Brain Injury Lawyer - New York

Mild head injury and mild brain injury found to cause changes in brain function

Even mild head injuries can cause significant abnormalities in brain function that last for several days, which may explain the neurological symptoms experienced by some individuals who have experienced a head injury associated with sports, accidents or combat, according to a study by Virginia Commonwealth University School of Medicine researchers, published in the May issue the Journal of Neuroscience.

Previous research has shown that even a mild case of TBI can result in long-lasting neurological issues that include slowing of cognitive processes, confusion, chronic headache, posttraumatic stress disorder and depression.

The research team, demonstrated for the first time, using sophisticated bioimaging and electrophysiological approaches, that mild injury can cause structural disruption of axons in the brain while also changing the way the neurons fire in areas where they have not been structurally altered. Axons are nerve fibers in the brain responsible for conducting electrical impulses. The team used models of mild traumatic brain injury and followed morphologically identified neurons in live cortical slices.

Preventing cell death following brain injury

A new device called mechanical tissue resuscitation (MTR) to prevent cell death may dramatically change the way brain injuries are treated.  The device has been demonstrated in animal studies to reduce the size and extent of damaged tissue caused by traumatic brain injury according to a paper published in the journal Neurosurgery this month.

Tested in rodents, MTR uses negative pressure in order to create an environment that encourages cell survival.

The device has been utilized for the past fifteen years to treat wound and burn injuries.

In this study, the researchers used the device to remove toxins and fluids that cause cell death from an injury site located deep within the brain.

Brain injuries sustained by trauma or explosion causes irreversible cell damage and cell death at the site of the impact. Injured cells, in the area surrounding the wound, release toxic substances, which cause swelling of the brain, restricting blood flow and oxygen levels, which in turn causes further extensive cell death that affects brain function.

The research team set out in order to determine whether removing fluid and toxic substances from around injured brain cells could help improve survival of the damaged cells. The researchers found that in mice treated with MTR, brain swelling, as well as release of toxic substances considerably reduce compared to untreated brain injuries.

In addition, the device helped to preserve over 50% more brain tissue in animals treated with the MTR than in non-treated animals. After conducting behavioral function tests the team found that function returned faster in rodents treated with MTR.

New nonsurgical method being developed to monitor intracranial blood pressure

Traumatic brain injuries can lead to increased pressure inside the skull, which can cause further brain damage by direct damage to nerve cells and by impeding the flow of oxygen to brain cells. Up to now, the monitoring of intra cranial pressure had had to be done by drilling a hole in the patient’s brain and inserting a monitoring device.

A new nonsurgical method for monitoring brain pressure is described in an article appearing in the April 11 issue of the journal Science Translational Medicine.   

This new method is much less invasive and may enable doctors to measure brain pressure in patients who have milder head injuries, but would benefit from close monitoring.  While still in the study phase the new method is based on a computer model of how blood flows through the brain. The researchers found that they can calculate brain pressure from two less-invasive measurements: arterial blood pressure and an ultrasound measurement of how quickly blood flows through the brain.  This approach enables changes in brain pressure to be monitored over time so that doctors can detect problems that might develop gradually, the researchers said.

Mapping intelligence functions of the brain

In a study published in Brain: A Journal of Neurology, researchers report that they have mapped the physical architecture of intelligence in the brain.

The study used 182 volunteer Vietnam veterans with highly localized brain damage from penetrating head injuries.

By using brain injury survivors with focal brain injuries the study was able to look at how damage to particular brain regions produces specific forms of cognitive impairment.

The researchers took CT scans of the participants' brains and administered an extensive battery of cognitive tests. They pooled the CT data to produce a collective map of the cortex, which they divided into more than 3,000 three-dimensional units called voxels. By analyzing multiple patients with damage to a particular voxel or cluster of voxels and comparing their cognitive abilities with those of patients in whom the same structures were intact, the researchers were able to identify brain regions essential to specific cognitive functions, and those structures that contribute significantly to intelligence.

What to look for after a concussion in children when they return to school

A new study appearing in the Archives of Pediatrics & Adolescent Medicine confirms that children may suffer attention and memory difficulties following a concussion for a year following the original injury and sometimes even longer.

The confirmation that brain damage following a concussion can last a lifetime has important implications for the role of the school and educators in dealing with the long term deficits following a traumatic brain injury.  Schools need to focus on the need to provide assistance and accommodations to students returning to the classroom following a concussion,

The study found that children with brain injuries were more likely to have both "somatic" symptoms like headache, fatigue and balance problems, and cognitive symptoms such as forgetfulness and attention problems.

The somatic symptoms tended to wane over time, but in some cases the cognitive problems persisted, particularly for those children who lost consciousness when they hit their head or had abnormal results on an MRI scan.

According to the most recent statements by the Centers for Disease Control, when students return to school after a concussion, school professionals should watch for:

• Increased problems paying attention or concentrating
• Increased problems remembering or learning new information
• Longer time needed to complete tasks or assignments
• Difficult organizing tasks or shifting between tasks
• Inappropriate or impulsive behavior during class
• Greater irritability
• Lessor ability to cope with stress
• Being more emotional than usual
• Fatigue
• Difficulties handling a stimulating environment (lights, noise, etc.)
• Physical symptoms (headache, nausea, dizziness)

 

New drug shows promise in speeding recovery following severe brain injury

An article in today’s New England Journal of Medicine discusses research on a drug called Amantadine which has been shown to speed recovery from severe traumatic brain injury.  The researchers have concluded that the administration of this drug to patients in a vegetative state caused them to become responsive.

