Brain Injury Lawyer - New York

Better Long Term Care Options Needed For Our Troops

A  compelling editorial in The Saratogian today supports the need for better long term brain injury rehabilitation care for our troops.

Here is what they have to say:

The veterans health care agencies are not equipped to deal with the number and severity of brain injuries suffered by American troops.  There is no easy, quick or cheap solution. But two U.S. senators, New York's Hillary Clinton and Indiana's Evan Bayh, have proposed what even they concede would be only a temporary solution to the problem. Their legislation would let soldiers with traumatic brain injury extend their active duty status for a year after suffering the injury, rather than being retired for medical reasons.

This option would not send the brain-injured troops back into combat, but it would make them eligible for the best available medical care, as reported in the Marine Corps Times, "from the Defense Department and from specialized private care centers, which would be better than care from the Department of Veterans Affairs."
As Sen. Clinton said, "When you serve your country, your country should serve you."
We have to agree with the senators that a temporary fix is better than none with the well-being of troops is at stake.

Hopefully all troops whether on active duty status or receiving veteran's benefits will be able to access the best possible long term brain injury rehabilitation.  As I have said on multiple occasions, it just doesn't make sense for the VA to be trying to reinvent the wheel.  Their are many brain injury rehabilitation facilities throughout the country that are presently equipped to provide the best possible care to these soldiers.  Why the VA doesn't utilize these services is a real mystery to me.

Digital Brain Atlas

If you interested in an interactive digital brain atlas, then the images at brainmaps might be for you. The site contains thousands of microscopic brain images including 3 D slides of the brain.  It includes both animal and human brains and the site authors say it is the largest site of this kind.  Thanks to the Dan Gordon at the Dana's Foundation's Brain in the News for providing a heads up on this site.

NFL To Do Preseason Concussion Evaluation on Players

The New York Times reports that the NFL hopes to conduct pre-training camp neurological tests on players to determine susceptibility to concussions.  I am not sure exactly what testing the league has in mind but I hope that it is a baseline evaluation of EACH AND EVERY PLAYER so that once a concussion or a suspected concussion takes place, the player can be retested to see how soon they return to baseline.  This is the only way that informed return to play decisions can be made.

As reported in the Times story, "Commissioner Roger Goodell said Thursday during a meeting with sports editors that the league's medical committee has been working on a way to implement mandatory tests, perhaps as early as this summer when training camps open. That comes after a session at March's league meetings in Arizona in which officials and coaches agreed that head injuries need the closest monitoring."

Read the full Times article by clicking here .

Even after 19 years in a coma, brain still capable of rewiring itself

Cornell University researchers have documented an Arkansas man's brain that rebuilt nerve pathways after 19 years in a coma-like state in an article published in the Journal of Clinical Investigation.

In 2003, Terry Wallis emerged from a minimally conscious state at the age of 39 and said the word "Mom." He had been injured in a pickup truck that fell 25 feet and landed on its roof.

Using PET scans and an imaging technique called diffusion tensor imaging, researchers from Cornell University's Weill Medical College examined Wallis' brain after he regained full consciousness.  They found cells in relatively undamaged areas had formed new axons, the long nerve fibers that transmit messages between neurons.  Wallis has regained the ability to form sentences and has recovered some use of his limbs, but still can't walk or feed himself.

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.

Major League Soccer Takes Important Step To Deal With Concussions

Players colliding with each other or running into posts are a major cause of injury in soccer.  Many of these injuries are concussion related with potential serious and lifelong consequences. 

I was pleased to see that Major League Soccer (MLS) have announced a strategic partnership to launch a formal Concussion Management Program that will promote testing, education, awareness, and state-of-the-art standards of care to each of MLS’ 13 teams with the concussion professionals at ImPACT.

The ImPACT™ Concussion Management Program is a computerized series of neurocognitive tests that help medical staffs determine the severity of concussions and when it is safe for injured athletes to return to play.  The ImPACT program, the world’s most widely used computerized sports concussion evaluation system, has been adopted by team doctors and athletic trainers for numerous top sports leagues in the world, including the National Football League, Major League Baseball, and the NCAA.

Here is some information from the ImPACT press release:

"Concussion is any change in mental status caused by a sudden violent rocking back and forth of the brain inside of the skull due to a blow to the head or upper body.  Symptoms can include headache, amnesia, dizziness, confusion, lack of hand-eye coordination, and in some cases, loss of consciousness.  Generally, an athlete can safely recover from an initial concussion as long as the brain has had time to heal.  If a second concussion occurs prior to full recovery from the first, an athlete may experience long-term symptoms in the form of chronic headaches, sleep difficulties, personality changes or memory problems.  In rare cases, a second concussion may even result in death from ‘second impact syndrome.’"

