Brain Injury Lawyers and Law, Brain Injury Rehabilitation, Coma Recovery
Why restricting care to brain injury victims makes no sense
This week, Professor Joseph Fins wrote an article advocating for the rights of brain injury victims. The article entitled, Why advances in treating those with brain injuries require advances in respecting their rights is a worthwhile read.
Some important comments that need repeating:
[A]fter gratitude for a life that has been saved, the truly difficult part begins. Patients and families face a slow-paced and often fickle recovery. Tragically, this phase is often made more challenging by the burden of poorly designed insurance coverage.
Families struggle to get their loved ones needed rehabilitation. If they do get rehabilitation, it is often too short to make a difference. Indeed, if patients are too slow to demonstrate improvement, services can be cut off because of stringent “medical necessity” admission criteria, often from third-party insurers.
This cutoff makes no sense. if we don’t know how long it takes the injured brain to heal, how do we know the pace is too slow? In the end, the vast majority are placed in a nursing home or institution, which is euphemistically called “custodial care.”
It's time that insurance companies provide the care to brain injury victims that they deserve. Anything less is a violation of their rights.
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The Crash Reel-An important message on the life long consequences of traumatic brain injury
I had the pleasure of viewing in preview, a new HBO documentary, The Crash Reel exploring the life and brain injury sustained by American snowboarding champion, Kevin Pearce which will debut on Monday, July
15th at 9 PM eastern time, 8 c on HBO.
As an advocate for persons with a brain injury, I appreciated the compassionate approach to the subject matter. The treatment of Kevin as a person with a brain injury, rather than a brain injured person is a very important message for members of the public. Kevin does not allow his brain injury to define who he is. He is an inspiration to anyone who has sustained a traumatic brain injury.
The stages of the film depicting Kevin’s journey are quite helpful to an understanding of the transitions that an individual and their family members go through following profound brain trauma.
This film will make a very important contribution to the understanding of traumatic brain injury in the minds of the public.
The filmmakers have launched a comprehensive traumatic brain injury awareness and outreach campaign called #LoveYourBrain and the Pearce family has started the Kevin Pearce Fund to support families and individuals
affected by traumatic brain injury and other challenges.
For more information on the documentary, visit their face book site.
Comments Sought for Development of Guideline on Disorders of Consciousness
The American Academy of Neurology (AAN) is currently seeking comments to be used in developing new guideline recommendations for the diagnosis, prognosis, and treatment of vegetative state and other disorders of consciousness. The deadline for submitting comments is October 5, 2012. For more information, click here.
Brain Injury Latest Medical News, Coma Recovery
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.
Brain Injury Broadcasts, Brain Injury Publications, Coma Recovery
Free webinar to examine recovery from severe traumatic brain injury resulting in coma and loss of consciousness
The Brain Trauma Foundation is presenting a free webinar on Assessment & Prognosis in Severe Traumatic Brain Injury on Wednesday, April 25, 2012, 12-1 Eastern Time. This webinar is open to all.
Survivors of severe traumatic brain injury face a wide range of possible prognoses, from nearly complete recovery to permanent unconsciousness. The ability to predict prognosis at an early point is limited, but the time until return of consciousness (e.g., command following) and orientation (e.g., duration of post-traumatic amnesia) are useful predictors in the early days and weeks. More specialized assessment techniques exist of those with persistent disorders of consciousness, and new assessment tools and promising treatment options are under development. This presentation will review the range of outcomes that are possible after severe TBI, suggest ways to improve prognostic prediction and treatment planning, and offer insight into emerging treatments.
By the end of this webinar the participant will be able to:
1. Describe the range of outcomes and prognosis that are possible following severe TBI.
2. Identify 2 approaches to the assessment of patients whose level of consciousness remains impaired.
3. Use time frame and prognostic information to guide treatment planning.
You can click here to register.
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EEG can provide important clues to determine if persons in a vegatative state have some cognitive awareness
Important research will aid in determining the cognitive functioning of individuals thought to be in a vegetative state. A simple technique using electroencephalography (EEG) may aid in detecting residual cognitive function and conscious awareness in patients otherwise apparently in a vegetative state, according to findings published on line in The Lancet.
Researchers report that responses on EEG showed signs of residual awareness in 3 of 16, or almost 20%, of patients otherwise meeting clinical definition of a vegetative state.
EEG’s can be performed at a patient’s bed side and the results will have profound implications for the rehabilitation of those previously thought to be in the vegetative state.
The results will also have important implications for brain injury attorneys who must prove some conscious awareness of the individual in order to obtain compensation for conscious pain and suffering and loss of the enjoyment of life.
Previous research has found several cases of patients in an apparently vegetative state nevertheless showed signs of brain activation on functional magnetic resonance imaging (fMRI). The scientists were able to show reliable differentiation of response on fMRI to questions that could be answered "yes" or "no" by asking the patients to imagine themselves either playing tennis or walking through their home — tasks the researchers knew would engage different parts of the brain.
Because fMRI scanning is expensive and the availability of this scanning technique is limited, the use of EEG studies is an important new development in assessing conscious awareness in these individuals. EEG’s are relatively inexpensive to perform and can be performed at the patient’s bedside.
