Brain Injury Lawyer - New York

Dept of Defense opens new brain injury center

The United States Defense Department has opened the  $65 million National Intreprid Center of Excellence at the National Naval Medical Center in Bethesda Maryland to address the psychological and neurological damage caused by traumatic brain damage in wounded soldiers.

Neurologist Thomas DeGraba, the center's chief of medical operations, said family care is central to the facility's holistic approach to healing. The Fisher House Foundation, established by Arnold Fisher's family, is building a 21-room residence next door for the exclusive use of families with patients at the center.

DeGraba said the cost of running the center is estimated at $31 million a year. He said it will serve as a hub for all the military's traumatic brain injury and  post traumatic stress disorder (PTSD) care. Treatments developed at the center will be shared with other military and VA facilities, he said.

Deputy Defense Secretary William Lynn said studies indicate that more than 10 percent of returning troops have suffered concussions and at least 12 percent have exhibited symptoms of combat stress, depression or other mental problems that can mimic brain injuries.

DeGraba said one of the center's goals is to better distinguish the source of such symptoms and treat them accordingly.

Concussions again found to cause permanent brain damage

The evidence continues to mount concerning the permanent brain damage that takes place as a result of concussions.

Yesterday, Neurosurgeon Julian Bailes and California medical examiner Bennet Omalu, co-directors of the Brain Injury Research Institute at WVU, publicly announced their findings concerning the brain of Cincinnati Begals receiver Chris Henry who passed away in December after falling off the back of a truck.

The physicians who have been looking at pathological changes in the brains of deceased athletes found that Henry suffered from a chronic brain injury that may have influenced his mental state and behavior before he died last winter.

The doctors had done a microscopic tissue analysis of Henry's brain that showed he suffered from chronic traumatic encephalopathy. This condition is caused by repeated head injury and resembles Alzheimer’s disease.

Bailes and fellow researchers believe chronic traumatic encephalopathy, or CTE, is caused by multiple head impacts, regardless of whether those blows result in a concussion diagnosis. A number of studies, including one commissioned by the NFL, have found that retired professional football players may have a higher rate than normal of Alzheimer's disease and other memory problems.

What's interesting, Bailes said, is that Henry was only 26, and neither NFL nor WVU records show he was diagnosed with a concussion during his playing career.

CTE carries specific neurobehavioral symptoms, Bailies said — typically, failure at personal and business relationships, use of drugs and alcohol, depression and suicide.

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

BrainLaw launches brain injury video blog

I am pleased to announce the launching of the BrainLaw video blog.

BrainLaw is the web site for the Brain Injury Law Firm® devoted to providing quality legal representation to victims of traumatic brain injury and their families. 

The first four videos discuss:

The brain injury law firm of DeCaro & Kaplen, LLP ®

Suggestions on selecting a brain injury attorney

A discussion on the various definitions of concussion

Using medical imaging to prove traumatic brain injury in court

 

Important safety information about baby walkers

Baby Walkers Recalled by Suntech Enterprises Due to Fall Hazard

The U.S. Consumer Product Safety Commission, in cooperation with the firm named below, today announced a voluntary recall of the following consumer product. Consumers should stop using recalled products immediately unless otherwise instructed. It is illegal to resell or attempt to resell a recalled consumer product.

Name of Product: Baby Walkers

Units: About 8,400

Importer: Suntech Enterprises Inc., of Commerce, Calif.

Hazard: The recalled walkers can fit through a standard doorway and fail to have sufficient stair-fall protection to prevent falls down stairs. Babies using these walkers can be seriously injured or killed if they fall down stairs.

Incidents/Injuries: None reported.

Description: The baby walkers have a plastic frame supported by four wheels and eight brake pads. The walkers were sold in blue, pink, and green with a white activity tray and patterned, vinyl seat. Item number WK110 or WK112 is printed on the side of the packaging.

Sold at: Small juvenile product stores in California, Illinois, New York and Texas from January 2007 through December 2009 for between $25 and $30.

