Veterans of the wars in Iraq and Afghanistan, whose claims for benefits based on post-traumatic stress disorder (PTSD) were rejected, will have another chance to get relief. For the full story, see http://www.military.com/news/article/vets-with-ptsd-may-get-benefits-upgrade.html
The military has agreed to do an expedited review of the claims due to a judge’s order, which stemmed from a class-action lawsuit filed by seven combat veterans who were discharged for PTSD. Those vets claim they were illegally denied health care and other benefits that they were entitled to with their disability.
One of the original plaintiffs was ex-Army Sgt. Juan Perez, who suffers from PTSD and has problems with migraines and his eye resulting from a head injury he sustained during two tours in Iraq.
The Pentagon mandates that soldiers who leave the military due at least in part to PTSD must receive a disability rating of at least 50 percent to get full benefits, according to the National Veteran Legal Services Group.
But roughly 4,300 former soldiers earned ratings of less than 50 percent, so they were denied benefits. Those veterans will soon receive legal notice that they will be able to have an expedited review of their cases by the military, and that they can “opt in” to a class action lawsuit involving the matter.
The seven ex-soldiers who started the class action suit had disability ratings of 10 percent or less.
After the new review, former soldiers who get ratings of 30 percent or more will become eligible for benefits, according to The New York Times. http://www.nytimes.com/2010/01/26/us/26brfs-BENEFITSELIG_BRF.html
Those applications can be found at ptsdlawsuit.com.
Lawyers for the veterans expect that the reviews will result in ex-soldiers getting millions of dollars.
http://www.wsmv.com/news/22338751/detail.html
The higher disability rating will translate to lifelong monthly disability payments, and free health care for the veteran, his or her spouse and their minor children.
Why Doctors Shouldn’t Be Too Quick To Diagnose a Child With a Concussion Rather than Mild Traumatic Brain Injury
I have been fighting the labels and the distinctions about what you call the subtle damage to the mind as long as I have been an advocate. See my essay “Mind Damage” at http://tbilaw.com/essays.aaname.php Yet, according to new research, the labels make a huge difference in the perception of the severity of the injury.
According to this research, doctors apparently have to choose their words carefully when they’re talking to parents about their children’s head injuries. The study was published online this week by Pediatrics, the journal for the American Academy of Pediatrics. The study received a lot of play in the consumer press, with outlets such as The Los Angeles Times and UPI writing about it. See http://latimesblogs.latimes.com/booster_shots/2010/01/you-say-concussion-i-say-brain-injury-lets-call-the-whole-thing-serious.html
The bottom line of the research was that when a physician uses the term “concussion” rather than “mild traumatic brain injury,” parents don’t seem to believe that their child’s brain has really been damaged.
The Pediatrics article was headlined “My Child Doesn’t Have a Brain Injury, He Only Has a Concussion.” http://pediatrics.aappublications.org/cgi/content/abstract/peds.2008-2720v1
The research, conducted at McMaster Children’s Hospital in Canada by McMaster University, noted that doctors may choose to use “the concussion label” because it’s less alarming than the term mild brain injury. But the word “concussion” seems to imply to the parents that the injury is not serious and will have no long-term consequences for their child, the study found. Yet it’s known that’s not the case.
“Our study suggests that if a child is given a diagnosis of a concussion, the family is less likely to consider it an actual injury to the brain,” the study’s lead author, Carol DeMatteo, said in a press release on the research. “These children may be sent back to school or allowed to return to activity sooner, and maybe sooner than they should. This just puts them at greater risk for a second injury, poor school performance, and wondering what is wrong with them.”
Children diagnosed with a concussion were released earlier from the hospital, and returned to school quicker, according to the study. Yet it’s known that concussions can have serious after effects, including depression, memory issues and headaches. And returning to former activities, such as sports, before the brain damage of a concussion has healed can lead to dire health problems.
The concussion diagnosis was “significantly more likely” when the computed-tomography results were normal and the child had lost consciousness, according to the study.
The takeaway has to be that physicians should not be too quick to label a child as having a concussion, even if it is a less worrisome term than mile TBI.
