Brain Injury Lawyer - New York

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.

An Apple A Day May Prevent Dementia

An article in the Journal of Food Science reports that apples, bananas, and oranges  protect against neurodegenerative diseases, including Alzheimer’s Disease.

Researchers at Cornell University investigated the effects of apple, banana, and orange extracts on neuron cells and found that the phenolic phytochemicals of the fruits prevented neurotoxicity on the cells.

Among the three fruits, apples contained the highest content of protective antioxidants, followed by bananas then oranges.

You can read more about this by clicking here.

Carbon Monoxide Poisoning

Carbon Monoxide poisoning is a frequent cause of brain damage. 

Here is some interesting information on Carbon Monoxide poisoning put out by Fox News:

Carbon Monoxide is a colorless, odorless, tasteless, toxic gas that has the molecular formula CO.

Carbon Monoxide is produced by the incomplete combustion of the fossil fuels - gas, oil, coal and wood used in boilers, engines, oil burners, gas fires, water heaters, solid fuel appliances and open fires.

Dangerous amounts of CO can accumulate when, as a result of poor installation, poor maintenance or failure or damage to an appliance in service, the fuel is not burned properly, or when rooms are poorly ventilated and the Carbon Monoxide is unable to escape.

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Symptoms of Carbon Monoxide Poisoning:

At moderate levels, you or your family can get severe headaches, become dizzy, mentally confused, nauseated, or faint. You can even die if these levels persist for a long time.
Low levels can cause shortness of breath, mild nausea, and mild headaches, and may have longer term effects on your health.
Since many of these symptoms are similar to those of the flu, food poisoning, or other illnesses, you may not think that CO poisoning could be the cause.

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Having no smell, taste or colour, in today's world of improved insulation and double glazing, it has become increasingly important to have good ventilation, maintain all appliances regularly and to have absolutely reliable detector alarms installed giving both a visual and audible warning immediately there is a build-up of CO to dangerous levels.

Again, Carbon Monoxide has no smell, taste, or color and it is for these reasons that CO Detectors are the only way to alert you to increasingly dangerous levels of CO before tragedy strikes.

Carbon Monoxide poisons by entering the lungs via the normal breathing mechanism and displacing oxygen from the bloodstream. Interruption of the normal supply of oxygen puts at risk the functions of the heart, brain and other vital functions of the body.

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Tips to Prevent Carbon Monoxide Poisoning:

Have all of your fuel-burning appliances checked by a professional inspector every year.
Don't idle your car in a garage.
Follow all instructions that accompany fuel-burning appliances and tools.
Don't use gas-powered appliances or tools in enclosed spaces.
Don't ignore sudden symptoms

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Can A Monitor Prevent Brain Damage During Surgery?

An interesting article appeared in USA Today concerning a monitor that can determine oxygen saturation in the brain during surgery. 

Although this monitor has been in existence for over ten years, it still faces resistance from some doctors who still question it usefulness.

In the past I have represented individuals who have sustained anoxic brain damage during surgery as a result of poor anesthesia techniques and poor monitoring of a patient's blood pressure.  Any device that will warn physicians when the brain is not receiving sufficient quantities of oxygen is a welcome addition to efforts to improve patient safety.

The device discussed in the article will detect subtle changes in the amount of oxygen reaching the brain and cause increases in blood pressure and blood flow to the brain so that sufficient oxygen reaches it.  The brain is extremely sensitive to oxygen deprivation.  After only a few minutes without sufficient supplies of oxygen, brain damage will start to occur.

You can read the full story 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.

Exposure To Lead Can Affect Ability of Brain to Respond to Later Brain Injuries

Exposure to lead can hinder the brain's ability to recover from injury, a recent study in laboratory animals shows.

Researchers at Jefferson Medical College wanted to know if it was possible that lead might alter the potential for plasticity, the ability of the brain to compensate for an injury.  Their finding is reported in the latest issue of the journal, NeuroToxicology.

They studied young rats that were fed a diet supplemented with lead and compared them to others on a diet without lead. They found that even brief exposures to lead affected the ability of the brain to respond to later brain insults.

It is well known that lead exposure had detrimental effects on learning and memory.  This new study implicates lead as a cause of the failure of the brain to properly heal following insults later in life including traumatic brain injury.

Head Injury A Growing Problem in Skiing and Snowboarding

A review published in the journal Injury Prevention concludes that head and spinal injuries are on the rise as a result of skiing and snowboard accidents.  The authors conclude that faster speeds and complicated maneuvers are leading to more head and spine injuries among downhill skiers and snowboarders.

