Games, a wonderful book about the crisis of concussions in sports today, has just launched a new web site for the Sports Legacy Institute.

The Sports Legacy Institute  (SLI) is dedicated to studying the effects of concussions and other sports related brain injuries.  Through its efforts, SLI aims to  maximize the safety and vitality of all athletes who participate in contact and collision sports around the globe. 

If you go to the Institutes's web site, you can get on their email list to be updated on their mission.

Change the Face of Sports - Make a Donation to the Sports Legacy Institute:

To promote medical and scientific research, education, prevention, and advocacy in brain related sports injury issues, the Sports Legacy Institute relies on the financial support of people who are interested in seeing the health and wellness of athletes of all ages and the overall safety of sports improved.   Click here for further information about donating to the Sports Legacy Institute.

Army Institutes Educational Campaign to Recognize Traumatic Brain Injury

The Army in recognition of that many, if not most brain injuries are invisible to the casual and even medical observer, is launching an education program to teach 1 million soldiers how to recognize symptoms of brain injuries and Post Traumatic Stress disorder.

The program is designed to educate the Army about the signs and symptoms of traumatic brain injury and concussions and to encourage troops to get treatment.

The program will include the active military, the Army Reserves and the Army National Guard, both here and abroad.

Everyone is to receive a one-hour briefing on brain injuries and stress, in which teachers will be equipped with videos, slides and a list of expected questions and answers. It will be done through a rarely used "chain teach" program, that is, the subject is taught to leaders, who then teach it to soldiers, continuing down through the Army's chain of command.

I wonder if this program can be modified and used at all emergency rooms in the United States to train doctors, physician assistants, nurses and others about the hidden and invisible signs of concussion and brain injury?

The Best Cure For A Brain Injury Is Prevention

Because I feel so strongly about the need to prevent future brain injuries in are student athletes, I am reproducing an editorial Tackling football's silent killer that appears today in the Sun Chronicle:

High school sports may be safer now than they've been in years, as a recent article reported in tandem with a profile on a serious spinal injury suffered by King Philip wrestling star Donald McNeil.

However, the risk of a certain type of injury is climbing ever higher on the radar screen of school and professional sports. That's concussion, a traumatic injury to brain tissue as a result of a violent blow, shaking, or spinning. It is a sometimes nearly silent assault to the body that, without heightened awareness by coaches, teammates and parents, could go unnoticed until complications arise.

The National Football League is closely scrutinizing the injury, educating players and ensuring that concussion is reported by instituting a whistle-blower system at training camps this month.

"And if anyone feels they are being forced onto the field when they are not ready to play, we want to know about that and look into it," NFL commissioner Roger Goodell said after a conference last month in Rosemont, Ill., with medical personnel from every team in the league.

This initiative should be an added heads-up to high school coaches who soon will be starting a new season of play. Any hint of concussion must be taken seriously since longterm repercussions may be devastating.

The heightened awareness by the NFL comes amid studies indicating that players who suffered multiple concussions might be susceptible to neurological disorders later in life, reported the the Pittsburgh Tribune-Review.

The decision by parents to permit their children to play sports lies there, at home. Risks are everywhere in life. But it can pay for everyone to be educated about a brain injury that is real, common and drawing closer examination than ever.

"The real danger is when they have an injury and they continue to play and that creates a greater degree of danger in terms of their recovery," said Dr. Mark Lovell, director of the sports concussion program at the University of Pittsburgh Medical Center and director of the NFL neuropyschology program.

"Parents should be on the lookout if their kids are (suffering) symptoms like headaches, dizziness, nausea, balance problems. Difficulties with memory, if there is a sudden change in a child's personality, they should start asking questions and maybe call the coach up and ask, 'Did my son get hit today and what happened?' It's the stuff we don't know about that is really dangerous."

Football is a signature sport in this area, but there's no reason that zealousness about winning cannot co-exist with an equal passion for enhanced safety measures and vigilance.

Hopefully, parents, coaches and students themselves will take this advice to heart.

State to screen returning troops for brain injury

The state of Illinois has announced that it would begin mandatory screening of their National Guard members who were deployed to Iraq and Afghanistan for traumatic brain injuries.

Reportedly, Illinois officials have become increasingly frustrated with the screening procedures of the federal government and the services and support available made available to returning vets with brain damage by Washington.

So, state veteran affairs officials have taken matters into their own hands.  They will require mandatory screening for brain injury of all returning members of their national guard and offer brain injury screening to other veterans of the state.  They will also provide a 24-hour hot line for psychological counseling services for brain injury victims.

Medical professionals in Illinois recognize the difficulties in detecting mild traumatic brain injury and are directing special attention to the symptoms of mild brain injury including irritability, headaches, dizziness, memory problems, feeling tired or feeling groggy.  The screening program includes a written questionnaire and an assessment by a trained brain injury professional.  Any soldier with a suspected brain injury would then be referred to a veterans center for further evaluation and treatment.