According to this research, doctors apparently have to choose their words carefully when they’re talking to parents about their children’s head injuries. The study was published online this week by Pediatrics, the journal for the American Academy of Pediatrics. The study received a lot of play in the consumer press, with outlets such as The Los Angeles Times and UPI writing about it. See http://latimesblogs.latimes.com/booster_shots/2010/01/you-say-concussion-i-say-brain-injury-lets-call-the-whole-thing-serious.html
The bottom line of the research was that when a physician uses the term “concussion” rather than “mild traumatic brain injury,” parents don’t seem to believe that their child’s brain has really been damaged.
The Pediatrics article was headlined “My Child Doesn’t Have a Brain Injury, He Only Has a Concussion.” http://pediatrics.aappublications.org/cgi/content/abstract/peds.2008-2720v1
The research, conducted at McMaster Children’s Hospital in Canada by McMaster University, noted that doctors may choose to use “the concussion label” because it’s less alarming than the term mild brain injury. But the word “concussion” seems to imply to the parents that the injury is not serious and will have no long-term consequences for their child, the study found. Yet it’s known that’s not the case.
“Our study suggests that if a child is given a diagnosis of a concussion, the family is less likely to consider it an actual injury to the brain,” the study’s lead author, Carol DeMatteo, said in a press release on the research. “These children may be sent back to school or allowed to return to activity sooner, and maybe sooner than they should. This just puts them at greater risk for a second injury, poor school performance, and wondering what is wrong with them.”
Children diagnosed with a concussion were released earlier from the hospital, and returned to school quicker, according to the study. Yet it’s known that concussions can have serious after effects, including depression, memory issues and headaches. And returning to former activities, such as sports, before the brain damage of a concussion has healed can lead to dire health problems.
The concussion diagnosis was “significantly more likely” when the computed-tomography results were normal and the child had lost consciousness, according to the study.
The takeaway has to be that physicians should not be too quick to label a child as having a concussion, even if it is a less worrisome term than mile TBI.
University of Cincinnati Study to Test Progesterone Effectiveness in Severely Brain Injured Individuals
Editors Note: The greatest advancements in the treatment of brain injury have been in the area of increasing the number of people who survive the severest injuries. Helicopters, CT scans and ICP monitors account for the biggest chunk of that improvement. The press release below from the University of Cincinnati details a new study that is being proposed for 100 severely brain injured people to see what benefit administration of the hormone progesterone will have on outcomes.
Such research is extremely important and the double blind method is critical for research to have any scientific validity. My only concern with this study is that we don’t know how progesterone is supposed to help. If the projected improvement rate is 5%, that may be a lot of effort for what may not be a statistically significant result. But that is what scientific research is there to determine. And if you were one of the 5% who got better that would be significant to you and your family.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
https://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2010
(Media-Newswire.com) – CINCINNATI–Neurotrauma experts at the University of Cincinnati Neuroscience Institute at University Hospital are seeking public input before launching federally funded research aimed at improving outcomes for patients who suffer traumatic brain injury ( TBI ).
The randomized clinical trial will assess whether administering the naturally occurring hormone progesterone in patients immediately after a moderate to severe traumatic brain injury will reduce brain damage and swelling and thereby improve the patients’ mental and physical outcomes.
The Cincinnati portion of the study will be led by Jay Johannigman, MD, associate professor and director of the division of trauma and critical care, and Lori Shutter, MD, associate professor of neurosurgery and neurology and director of the neurocritical care program.
“The nation is becoming increasingly aware of the devastation that traumatic brain injury can have on a person’s life,” Shutter says. “Unfortunately, although there have been many efforts, we still do not have an effective treatment for a traumatic injury to the brain. The early information on progesterone for treatment of TBI renews our hopes that we may have something that can improve long-term outcomes.”
The progesterone study, funded by the National Institute of Neurological Disorders and Stroke, is known as ProTECT III, which stands for Progesterone for Traumatic Brain Injury–Experimental Clinical Treatment. The $14.5 million trial will enroll 1,140 patients over a period of three years at 17 medical centers throughout the United States. David Wright, MD, assistant professor of emergency medicine at Emory University in Atlanta, is the multicenter study’s lead investigator.
Public comment is required before the ProTECT study begins because a patient who has suffered a brain injury is unconscious and would not be able to give consent before doctors administer the treatment. In addition, a relative or guardian may not be immediately available to grant consent on the patient’s behalf.