Manufactured in: China

Remedy: Consumers should immediately stop using the walkers and return them to the store where purchased for a full refund.

Consumer Contact: For additional information, contact Suntech Enterprises toll-free at (888) 268-8139 between 9 a.m. and 5 p.m. PT Monday through Friday.

Note: This recall is being conducted voluntarily, however, in May 2010, CPSC issued a new mandatory rule on baby walkers that is effective on December 21, 2010. The walkers will be required to either: 1) be too wide to fit through a standard doorway, or 2) have features, such as a gripping mechanism, to stop the walker at the edge of a step.

Management of Intracranial Pressure

One of the most interesting aspects of writing this brain injury news and information blog is the information that I receive from assorted sources. 

Today, I received a press release from a pharmaceutical company, InnerSpace, Inc. announcing the marketing of a new device to monitor intracranial cerebral pressure ffor the management of traumatic brain injury. The monitoring system is called Hummingbird Synergy.

According to the press release, Hummingbird Synergy is designed to provide integrated access for concurrent monitoring of Intracranial Pressure (ICP), Oxygen, or Cerebral Blood Flow while providing ventricular drainage. It does so through a single burr-hole vs. the two or three holes now required. The design minimizes the potential for complications and infections, thereby reducing patient risk. Dedicated access ports allow an Oxygen or Cerebral Blood Flow probe to be precisely and reproducibly placed.

The monitoring of intracranial pressure is crucial for better outcomes according to the Brain Trauma Foundation which has been a leading advocate for advances in ICP management. The Brain Trauma Foundation has established guidelines for the monitoring of intracranial pressure.

You can read more about this new system by clicking here.

Federal Traumatic Brain Injury Update

The following legislative update was prepared by the Brain Injury Association of America (BIAA):

Federal TBI Program Update

On June 15, 2010, BIAA and other TBI stakeholders met with Mary Wakefield, the Administrator of Health and Human Service’s (HHS) Health Resources and Services Administration (HRSA) to discuss the future of the federal TBI program, one of the programs funded through the TBI Act. The federal TBI program provides grants to states to improve access to care for people with brain injury. 

The meeting was very positive and both the TBI stakeholders and HRSA are committed to working together to bring the attention needed to the program in order to grow the program and receive more funding for the TBI population in each state. HRSA has committed to working with stakeholders going forward to craft a strategic plan for the program and solicit public comment from appropriate entities such as BIAA state affiliates and state lead agencies in order to ensure that elevation of the program is successful.

BIAA is encouraged by the partnership forged between TBI stakeholders and HRSA and will continue to pass on important information as efforts progress.

New York Office of Mental Retardation and Developmental Disabilities to get needed name change

The New York State legislature has passed legislation officially changing the name of the state agency responsible for providing services to individuals suffering from developmental disabilities from the Office of Mental Retardation and Developmental Disabilities (OMRDD) to the New York State Office For People With Developmental Disabilities (OPWDD)

This vital legislation not only removes the words “Mental Retardation” from the name of the State agency, but also from State statute and regulations, excluding clinical references.

This change will finally remove the stigma of “mental retardation” from both the agency name and individuals that the agency serves.  The legislation now awaits the signature of Governor Patterson for it to become law.
 

Hospital delirium

Hospital delirium, a condition associated with hospitalizations in the elderly is an increasingly common occurrence according to a fascinating story in today’s New York Times, Hallucinations in Hospital Pose Risk to the Elderly.
 
According to the article, hospital delirium affects about one-third of patients over 70, and a greater percentage of intensive-care or postsurgical patients citing the, the American Geriatrics Society.

The cause of delirium is unclear, but there are many apparent triggers: infections, surgery, pneumonia, and procedures like catheter insertions, all of which can spur anxiety in frail, vulnerable patients. Some medications, difficult for older people to metabolize, seem associated with delirium.