Amantadine was originally used to treat flu symptoms and was then found to be effective in treating Parkinson’s disease.

In a quote to AP, Joseph Giacino of  Boston's Spaulding Rehabilitation Hospital, co-leader of the study said, "This drug moved the needle in terms of speeding patient recovery, and that's not been shown before” and adding,  "It really does provide hope for a population that is viewed in many places as hopeless."

Although some question whether this drug actually improves long term recovery or just speeds up the pace of recovery, it is an important first step in finding medication that assists in the treatment of those suffering from a traumatic brain injury and may be a clue to the development of other medications.

As stated by Brain Injury Association of America President and Chief Operating Officer to the New York Times, "Hope is critical and false hope is cruel for families dealing with this,”  The new findings, she added, are “a little piece of hope, the real kind.”

You can read a full story in today’s New York Times or go to the New England Journal of Medicine.

Brain injuries more prevalent than previously thought

A new study by researchers from Mayo Clinic has found that the incidence of traumatic brain injury is likely greater than has been estimated by the Centers for Disease Control and Prevention (CDC). This study differs from previous similar studies in that it uses a new and refined system for classifying injuries caused by force to the head: the Mayo Traumatic Brain Injury Classification System.

“Even mild traumatic brain injuries can affect sensory-motor functions, thinking and awareness, and communication,” says study author Allen Brown, M.D., director of brain rehabilitation research at Mayo Clinic. “In assessing frequency, we have likely been missing a lot of cases. This is the first population-based analysis to determine prevalence along the whole spectrum of these injuries.”

Using the Rochester Epidemiology Project, a several decades-long compilation of medical records in Olmsted County, Minn., the team determined that TBIs occur in as many as 558 per 100,000 people, compared to the 341 per 100,000 estimated by the CDC. Researchers found that 60 percent of injuries fell outside the standard categorization used by the CDC, even though two-thirds of them were symptomatic.

Mayo researchers found the elderly and the young were found most at risk for “definite” and “possible” injury, respectively, and men were more at risk than women. The findings reinforce ongoing efforts by the CDC to create a brain injury classification that more broadly encompasses traumatic head injury.

New concussions management standards issued by Canadian Paediatric Society

The Canadian Paediatric Society, has issued a new position statement stating that it is "vital" that athletes, coaches, trainers, parents and doctors be aware of the signs and symptoms of concussions and any child who sustains a head injury should be seen by a doctor as soon as possible.

To minimize the risk of concussions, hockey associations should ban hits to the head, checking from behind, or checking outright in younger age groups as well as fighting. The pediatrician's group is also discouraging parents from enrolling their children in sports such as boxing that promote "intentional injury to the head."

The CPS recommends a child or teen who has sustained a head injury should:

- Be removed from play immediately, not allowed to return to play that game, monitored closely for any signs of deterioration and not be left alone;

- Be seen by a doctor as soon as possible;

- Rest until all symptoms are gone;

- Not play sports, exercise or participate in any recreational activities until they have recovered;

- Limit reading, texting, watching TV, computer work or electronic games until symptoms have resolved; and

- Be cleared by a doctor before returning to school or sports.

Neurologists urged to screen for domestic violence and traumatic brain injuries

Domestic violence is a major cause of traumatic brain injuries.  Unfortunately, many victims of domestic violence do not received adequate screening for brain trauma and many practitioners fail to even screen patients for domestic abuse.  

The American Academy of Neurology has now recognized the importance of routine screening for domestic violence and traumatic brain injury in a new position statement published online and in the February edition of the journal, Neurology.

The statement also notes that anyone who is physically or cognitively impaired is at a higher risk for abuse and abusive treatment, and that such treatment can also effect the development of neurologic disease.

Research shows that more than 90% of injuries stemming from intimate partner violence occur to the head, face, or neck region, which may lead to traumatic brain injury.

In addition to integrating questions about abuse into the medial history, patients may also be asked about abuse directly. Optimally, this should happen when they are alone; this is essential when questioning children about abuse. Appropriate questions may include:

•Have you ever witnessed violence?

•Have you ever been hit, kicked, punched, or otherwise physically abused?

•Has anyone ever tried to control you by threat or intimidation?

•Have you ever felt controlled or isolated by your partner?

•Have you ever been forced to perform sexual acts?

•Have you ever been taken advantage of financially?

•Have you ever been concerned for your safety?

If spousal abuse is identified, the neurologist also should ask whether child abuse is also occurring.

The American Academy of Neurology joins several other professional organizations that have also encouraged screening for abuse. In 2008, for example, the American Medical Association advised physicians to routinely ask about the family violence histories of their patients, noting that this knowledge is essential for effective diagnosis and care.

An American College of Obstetricians and Gynecologists Committee has also recommended that obstetricians and gynecologists to routinely and periodically screen all women for intimate partner violence.

Victims of domestic abuse may be able to bring a lawsuit against their spouse for brain damage. The brain injury law firm of De Caro & Kaplen, LLP, can provide legal advice and assistance.

Traumatic Brain Injury to be part of medical school curriculum

The Obama administration has announced a new partnership with U.S. medical schools to include traumatic brain injury as part of their medical school curriculum.

A total of 105 medical schools and 25 osteopathic colleges have pledged to include traumatic brain injury as part of their curriculum.