Traumatic brain injury involves sudden damage to the brain caused by an outside force to the head, such as a car crash, a fall or a forceful blow from a heavy object. Roughly 1.5 million to 2 million adults and children suffer a traumatic brain injury in the United States each year. About 50,000 die and another 80,000 are permanently disabled, according to the Centers for Disease Control and Prevention. Traumatic brain injury is the leading cause of death and disability among people aged 1 to 44.
ProTECT III is the third phase of groundbreaking research into the effectiveness of progesterone, which is most commonly recognized as a female hormone but also has “protective” properties. Progesterone receptors are abundant in the brain, and laboratory research suggests that progesterone plays a role in the development of brain cells and in the protection of injured brain tissue.
Emory researchers concluded in an earlier pilot study involving 100 patients that giving progesterone to trauma victims shortly after a brain injury appeared to be safe and effective. Emory researchers also reported a 5 percent reduction in mortality among patients treated with progesterone as well as improved outcomes among patients with moderate injury.
Progesterone is an attractive therapy for several reasons, Shutter says. “It is FDA-approved; it can be administered quickly; it enters the brain quickly; and it is inexpensive.”
The current study, ProTECT III, involves patients aged 18 and over who have suffered a moderate to severe traumatic brain injury and who can begin treatment within four hours of their injury. A qualifying patient will be randomly assigned to one of two groups. One group will receive an IV mixture that contains progesterone ( the study medicine ). The other group will receive an IV mixture that has no progesterone ( a placebo ). The UC team expects to enroll approximately 100 patients over the three-year period at University Hospital.
Federal law established the “waiver of consent” in 1996 so that physicians could begin emergency treatment after any injury before obtaining consent from the patient or from a legal guardian or family member. Under terms of the ProTECT study, if a hospital is unable to reach a family member after 60 minutes of diligent effort, the emergency medicine team is allowed to enroll patients who meet the study’s stringent criteria.
To qualify for the waiver, researchers must first explain the research to the community and gather feedback. UC researchers will discuss the ProTECT trial at community meetings during the next several months, with particular emphasis on demographic groups known to have a statistically elevated risk of severe traumatic brain injury. In addition, UC researchers must assess local residents’ willingness for themselves or a family member to participate in this study. A complete description of the study can be reviewed at www.protectiii.com.
Those who review the study description will be invited to complete a short accompanying survey.
ProTECT III is a project of the Neurological Emergencies Treatment Trials ( NETT ), which was established by NIH in early 2007. NETT is a permanent research network that currently involves 17 university medical centers throughout the United States. UC’s involvement in NETT is overseen by Arthur Pancioli, MD, associate professor of emergency medicine and a member of UCNI.
Individuals who are opposed to being enrolled in a NETT study in the event that they were to suffer a neurological emergency can request an “opt out” bracelet by calling ( 513 ) 558-NETT ( 0095 ).
For more information about ProTECT, please contact Sara Stark at ( 513 ) 558-0095 or sara.stark@uc.edu. For more information about NETT, please visit http://nett.umich.edu/nett/welcome.
Such research is extremely important and the double blind method is critical for research to have any scientific validity. My only concern with this study is that we don’t know how progesterone is supposed to help. If the projected improvement rate is 5%, that may be a lot of effort for what may not be a statistically significant result. But that is what scientific research is there to determine. And if you were one of the 5% who got better that would be significant to you and your family.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
https://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2010
(Media-Newswire.com) – CINCINNATI–Neurotrauma experts at the University of Cincinnati Neuroscience Institute at University Hospital are seeking public input before launching federally funded research aimed at improving outcomes for patients who suffer traumatic brain injury ( TBI ).
The randomized clinical trial will assess whether administering the naturally occurring hormone progesterone in patients immediately after a moderate to severe traumatic brain injury will reduce brain damage and swelling and thereby improve the patients’ mental and physical outcomes.
The Cincinnati portion of the study will be led by Jay Johannigman, MD, associate professor and director of the division of trauma and critical care, and Lori Shutter, MD, associate professor of neurosurgery and neurology and director of the neurocritical care program.
“The nation is becoming increasingly aware of the devastation that traumatic brain injury can have on a person’s life,” Shutter says. “Unfortunately, although there have been many efforts, we still do not have an effective treatment for a traumatic injury to the brain. The early information on progesterone for treatment of TBI renews our hopes that we may have something that can improve long-term outcomes.”