While injuries in general are declining in these two sports, head injury continues to rise.

Helmet use is associated with a 22 percent to 60 percent reduction in head injury risk, but helmets are not being used by the majority of those on the slopes. The U.S. Consumer Product Safety Commission estimates that half of head injuries on the slopes could be prevented by helmets, but a survey of several United States ski resorts found that helmets were worn by just one in eight skiers and snowboarders. Notably, the most-skilled athletes were most likely to wear a helmet.

Although there has been some speculation that helmets may increase the odds of spinal injury in children, the new review cites three studies showing that helmets do not raise such a risk. It is true that many parents buy helmets too big, so that kids will grow into them; a poorly fitted helmet offers less protection, impeding vision and muffling hearing. Although more study is needed, the review authors conclude that the benefits of helmet use in preventing serious head injury far outweigh any risk.

ATV'S Unsafe For Children

Kids who ride ATVs have an alarming number of potentially disabling injuries, according to a study reported in USA Today.

The study reported at the annual meeting in Chicago of the Radiological Society of North America studied 500 children and teens injured in ATV accidents and brought to the emergency room at Children's Hospital over eight years. They found that the number of ATV injuries more than doubled from 1998 to 2006. The study adds to other evidence suggesting dangers faced by children who ride ATVs: The Consumer Product Safety Commission says 40,400 children were treated in U.S. emergency rooms in 2005 after ATV accidents.

Bone fractures were the most common problem during that time frame: 208 children received such an injury.  Head injuries also were common. The team counted 85 skull fractures, 66 cases of bleeding in the brain and 59 children who had damage to the brain tissue. In 12 cases, children were injured so severely in an ATV crash that doctors at the Arkansas hospital had to amputate an arm or a leg.  The study said six children died after ATV accidents.

The American Academy of Pediatrics recommends that children under 16 be barred from ATV use. At the very least, if you know someone is is operating an ATV, make sure they are wearing a helmet!

You can read the full story in USA Today by clicking here.

New Lead Poisoning Recommendations Released by CDC

The Center for Disease Control's Advisory Committee on Childhood Lead Poisoning Prevention has issued new recommendations in a report issued last week.

Lead contamination and exposure to lead is associated with significant cognitive impairments, motor impairments and behavioral difficulties in children.  In 1991 the CDC defined  the blood lead level (BLL) that should prompt public health action as 10 units.  Since that time, strong evidence has been discovered to show that lead levels below 10 units should be of concern to public health officials as well as parents and medical personnel. 

The full CDC Lead report  can be found on line at the CDC web site. The report is dated November 2, 2007 and is number 56(RR08); 1-14; 16

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.

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.

 

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.

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.

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.

Useful Tips on Preventing Brain Injuries and Other Childhood Injury

Here's some useful advice to pass along to parents from the Consumer Product Safety Commission (CPSC) on preventing head injury and other injuries to children returning to school:

The U.S. Consumer Product Safety Commission (CPSC)  offers the following ABCs of back-to-school safety:

    (A)  Always wear the right helmet for the activity.

     Wearing a helmet significantly reduces the risk of a head injury and can save your child's life. Bicycle helmets, for instance, can reduce the risk of head injury by as much as 85 percent.
    There are different helmets for different activities. Each type of helmet is made to protect the head from the impacts that are common to a particular sport or activity. For the best protection, make sure your child wears the right helmet whether it's for biking, football or baseball.
    Fit is important. A helmet should be comfortable and snug, level on the head and securely buckled so it doesn't move or fall off during a fall or collision.
    For more information on helmet safety, go to CPSC's publication "Which Helmet for Which Activity"

     (B) Be safe on the playground and on the soccer field.

    Hidden hazards can lurk on the playground or sports field. More than 200,000 children each year visit hospital emergency rooms due to injuries received on playgrounds.
    To prevent the most common type of playground injury -- a child falling from equipment -- make sure there is at least a nine inch layer of shock absorbing surface material made of wood chips, mulch, sand, or pea gravel, or safety-tested rubber or fiber material mats underneath and around playground equipment.
    Cover exposed hardware that can catch clothing, and remove any free-hanging ropes. Both are strangulation hazards.
    On the soccer field, work with your school to ensure portable soccer goals are securely anchored when in use. Movable soccer goals can fall over and kill or injure children who climb on them or hang from the crossbar.  Since 1979, CPSC has reports of at least 28 deaths associated with soccer goals.