“This type of innovative tool is extremely beneficial to MLS athletes and can help us to objectively determine when full recovery from concussion has occurred,” said Larry Lemak, M.D., medical director of Major League Soccer.  “By using ImPACT, a concussion can be more accurately diagnosed, and based on objective data a proper return time can be determined to reduce the risk of a secondary concussion.”

"ImPACT evaluates and documents multiple aspects of brain functions, including memory, processing speed, reaction time and post-concussive symptoms.  Through a 20-minute test, baseline data on an athlete’s neurocognitive functional state is collected and stored.  When a concussion is suspected during the season, the athlete is re-tested and the baseline neuropsychological data is compared to post-concussion data to help determine the athlete’s post-concussion neurocognitive status, as well as when it is safe for the player to return to play."

Brain Injury Caregiver Workshops

Two workshops have been announced for the family members of brain injury survivors sponsored by the Brain Injury Association of New York State

Caregiving is a Family Matter. Caregivers often experience such feelings as sadness, anger, and frustration. Join other caregivers in the community and learn how to satisfy your own needs while fulfilling the needs of your loved one. Your experiences are valuable.

Albany Area Workshop
Date: Thursday, May 3 from 7 to 9 pm
Facilitators: Judy Sandman, Kristin Lansley, and Karen Thomas of the Brain Injury Association of NYS.
Guest speaker: Maria Deinzer Lifrak, PhD, ABPP-CN, Clinical Neuropsychologist
Location: William K. Sanford Colonie Town Library, 629 Albany-Shaker Road, Loudonville, NY
RSVP by May 1 by calling 800-228-8201
PLEASE NOTE: This meeting is for caregivers only. If the survivor must accompany you, they may attend a separate survivor meeting to be held in another room.

Westchester County Area Workshop
Date: Thursday, May 17 from 7 to 9 pm
Facilitators: Judy Sandman, Director of Membership, Brain Injury Association of NYS, and Jay Dunkle, PhD, Neuropsychological Services of Westchester
Location: Burke Rehabilitation Hospital, 785 Mamaroneck Avenue, White Plains, NY
RSVP by May 14 by calling 800-228-8201
PLEASE NOTE: This meeting is for caregivers only. If the survivor must accompany you, they may attend a separate survivor meeting to be held in another room.

Click here for further information from the Brain Injury Association.

Dementia Linked to Repeated Concussions

The tragic deaths of NFL football players, Mike Webster, Andre Waters and Terry Long have provoked considerable interest in the association between repetitive brain injury and dementia.

In a meeting held last Friday at the National Summit on Concussions, Dr. Bennett Omalu, the neuropathologist who linked Mike Webster's suicide to his repeated concussions gave this condition a new name, Neurofibrillary Football Linked Dementia or NFL Dementia for short. 

The term was apparently first used by Chris Nowinski, who authored Head Games, a book on concussions in the NFL, and who initiated the investigation into the death of Andre Waters.  This is an excellent book which I recommend to all those interested in the subject of concussions, especially the dangers faced to athletes in all types of sports.

"We saw different clinical manifestations of the disease than we would expect to see, for example, in boxers with what we call dementia pugilistica," said Nowinski. "That evidence, combined with the [brain] tissue evidence, combined with known unique biomechanical forces of football have lead us to propose that this may be a different subtype of chronic encephalopathy."

The NFL in the past has taken the position that there is no link between dementia and repeated concussions. 

"This case series constitutes indisputable scientific evidence of the link between repeated concussions in football and dementia and major depression," said Dr. Omalu. "Given the prevailing scenarios in these cases of abnormal proteins in such young athletes it cannot be caused by anything else but repeated concussions."

You can read the full story about this conference which was reported in Sports Illustrated on line.

Outcome Following Severe Brain Injury in Early Infancy

A new study has been published which looks at the  causes and prognostic factors for outcome in severe traumatic brain injuries (TBI) in early infancy.  The authors looked at children less than 12 months of age who suffered from severe brain injury. The authors compared outcomes at the time of discharge and one year later.

The study concluded that the main causes of trauma were domestic accidents followed by car accidents. The highest positive correlation was found between the Glasgow Coma Scale (GOS) score at 1 year and the presence of hypoxia and hypotension at admission, the presence of hyperglycaemia at 24 h and the occurrence of major clotting disorders. A significant but weaker correlation was found with the Children's Coma Scale (CCS) at admission, the occurrence of early post-traumatic seizures and the length of stay in the intensive care unit.

The study is published in Childs Nerv System, March 2007.

Protecting Brains of Premature Infants

Magnesium sulfate given before very preterm birth may protect infants against brain injury without harming the mother, according to a report in the March issue of the British Journal of Obstetrics and Gynecology.

Several reports have suggested that prenatal administration of magnesium sulfate for tocolysis or preeclampsia is associated with lower neonatal mortality and lower risk of cerebral palsy in very-low-birth-weight children, the authors explain.

Obtain more information on the study by clicking here.