The progesterone study, funded by the National Institute of Neurological Disorders and Stroke, is known as ProTECT III, which stands for Progesterone for Traumatic Brain Injury–Experimental Clinical Treatment. The $14.5 million trial will enroll 1,140 patients over a period of three years at 17 medical centers throughout the United States. David Wright, MD, assistant professor of emergency medicine at Emory University in Atlanta, is the multicenter study’s lead investigator.
Public comment is required before the ProTECT study begins because a patient who has suffered a brain injury is unconscious and would not be able to give consent before doctors administer the treatment. In addition, a relative or guardian may not be immediately available to grant consent on the patient’s behalf.
Traumatic brain injury involves sudden damage to the brain caused by an outside force to the head, such as a car crash, a fall or a forceful blow from a heavy object. Roughly 1.5 million to 2 million adults and children suffer a traumatic brain injury in the United States each year. About 50,000 die and another 80,000 are permanently disabled, according to the Centers for Disease Control and Prevention. Traumatic brain injury is the leading cause of death and disability among people aged 1 to 44.
ProTECT III is the third phase of groundbreaking research into the effectiveness of progesterone, which is most commonly recognized as a female hormone but also has “protective” properties. Progesterone receptors are abundant in the brain, and laboratory research suggests that progesterone plays a role in the development of brain cells and in the protection of injured brain tissue.
Emory researchers concluded in an earlier pilot study involving 100 patients that giving progesterone to trauma victims shortly after a brain injury appeared to be safe and effective. Emory researchers also reported a 5 percent reduction in mortality among patients treated with progesterone as well as improved outcomes among patients with moderate injury.
Progesterone is an attractive therapy for several reasons, Shutter says. “It is FDA-approved; it can be administered quickly; it enters the brain quickly; and it is inexpensive.”
The current study, ProTECT III, involves patients aged 18 and over who have suffered a moderate to severe traumatic brain injury and who can begin treatment within four hours of their injury. A qualifying patient will be randomly assigned to one of two groups. One group will receive an IV mixture that contains progesterone ( the study medicine ). The other group will receive an IV mixture that has no progesterone ( a placebo ). The UC team expects to enroll approximately 100 patients over the three-year period at University Hospital.
Federal law established the “waiver of consent” in 1996 so that physicians could begin emergency treatment after any injury before obtaining consent from the patient or from a legal guardian or family member. Under terms of the ProTECT study, if a hospital is unable to reach a family member after 60 minutes of diligent effort, the emergency medicine team is allowed to enroll patients who meet the study’s stringent criteria.
To qualify for the waiver, researchers must first explain the research to the community and gather feedback. UC researchers will discuss the ProTECT trial at community meetings during the next several months, with particular emphasis on demographic groups known to have a statistically elevated risk of severe traumatic brain injury. In addition, UC researchers must assess local residents’ willingness for themselves or a family member to participate in this study. A complete description of the study can be reviewed at www.protectiii.com.
Those who review the study description will be invited to complete a short accompanying survey.
ProTECT III is a project of the Neurological Emergencies Treatment Trials ( NETT ), which was established by NIH in early 2007. NETT is a permanent research network that currently involves 17 university medical centers throughout the United States. UC’s involvement in NETT is overseen by Arthur Pancioli, MD, associate professor of emergency medicine and a member of UCNI.
Individuals who are opposed to being enrolled in a NETT study in the event that they were to suffer a neurological emergency can request an “opt out” bracelet by calling ( 513 ) 558-NETT ( 0095 ).
For more information about ProTECT, please contact Sara Stark at ( 513 ) 558-0095 or sara.stark@uc.edu. For more information about NETT, please visit http://nett.umich.edu/nett/welcome.
Brain Damage Can Kill Too – Car Pedestrian Collision Kills 104 NY Legend
I know it is a continuing oversight by me, but the reality is that brain damage does not only disable, it can kill. In fact statistically, about the same number of people die each year from brain damage as those who have severe brain injury. Now I could be wrong about that, because that is a statistic I have kept in my mind for over 15 years, and perhaps. we are doing a little better with keeping people alive.
Today, one of the world’s most interesting people died. He survived boxing, acting and old age, to be struck down in the prime of his life, at 104 years old, by a minivan. The New York Times told the story exquisitely well. Reading the story I felt like I reading the first chapter of a great novel. Carnivals, Coney Island and all of that lost colorful history of New York and America when we still believed what is says about welcoming immigrants on the Statue of Liberty.