    (C)  Care with clothing and art materials.
   
      Don't buy jackets or sweatshirts, or any upper outerwear for children,if they have hood or neck drawstrings. Remove drawstrings from hoods or around the necks of jackets and sweatshirts in your children's closets.  Drawstrings pose a strangulation hazard because they can get caught on playground equipment or other products. Over the past 20 years, CPSC has received reports of 23 deaths and 64 non-fatal incidents involving the entanglement of children's clothing drawstrings.
   
      Art should be fun, not dangerous. Make sure any new art materials you buy or that your school uses contain the statement, "CONFORMS TO ASTM D-4236." Check older art materials to see if they've been recalled .

    For more information on back-to-school safety, go to CPSC's "Back to School Safety Checklist,"

Lead Paint Danger's At Home

By now we all have heard about the dangerous levels of lead paint found in Mattel toys manufactured in China.  But, did you know that the largest threat for lead poisoning in children today is still the lead paint found in walls and on other surfaces in the home?

Lead-based house paint was banned in 1978, but it's still on the walls, windows, trim and doors of an estimated 20 million homes. It likely has been painted over many times in most homes, but it's still a hazard if exposed. What's worse, old paint on window casings can create lead dust for decades when the window is opened and closed.

Lead is a potent neurotoxin that can affect the brain, resulting in a lower IQ, poor memory and attention, decreased motor skills and self-control, and increased aggression.

Infants and toddlers are especially vulnerable because their brains are developing quickly, and they tend to put their hands in their mouths often, swallowing lead dust from floors, walls and elsewhere.

Because the dangers of lead paint poisoning cannot be detected by merely looking at a child, all children need to have blood tests for lead paint screening. 

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.

fMRI Used To Detect Concussions and Return to Play Decisions In Athletes

fMRI (Functional MRI studies) have been reported to be used by the University of Pittsburgh to assist in making important return to play decisions following sports concussions.

A five year study funded by the National Institutes of Health is published in the August issue of Neurosurgery.  This study conducted by the Sports Medicine Concussion Program at the University of Pittsburgh School of Medicine  found that the brain activity in children and adolescents on functional MRI (fMRI) was clearly related to their performance on neuropsychological tests of attention and memory and to their report of symptoms such as headaches.

The study authors Drs Lovell and Collins conclude that the results of their study confirm crucial objective information that is commonly obtained by neuropsychological testing to help team doctors and athletic trainers make critical decisions about concussion management and safe return to playor understanding the recovery process after sports-related concussions.

The study helps define concussion and recovery for safe return-to-play and confirms information obtained by neuropsychological testing.

A concussion can occur when an athlete receives a traumatic force to the head or upper body that causes the brain to shake inside of the skull. Injury is defined as a concussion when it causes a change in mental status such as loss of consciousness, amnesia, disorientation, confusion or mental fogginess. The severity, effects and recovery of concussion are difficult to determine because no two concussions are alike, and symptoms are not always straightforward.

In recent years, research has shown that until a concussed brain is completely healed, the brain may be vulnerable to further injury, which has led to published studies that have raised public awareness and significantly changed the way sports concussions are managed. Importantly, much of this research has included data that proves the usefulness of objective neuropsychological test data as part of the comprehensive clinical evaluation to determine clinical recovery following concussion.

While neuropsychological testing has become an increasingly useful tool, no other published studies have examined the relationship between changes in computerized neuropsychological testing completed in a medical clinic and brain function as measured by fMRI.

fMRI is one of the few brain scanning tools that can show brain activity, not just the anatomy. Traditional brain scanning techniques such as MRI and CT are helpful in viewing changes to the brain anatomy in more severe cases, but cannot identify subtle brain-related changes that are believed to occur on a metabolic rather than an anatomic level.

fMRI can determine, through measurement of cerebral blood flow and metabolic changes, which parts of the brain are activated in response to different cognitive activities.

For more information on published research concerning sports concussion management, visit the UPMC Sports Medicine Concussion Program Web site .

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.

New Tests Approved to Detect Meningitis in Children

Having been involved in several medical malpractice cases where doctor's failed to properly detect meningitis in children leading to permanent brain damage, I was pleased to learn that the FDA has approved of new tests to accurately and quickly detect meningitis before discharging children from either the emergency room or office.

The test will help physicians distinguish between viral meningitis and the less-common, but more severe, version of meningitis caused by bacteria.