Even short episodes can hinder recovery from patients’ initial conditions, extending hospitalizations, delaying scheduled procedures like surgery, requiring more time and attention from staff members and escalating health care costs. Afterward, patients are more often placed, whether temporarily or permanently, in nursing homes or rehabilitation centers. Older delirium sufferers are more likely to develop dementia later.

Other triggers involve disorienting changes: sleep interrupted for tests, isolation, changing rooms, being without eyeglasses or dentures. Medication triggers can include some antihistamines, sleeping pills, antidepressants and drugs for nausea and ulcers.

Frequently, geriatricians say, delirium is misdiagnosed, or described on patient charts as agitation, confusion or inappropriate behavior, so subsequent doctors might not realize the problem. One study found “delirium” used in only 7 percent of cases; “confusion” was most common. Another study of delirious older emergency-room patients found that the condition was missed in three-quarters of them.

People with dementia seem at greater risk for delirium, but many delirious patients have no dementia. For some of them, delirium increases the risk of later dementia. In such cases, it is unclear if delirium caused the dementia, or was simply a signal that the person would develop it later.

Some hospitals are adopting delirium-prevention programs, which adjusts schedules, light and noise to help patients sleep, ensures that patients have their eyeglasses and hearing aids, and has them walk, exercise and do cognitive activities like word games.

New outcomes reported for patients in the minimallly conscious state and those in the persistent vegetative state

Results of 2 new studies provide valuable new information on the prognosis of minimally conscious (MCS) and vegetative states (VS).

The reports will appear in the July 20th issue of the Journal Neurology.

A retrospective study was utilized to examine long-term outcomes of MCS and VS patients up to 5 years after injury and found that in contrast to the VS patients, one third of MCS patients improved more than a year after coma onset.

"This emphasizes the need to define reliable boundaries between VS and MCS using repeated clinical evaluations, and all imaging and neurophysiologic tools available today," the authors conclude.

Vegetative state of wakefulness without awareness was first described in 1972 by Jennett and Plum  The minimally conscious state (MCS), formerly and more accurately called the minimally responsive state, was defined diagnostically in 2002 as profound unresponsiveness despite nominal and intermittent evidence of awareness.

In cases of individuals in the vegetative state following a  traumatic brain injury, the authors report that although the outcome for recovery is poor, the chances are better for this group of patients as compared to those who are in this state from other causes.

The unexpectedly high rates of recovery of responsiveness and consciousness, albeit with severe impairments, may have important ethical implications, the study authors conclude.

The present follow-up study demonstrates the necessity of long-term monitoring for patients with chronic disorders of consciousness and of new research on specific interventions in the hope of promoting recovery from VS or MCS, according to the authors.  "Multicenter, prospective studies on large cohorts of patients are needed to answer the questions about the evolution, management, and care of long-lasting VS and MCS renewed by the present study."

New guidelines for determining brain death issued by American Academy of Neurology

The American Academy of Neurology has released new guidelines for determining brain death in adults. Updated for the first time in 15 years, the recommendations provide step-by-step instructions to help guide clinical decision making.

"The brain death diagnosis can be made only after a comprehensive clinical evaluation and often involves more than 25 separate assessments," lead author Eelco Wijdicks, MD, from the Mayo Clinic in Rochester, Minnesota, said in a news release.

The guidelines are published in the June 8 issue of Neurology.

The authors report that new data have confirmed the effectiveness of earlier recommendations. They saw no evidence of recovery of neurologic function after a diagnosis of brain death using the criteria from the 1995 practice parameter.

The authors report insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. They say this will be highly variable patient to patient, and there is no general rule.

These new guidelines focus on patients 18 years and older. Another group is currently working on new brain death recommendations for children. Those recommendations are expected to be released in a couple of months. Some predict those guidelines will include a prescribed observation period.

The American Academy of Neurology will be hosting an online conference about the new guidelines Monday, June 21. The authors will present at the session and take questions. The registration deadline for continuing medical education credit is June 16. Clinicians wanting to participate will need a computer with Microsoft Office Powerpoint and a telephone. For more information and to access the audio conference, visit the academy's Web site.