Anyone who was a fledgling reporter on any newspaper, knows about writing obituaries. Yet when it came time to tell the story of Joe Rollino’s life, Manny Fernandez and Michael S. Schmidt of the NY Times did all Pulitzer Prize hopefuls, proud. The story is and the character they portray such a delight, I don’t even want to quote it hear. I am thankful that there are those like Joe Rollino who make it to 104. I am saddened that a life lived so well, could end so quickly because of brain damage. I am proud of the profession of which I was first trained that the NY Times reporter saw that this was not just a story about who survived Joe, but about the life he lived.
The story is so good I don’t want to even quote from it or sum it up. Read it. It is a great story. http://www.nytimes.com/2010/01/12/nyregion/12ironman.html?hp
Today, one of the world’s most interesting people died. He survived boxing, acting and old age, to be struck down in the prime of his life, at 104 years old, by a minivan. The New York Times told the story exquisitely well. Reading the story I felt like I reading the first chapter of a great novel. Carnivals, Coney Island and all of that lost colorful history of New York and America when we still believed what is says about welcoming immigrants on the Statue of Liberty.
Anyone who was a fledgling reporter on any newspaper, knows about writing obituaries. Yet when it came time to tell the story of Joe Rollino’s life, Manny Fernandez and Michael S. Schmidt of the NY Times did all Pulitzer Prize hopefuls, proud. The story is and the character they portray such a delight, I don’t even want to quote it hear. I am thankful that there are those like Joe Rollino who make it to 104. I am saddened that a life lived so well, could end so quickly because of brain damage. I am proud of the profession of which I was first trained that the NY Times reporter saw that this was not just a story about who survived Joe, but about the life he lived.
The story is so good I don’t want to even quote from it or sum it up. Read it. It is a great story. http://www.nytimes.com/2010/01/12/nyregion/12ironman.html?hp
Experienced Brain Injury Attorney Essential in Severe Brain Injury Cases
One of the frustrations of hearing the multitude of calls we get having one of the leading web resources for brain advocacy is the cries for help from potential clients who it is too late to help. Most of those people hired a lawyer who was not an expert in traumatic brain injury. The problems that are created are typically forensic problems, those that relate to the case itself. Sometimes these can be undone, sometimes not.
But as I reflect on the harm that can come to a brain injured person by not hiring the right lawyer, right away, my biggest concern is for those with severe brain injuries, which one would think would be the easiest cases for a non-TBI lawyer to handle. After all, how hard is it to prove someone has been catastrophically damaged, when they have been catastrophically injured?
We get far fewer calls from survivors of coma injury cases than we do concussion survivors. In a coma case, there is never a shortage of lawyers wanting the case and most times family members have chosen a lawyer while the injured person is in the ICU. In contrast, proof of brain injury and disability is so much more difficult in a concussion case that many brain injured people can’t even get representation.
The difference a TBI lawyer makes however may be most significant in the severe brain injury cases. That is because the legal advocacy that is done at the beginning may not only make the case easier to prove, it may also make a huge difference in the access to acute and sub-acute care, in those first few months after a catastrophic brain injury when it is most needed. Thus I think it is important to reflect on what difference a TBI lawyer can make from the start.
The first thing that must be done from the advocacy standpoint after a severe brain injury occurs, is to have a guardian or conservator appointed. While many family members might wonder why they can’t continue on without a guardian, from a legal standpoint no real decisions can be made until someone is given the authority to make those decisions by a court. Many people are afraid of the word “guardian” because it connotes some type of loss of freedom of choice, but without a guardian, the severely brain injured person is left in a legal no man’s land. Among the things that can’t be done without a guardian is hire a lawyer to represent the brain injured person in a lawsuit.
The second area of advocacy that is critically important during those first few weeks after injury is to make sure that a professional case manager is assigned to the case – someone who does not work for the hospital or treatment center. A case manager is someone who will coordinate and manage the treatment and rehabilitation of the brain injured person. In today’s world, especially if it is a Medicaid payment case, the case manager is an essential advocate to assure that treatment doesn’t get suspended or underprovided because of some red tape.
Often times when a professional guardianship firm is utilized, the guardianship firm will have their own case managers. This can be an advantageous situation for the injured person and one reason I often recommend that professional case guardians be utilized.