Meningitis is an infection of the cerebrospinal fluid surrounding a person's spinal cord and brain, causing inflammation of the tissues in these areas. The illness is diagnosed by testing the fluid obtained from a patient during a spinal tap. Typically, diagnostic tests for meningitis can take up to a week to get results. But using this new test, results are available in two and one-half hours.

From the FDA press release: "Because this test is significantly faster than existing methods for diagnosing meningitis, it could minimize delays in treating patients. Swift recognition of the cause and appropriate treatment is critical to patient recovery," said Daniel Schultz, M.D., director of the Center for Devices and Radiological Health. "Since bacterial meningitis can be deadly within as little as two days, patients who have viral meningitis are frequently treated with antibiotics as a safeguard against the more dangerous bacterial meningitis. This test should help physicians manage patients appropriately and prevent unnecessary treatment with antibiotics."

Knowing whether the meningitis is viral or bacterial is imperative to early effective treatment. But distinguishing between the two types of infection is difficult because of similar symptoms. Patients with viral meningitis usually recover within two weeks without any medical intervention. Bacterial meningitis, however, can lead to brain damage, hearing loss and even death if not treated properly.

For patients over two years of age, symptoms of meningitis include fever, severe headache, stiff neck, nausea, sleepiness, confusion, and sensitivity to bright lights or seizures. These symptoms may be absent or difficult to detect in newborns and small infants who may only appear slow or inactive, or be irritable, have vomiting or feed poorly.

Read the full FDA release by clicking here.

Nail Gun Injuries Increase

According to new statistics  the number of injuries from nail guns has almost doubled since 2001. Sadly, many of these nails end up in the victim's brain.

The number of individuals treated each year for nail gun injuries in emergency rooms in U.S. hospitals more than tripled between 1991 and 2005, increasing to about 14,800 per year, according to an analysis by researchers at Duke University Medical Center and the National Institute for Occupational Safety and Health.

Nail guns typically use compressed air to drive nails into wood. First used by construction workers and professional carpenters, the guns now are sold routinely in hardware stores and home improvement centers.

The Duke researchers said that many injuries caused by nail guns could be prevented by using tools that fire only when the nose piece is depressed before the trigger is pulled. This "sequential" trigger mechanism is designed to prevent rapid, unintentional firing, but it has not been used as much as tools that allow the user to rapidly "bounce fire' nails.

It is recommended that consumers purchase nail guns with a sequential-trip trigger or purchase kits to convert their current nail gun triggers to the safer type.

The findings appear in the April 13, 2007, issue of Morbidity and Mortality Weekly Report, published by the federal Centers for Disease Control and Prevention.

Brain Injury in Children

As reported in today's New York Times, a study published in he journal Pediatrics reports that children who suffer a head injury are much more likely to have another one within six months.

Until now, the study said, there has been some circumstantial evidence suggesting that one head injury predisposes children to another. Trying to determine if this was really the case, the researchers looked at what happened to more than 11,800 children, ages 1 to 18, who came to two pediatric emergency rooms over a little more than two years for treatment of a head injury.

Although the researchers were unable to establish what kind of children were at most risk to be injured again — beyond the well-known fact that boys are more likely to have injuries than girls — they suggested that repeated injuries probably involved a “complex interaction between children and their personal and social environments.”

To begin with, a mild head injury can cause continuing problems that may not be obvious. “Even subtle deficits in coordination, balance or endurance,” the study said, “combined with cognitive and behavioral limitations, might reduce a child’s ability to meet the demands of a difficult task.”

It may also be, the researchers said, that the children who are injured again are exposed to more hazardous environments or have less parental supervision.

The study recommended that families of children who have had head injuries might benefit from counseling on injury prevention. It also said doctors might consider extending the four-week restriction on activity that patients are often advised to follow.

Latest CDC Statistics Show Increases in Traumatic Brain Injury

The latest data from the Centers for Disease Control on the epidemic of traumatic brain injury in the United States as contained in the MMWR (Morbidity and Mortality weekly review) [March 2, 2007 / 56(08);167-170] shows a startling increase in the rates of hospitalization for persons suffering from head trauma.