It is important to note that the absence of positive EEG findings does not mean that the individual has no conscious awareness according to the study authors since three aware control individuals did not have positive EEG ‘s.
"Despite rigorous clinical assessment, many patients in the vegetative state are misdiagnosed," the authors conclude. This new EEG method "could allow the widespread use of this bedside technique for the rediagnosis of patients who behaviorally seem to be entirely vegetative, but who might have residual cognitive function and conscious awareness."
The study can be read online
The New York brain injury attorneys at De Caro & Kaplen, LLP have provided legal assistance to numerous individuals who have sustained severe traumatic brain injuries including those in coma’s, the vegetative state and those with minimal levels of consciousness.
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Individuals in a minimally conscious state are capable of dreaming
A new study in the August issue of Brain concludes that some patients do dream while in a minimally conscious state and are therefore likely to still have a form of consciousness about themselves and the external world. (The three stages of unconsciousness are coma, vegetative state and minimally conscious state.)
The researchers compared electrical brain activity using EEG’s in patients who were considered to be in a vegetative state and in an minimally conscious state.
Electrical activity differed little between sleep and wakefulness in patients in a vegetative state, but the sleep of patients in a minimally conscious state was similar to that of normal sleep in a healthy person, the investigators found.
During sleep, the patients in a minimally conscious state had changes in "slow wave" activity in the front of the brain considered important for learning and brain plasticity. They also had non-rapid eye movement, slow wave sleep and rapid eye movement, which is associated with dreaming.
The researchers concluded that that their results indicate that individuals in the minimally conscious state do have a form of consciousness about themselves as well as the outside world.
Brain Injury Latest Medical News, Coma Recovery
Should the Glasgow Coma Scale Be Abandoned ?
According to an editorial published yesterday in the Annals of Emergency Medicine, the Glasgow Coma Scale (GCS), which is used to assess the extent of brain injury in hospital emergency departments and at the scene of an accident is unreliable, hard to remember and too non-specific to be useful for emergency patients.
The scale provides point values to different levels of observed physical and cognitive functions which are assigned point values. A score of 3 is the worst score that can be obtained and a score of 15 is the best. Based upon this criteria, the patient is then placed in one of three categories, mild brain injury, moderate brain injury or severe brain injury.
The scale has been misused to predict long term prognosis and in particular, in the area of mild traumatic brain injury to conclude that a score of "15" translates into no brain injury or cognitive damage which is an unfair use of the grading system.
"The Glasgow Coma Scale (GCS) is obsolete within acute care medicine," said the editorial's author, Steven M. Green, MD, FACEP of Loma Linda University in Loma Linda, Calif. "The GCS should be abandoned in the emergency department and pre hospital settings altogether. There are other, better ways to assess trauma patients, such as SMS or TROLL, which stands for Test responsiveness: obeys, localizes or less."
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society.
New coma scale and new terminology for those previoulsy described as being in the "persistent vegetative state"
A new scale has been proposed to assess individuals in a coma which will better describe their condition during the 21st Meeting of the European Neurological Society.
The scale proposed by Professor Steven Laureys, MD, PhD, head of the the Coma Science Group in the Neurology Department at the University Hospital of Liege, Belgium is intended to replace the Glascow Coma Scale. The new scale called the Full Outline of Unresponsiveness (FOUR) score is reported to be superior in describing subtle signs of consciousness.
The scale according to its proponents has the advantage of being able to be performed in intubated patients who are on a respirator and can be used to identify nonverbal signs of consciousness by assessing visual pursuit.
The Euprean Task Force on Disorders of Consciousness also proposed new terminology to replace those presently described as being in a "persistent vegetative state". The present term has led to end of life and often times leads to neglect.
Instead, a new term entitled, "unresponsive wakefulness syndrome" has been proposed which will clinically describe what a clinician sees, but will not judge whether there is consciousness or not.
Additionally other new terms are the minimally responsive state which will be used to describe those patients who show lo level behavioral responses such as reaching to pain and being able to follow commands. The term functional locked in syndrome has been proposed to describe patients who show no behavioral response bt near normal brain activity measusred by imaging studies. These patients seem to be consciousn but are not able to use their bodies to communicate.
Brain Injury Latest Medical News, Coma Recovery
Comparing Coma and Anesthesia
A three year study examining similarities and differences between sleep, anesthesia and coma was published in last week’s New England Journal of Medicine Researchers found that general anesthesia is more like a reversible drug-induced coma that a deep sleep as it is often referred to by anesthesiologists. The results may lead to a better understanding of the comatose state and more effective anesthetic agents.
According to study author, Dr. Nicholas Schiff, an authority on coma recovery, "General anesthesia is pharmacological coma, not sleep." While doctors and patients commonly describe general anesthesia as going to sleep, there are significant differences between the states, with only a bit of overlap between the deepest states of sleep and the very lightest phases of anesthesia. The study authors also state that while sleeping usually involves moving through a series of phases, in general anesthesia, patients are typically taken to a specific phase or state and kept there during the surgery. This phase most closely resembles a coma.
Hopefully this work will also lead to better monitoring tools and diagnostics to assess what stage of recovery a person with a coma is in, and it could be used to develop new strategies to help doctors bring patients back to consciousness.