The ultimate advantage of having an experienced brain injury advocate comes in the matter of the sub-acute treatment, the treatment in the months after the person has emerged from the coma. Fewer and fewer hospitals have inpatient rehab programs for severely brain injured survivors and it takes professionals to assure that the proper placement occurs. One of the advantages of having a top lawyer is that the potential for litigation proceeds may allow access to long term brain injury treatment facilities that would not be available under insurance or Medicaid reimbursement.
An experience brain injury lawyer can also help to avoid the dreaded nursing home placement where there may be a Catch 22 where no treatment occurs because only the nursing home can be reimbursed for treatment. The problem with that is the nursing home reimbursement is not enough to provide any meaningful rehabilitation. Thus rehabilitation is minimal at best. The only other alternative under the local reimbursement situation may be adult foster care placement with outpatient treatment, but often times the available foster care homes are completely inappropriate for the survivor.
An experienced TBI lawyer in the beginning can open up other options. We got involved in a case in California about three years ago with a severely brain injured person. Rather than a nursing home placement, the survivor was placed in a nationally recognized rehabilitation program. In that program, the client got 24/7 appropriate treatment and supervision. As a result of the ability of the lawyer to negotiate a lien payment option, the care wasn’t terminated at 30 days. The care continued long term. The ultimate result is the best possible care for that individual, which continues to this day. Future payment of treatment cost are assured because the jury awarded the plaintiff $49 million.
But as I reflect on the harm that can come to a brain injured person by not hiring the right lawyer, right away, my biggest concern is for those with severe brain injuries, which one would think would be the easiest cases for a non-TBI lawyer to handle. After all, how hard is it to prove someone has been catastrophically damaged, when they have been catastrophically injured?
We get far fewer calls from survivors of coma injury cases than we do concussion survivors. In a coma case, there is never a shortage of lawyers wanting the case and most times family members have chosen a lawyer while the injured person is in the ICU. In contrast, proof of brain injury and disability is so much more difficult in a concussion case that many brain injured people can’t even get representation.
The difference a TBI lawyer makes however may be most significant in the severe brain injury cases. That is because the legal advocacy that is done at the beginning may not only make the case easier to prove, it may also make a huge difference in the access to acute and sub-acute care, in those first few months after a catastrophic brain injury when it is most needed. Thus I think it is important to reflect on what difference a TBI lawyer can make from the start.
The first thing that must be done from the advocacy standpoint after a severe brain injury occurs, is to have a guardian or conservator appointed. While many family members might wonder why they can’t continue on without a guardian, from a legal standpoint no real decisions can be made until someone is given the authority to make those decisions by a court. Many people are afraid of the word “guardian” because it connotes some type of loss of freedom of choice, but without a guardian, the severely brain injured person is left in a legal no man’s land. Among the things that can’t be done without a guardian is hire a lawyer to represent the brain injured person in a lawsuit.
The second area of advocacy that is critically important during those first few weeks after injury is to make sure that a professional case manager is assigned to the case – someone who does not work for the hospital or treatment center. A case manager is someone who will coordinate and manage the treatment and rehabilitation of the brain injured person. In today’s world, especially if it is a Medicaid payment case, the case manager is an essential advocate to assure that treatment doesn’t get suspended or underprovided because of some red tape.
Often times when a professional guardianship firm is utilized, the guardianship firm will have their own case managers. This can be an advantageous situation for the injured person and one reason I often recommend that professional case guardians be utilized.
The ultimate advantage of having an experienced brain injury advocate comes in the matter of the sub-acute treatment, the treatment in the months after the person has emerged from the coma. Fewer and fewer hospitals have inpatient rehab programs for severely brain injured survivors and it takes professionals to assure that the proper placement occurs. One of the advantages of having a top lawyer is that the potential for litigation proceeds may allow access to long term brain injury treatment facilities that would not be available under insurance or Medicaid reimbursement.
An experience brain injury lawyer can also help to avoid the dreaded nursing home placement where there may be a Catch 22 where no treatment occurs because only the nursing home can be reimbursed for treatment. The problem with that is the nursing home reimbursement is not enough to provide any meaningful rehabilitation. Thus rehabilitation is minimal at best. The only other alternative under the local reimbursement situation may be adult foster care placement with outpatient treatment, but often times the available foster care homes are completely inappropriate for the survivor.