According to the CDC:  "Traumatic brain injury (TBI) is a major cause of morbidity and mortality in the United States. Each year, on average, TBIs are associated with an estimated 1.1 million emergency department visits, 235,000 hospitalizations, and 50,000 deaths in the United States (1). For 2002, the overall rate of TBI-related hospitalization reported by the 12 states in the CDC TBI surveillance system was 79.0 per 100,000 population (2); across these states, however, the rates varied substantially (from 50.6 in Nebraska to 96.9 in Arizona). To update results from the CDC TBI surveillance system, CDC analyzed data from 2003, the most recent year for which data were available. This report summarizes the results of that analysis, which indicated that an estimated 28,819 persons (87.9 per 100,000 population) were hospitalized with a TBI-related diagnosis in the nine states that reported data for 2003. For all age groups combined, rates were higher among males. Age-specific rates were highest among persons aged >75 years. Unintentional motor-vehicle--traffic incidents (MV-T) and unintentional falls were the two leading causes associated with TBI-related hospitalization. The findings underscore the need for states to continue monitoring the occurrence, external causes, and risk factors for TBI and to design and implement more effective injury-prevention programs."

With the increasing number of service connected brain injuries, these numbers are only going to increase.  Adequate funding for TBI research, treatment and prevention programs still needs to be addressed.

Support the reauthorization of the TBI ACT!

Government recalls

With so many products being recalled by various manufacturers because of hazards,  adulterated food and dangerous drugs, I want to alert my readers to a new site created by the Federal government where six federal agencies including FDA, Consumer Product Safety Commission and Department of Agriulture have joined together to provide a "one stop shop" for information on government ordered recalls.  You can go to the recall site by clicking here .

When a dangerous or hazardous product or tainted food causes a brain injury, remember to see the assistance of a brain injury lawyer without delay.  Remember, don't throw out the product or the food that was the cause of the injury as well as any instruction manuals and packaging material as well as your purchase receipt.

They just don't get it

If you are wondering if all the recent news about the dangers of concussions is sinking in, just look at what they are saying in Oklahoma.

Oklahoma receiver Manuel Johnson will not play Saturday against Baylor after being knocked out on a helmet-to-helmet hit in the Sooners' game against Texas Tech this weekend.

Johnson was hospitalized after the game Saturday but returned home on Sunday.

"He's all right. He looks normal. He got a concussion. A real bad concussion is what he had," said Malcolm Kelly, a fellow receiver and one of Johnson's roommates. "He came home yesterday, laughing and joking like there wasn't nothing wrong. He's cool."

You just can't allow these players to make the important return to play decisions!

I wonder if they are getting this misinformation from the NFL?

Read the full story by clicking here .

A memo to Coach Cowher and the NFL

The decision to allow Ben Roethlisberger to play this weekend is dangerous and ill founded.  If this was a parent, they would be prosecuted for child abuse. Egos, reputation and winning one for the gipper do not trump common sense.

It's not too late.  Protect Ben from further brain damage.  Protect our children who look at these player's as role models.

I am reproducing a memo from Arthur Pincus at FanNation to Coach Cohwer.

To: Coach Bill Cowher, Pittsburgh Steelers

From: Arthur Pincus, FanNation.com

This is more serious than we usually get in FanNation but we think this is too important for jokes. It's time for you to sit Ben Roethlisberger down and keep him out for the rest of the season. Put him in street clothes, give him a clipboard and give him time to recover from his two concussions in four months. There are no doctors here but we've paid enough attention to concussions in sports over the years to know that this is something that requires your full attention. If you don't win the Super Bowl again this season, you don't win it. You're 2-5 in case you hadn't noticed.

Bill, think of these names: Steve Young, Troy Aikman, Stan Humphries. They were all NFL quarterbacks, all Super Bowl QBs, who had their careers end prematurely because of repeated concussions. Bill, you remember this name: Al Toon, wide receiver New York Jets, college long jump champion; grace, speed and strength on the field. He retired early with the effects and the aftereffects of concussions. Here's the thing, when he retired, the Jets said he'd had five concussions, he believed it could have been as many as nine. Checking around the last few days, the number of Al Toon's concussions is now determined to be as high as 12.

Long after he retired Toon had this to say to The New York Times: "Typically I played the next week. It didn't feel like I was doing something detrimental in the long term. But it took less and less of a blow to create the same amount of impact."

Toon said that for four years after he retired he had trouble remembering information and focusing on events around him.

"It was kind of a dark and gloomy low point." 

Bill, Ben suffered a concussion when he took that ill-fated ride on his motorcycle last June. We all know he almost died from loss of blood, that he broke bones all over his face. But what stays with him is the concussion he suffered when he hit that windshield. Then in training camp he had to have his appendix removed and he was back starting a game 15 days later.