Hopefully, more states will follow the Illinois example and establish traumatic brain injury screening programs themselves.

You can read the full story in the New York Times, Screening for Brain Injury Is Set for Illinois Veterans, by clicking here.

NFL Concussion Summit Today

Following heated criticism of the National Football League (NFL) and their policies of concussion management, a concussion conference is being held today in Chicago.  The league has mandated that all teams send their medical representatives including doctors and trainers to discuss the important issues pertaining to concussion management.

The league as already instituted some important changes including requirements of baseline off season testing neuropsychological testing of all players and protection for those players who blow the whistle on coaches who ignore the health and safety of their players. 

I am hopeful that this conference will produce some further needed changes including mandatory time periods that players must be side lined before being allowed to return to play, I suggest that at a minimum, a player NEVER be allowed to return to play in the same game in which they had a concussion or a suspected concussion.

Further, following several concussions, a player should be required to undergo PET Scan study and other cognitive testing.  If the results of this testing shows, brain damage, then they should face mandatory retirement. 

The league must set up educational programs to alert players and their families about the subtle and hidden signs of concussions and the life long consequences of this injury.  Further, I am hopeful that the league will use some of their enormous profits to educate high school and college athletes about the dangers of repeated concussions.  Brain Injury prevention programs is something that the league needs to take an active part in.

For a comprehensive story on this conference and the background of how the NFL has dealt with concussions, read today's USA Today article, Concussions command NFL's attention in which I am quoted.

More Evidence of the Dangers of Multiple Concussions in Professional Football

More medical evidence establishing the link between repeated concussions and permanent brain damage has been reported in today's New York Times.

The Times reports that Dr.Omalu, the neuropathologist who first reported finding evidence of persistent brain damage on autopsy examination of the brains of retired football players has now confirmed a fourth case.

Dr. Omalu examined the brain of  former Pittsburgh Steelers offensive lineman Justin Strzelczyk, who died at age 36 following a car accident.  Before the accident, Strzelczyk was suffering from depression, mood swings and memory difficulties which related back to the multiple concussions and head trauma that he sustained in his years playing professional football. 

Strzelczyk is the fourth former National Football League player to have been found post-mortem to have had a condition similar to that generally found only in boxers with dementia or people in their 80s. The  condition is known as chronic traumatic encephalopathy and has been established in the brains of boxers subjected to repeated brain trauma. The diagnosis was made by Dr. Bennet Omalu, a neuropathologist at the University of Pittsburgh Medical Center. In the past five years, he has found similar damage in the brains of the former N.F.L. players Mike Webster, Terry Long and Andre Waters. The finding will add to the growing evidence that longtime football players, particularly linemen, might endure hidden brain trauma that is only now becoming recognized.

Omalu is quoted in the Times article as saying,  “This is irreversible brain damage,” “It’s most likely caused by concussions sustained on the football field.”  Omalu's findings have been backed up by other physicians who were asked to consult on this matter.

A great deal of credit for this continued investigation must go to Christopher Nowinski,  a former Harvard football player who retired from wrestling because of repeated concussions in both sports.  He is the author of a great book entitled, Head Games--Football's Concussion Crisis and has become an outspoken critic of how professional sports handles the issues related to repeat concussions and when to allow players to return to play.

Nowinski has teamed up with Dr. Omalu as well as with Dr. Julian Bailes, the chairman of the department of neurosurgery at West Virginia University and the Steelers’ team neurosurgeon during Strzelczyk’s career to form an organization, the Sports Legacy Institute, to begin conducting more formalized research.

“We want to get a idea of risks of concussions and how widespread chronic traumatic encephalopathy is in former football players,” Nowinski said. “We are confident there are more cases out there in more sports.” according to the Times. 

Next Tuesday, the NFL Mild Concussion Committee has scheduled a meeting in Chicago to discuss head trauma in the NFL.  The NFL continues to resist the mounting evidence of the link between head trauma, concussions, depression and other psychiatric conditions as well as early onset Alzheimer's Disease. I am hopeful that they begin to seriously address the issues raised by Dr. Omalu's findings.

You can read the full Times story by clicking here.

VA To Screen All Returning Veterans for Brain Injury

The associated press reports that all soldiers returning from Iraq or Afghanistan who seek any treatment at Veterans Affairs hospitals are now being screened for brain injuries and post-traumatic stress disorder according to  VA Secretary Jim Nicholson.

What troubles me however, are the countless soldiers who are not being screened because they have not accessed the VA medical system for any type of care.  We all know that many individuals suffering from the post concussion syndrome do not seek care and are not even aware that their symptoms and condition is the result of a brain trauma.

It would make sense to me that in addition to screening done at the VA clinic, ALL vets returning from Iraq be screened regardless of whether or not they are seeking any medical treatment.  It is only through this comprehensive screening that the post concussion syndrome will be timely diagnosed and timely treatment undertaken to assist these individuals.  Anything less is simply ignoring the bigger problem of traumatic brain injury and the number of soldiers plagued by this condition.