So Ben heals fast. So Ben has a high threshold for pain. So Ben can handle the discomfort that a concussion causes, at least it seems you and he think that is so. But ask some former athletes about their concussions. Ask some guys who had multiple concussions how easy it was to get the next one. You can spend 30 seconds on the Internet and get all the data you need.

Ben got the concussion against the Atlanta Falcons on October 22, four months and two weeks after his first one. We believe that should have ended his season right there. But he came back on October 29 against the Raiders. He's a pro, he's an athlete, he's tough, and he played horribly. It's enough, Bill.

Bill, read these words from hockey Hall of Famer Pat LaFontaine, whose career was ended by concussions. This is from his book "Companions in Courage."

"The one that changed my life happened in October 1996 when I was playing with the Buffalo Sabres...This concussion left me emotionally drained. My confidence, my courage, and my will to persevere diminished. At times I doubted that I would ever recover.

"Just a week later, I played against Montreal. I remember skating during the warmup and seeing stars and beams of little light particles and feeling tentative. I wasn't myself. I felt very strange and scared and wondered out loud to myself what I was doing out there.

"The doctors said I was fine and that I should be able to play. My body was obviously giving me small hints that something wasn't right; however, I was determined to make it right."

But Pat couldn't make it right and soon after he broke down in front of his teammates following a game against the Flyers. The next day, he went to practice and talked with his coach Ted Nolan.

"I looked at him for a long time, trying to compose myself, then I told him something was wrong and that I didn't have the enthusiasm and drive of a professional athlete and a captain. When I admitted how scared I felt...I totally lost it. He looked at me and told me that I needed help. What a sense of relief that simple observation gave me."

Pat sat out the rest of that season and returned with medical clearance the following year to play for the Rangers. But late in the season he suffered his final concussion when he bumped into a teammate at center ice and he never played again.

There's no way to know if the concussions Ben has suffered are as serious as those suffered by Aikman, Young, Humphries, Toon or LaFontaine. But Bill, please do for Ben Roethlisberger what Ted Nolan did for Pat LaFontaine. You're a decent and smart guy. Sit him down. Sit him down now.

President of New York State Brain Injury Association Calls upon NFL Commissioner to Stop the Carnage

New York, New York, November 4, 2006

MICHAEL V. KAPLEN, ESQ., the president of the Brain Injury Association of New York State, today called upon national football league commissioner, Roger Goodell to stop the carnage of permanent brain damage caused by misguided team return to play policies.

For the past week, Kaplen, a New York attorney who focuses his practice on representing victims of brain injury, and the president of the Brain Injury Association of New York State, has been calling upon the Congressional Brain Injury Task Force to conduct hearings regarding reports of fraudulent medical research sponsored by the NFL.  According to Kaplen, the misguided NFL return to play policies, supported by questionable medical research and poor judgment by team coaches exposes professional players to the consequences of lifelong brain damage.  It also has the more far-reaching effect of sending a dangerous and inaccurate message to high school and collegiate players about the serious and permanent health risks following a concussion.

Since issuing this call for Congressional action, Kaplen has been shocked by the league’s silence and indifference to this crisis. Ignoring a serious and detrimental issue will not make it disappear.   Kaplen is dismayed that the league continues its misguided policies by allowing Steelers’ quarterback Ben Roethlisberger to return to play again this Sunday despite the fact that he was obviously suffering from the aftereffects of numerous concussions and brain injury when he played last weekend against the Raiders.

“The Steelers exercised poor judgment last weekend in allowing their injured quarterback to return to play,” said Kaplen. “I can’t believe that they really think he threw four interceptions because he was having an off day.  It’s patently obvious to me that his poor performance was directly related to the lingering effects of a concussion”, Kaplen continued.   “To allow him to play again is outrageous” according to Kaplen.

“When a team can’t protect the health and safety of it’s players, the NFL commissioner must step in and make the call” said Kaplen.  “What are we teaching our high school and college players about the lifelong health risks of concussions when they continue to watch the misguided policies of the NFL” Kaplen questions.  “This will continue to affect their lives long after their sports careers are over”, he says. 

Concussions: It's more then an NFL Problem

Since calling for a congressional investigation of the way the NFL is dealing with concussions and their questionable research, I have received many messages from parents whose children have suffered disabling injury because of inappropriate return to play decisions as well as support from retired professional players who describe the culture of indifference of many professional teams.

If you want more proof on the extent of this public health crisis, just look at the story Arizona quarterback Will