An experienced TBI lawyer in the beginning can open up other options. We got involved in a case in California about three years ago with a severely brain injured person. Rather than a nursing home placement, the survivor was placed in a nationally recognized rehabilitation program. In that program, the client got 24/7 appropriate treatment and supervision. As a result of the ability of the lawyer to negotiate a lien payment option, the care wasn’t terminated at 30 days. The care continued long term. The ultimate result is the best possible care for that individual, which continues to this day. Future payment of treatment cost are assured because the jury awarded the plaintiff $49 million.
NFL Concussion Hearings in Congress – Moving Past the Need for Perfect Proof of Brain Damage
The issue of concussion awareness seems to have hit critical mass with yesterday’s hearings by Congress in Michigan. The hearings included a panel of former players and medical professionals on the issue of concussion in sport. For a thorough story on the hearings, see the New York Times story: Lawmakers Grill Doctor for His Views on Concussions. See http://www.nytimes.com/2010/01/05/sports/football/05hearing.html I will discuss in this blog some of the news highlights of that hearing and in the coming blogs will dig into the topic in more depth, from the documents on file from the U.S. House of Representatives website.
Once again Ira. R. Casson, M.D. was at the center of the controversy because of his claimed denial of evidence that NFL concussions cause permanent brain damage. As the debate on this issue has been heated in the media over the last few months, his statements made the most headlines. Frankly, they fit more into the non-denial, denial category and are not terribly significant. The NY Time article did see the forest for the trees. It began:
It is certainly a misstatement to say that Casson claims that the scientific evidence has been discredited. What Casson has said is that the studies clearly “proving” that concussion cause permanent brain damage in “NFL” players are flawed. Casson’s point seems to be an academic one with respect to methodological flaws in the studies that have been done.
Casson’s written statement, submitted before his testimony contained these statements:
The ridiculous part of Casson’s argument is that he is also saying that not all relevant concussions that happen to football players happen while they are in the NFL. The point is that all football, not just NFL football leads to brain damage. For Casson to defend the NFL because football players could have injured their brains before their professional career began is absurd. What is needed is reform in the way in which all concussions are diagnosed and treated, not just those that happen in the NFL or in football.
But these hearings are not about criticizing the NFL for not doing something sooner. The NFL has made significant change this year, even to the point that one of the big controversies of the fall was players criticizing team officials for not allowing players to return to the game. As pointed out in the NY Times story, the NFL has changed its concussion policy since the first round of these hearings in October. House Democrat John Conyers Jr. of Michigan, gets kudos here for his work.
Once again Ira. R. Casson, M.D. was at the center of the controversy because of his claimed denial of evidence that NFL concussions cause permanent brain damage. As the debate on this issue has been heated in the media over the last few months, his statements made the most headlines. Frankly, they fit more into the non-denial, denial category and are not terribly significant. The NY Time article did see the forest for the trees. It began:
Although the most theatrical moments of a House Judiciary Committee hearing on football brain injuries on Monday involved the grilling of a former NFL. doctor, most of the testimony centered on the application of recently strengthened professional rules to amateur levels, from youth leagues to college programs.With respect to Casson’s testimony, one Congressman, Steve Cohen a Democrat from Tennessee called out Dr. Casson, who recently resigned as a co-chairman of the NFL.’s committee on concussions, “for continuing to discredit mounting evidence linking professional football with cognitive decline and decrying what he called “the politicization” of science.”
It is certainly a misstatement to say that Casson claims that the scientific evidence has been discredited. What Casson has said is that the studies clearly “proving” that concussion cause permanent brain damage in “NFL” players are flawed. Casson’s point seems to be an academic one with respect to methodological flaws in the studies that have been done.
Casson’s written statement, submitted before his testimony contained these statements:
The conclusion that I have reached as a result of these analyses is that there is at present not enough valid, reliable or objective scientific evidence to prove that head impacts from professional football are the cause of chronic brain damage. Association does not prove causation.
I certainly agree that some retired NFL players have abnormal tau pathology in their brains. However the cause of this pathology is still uncertain. Head trauma may be playing a role, but even if it is, we do not know if the significant head trauma occurs in childhood, adolescence or at a later time in life. The presence of tau pathology in the brain of an 18 year old high school athlete and some middle aged men who had played high school and college football but never played in NFL certainly suggest that head trauma in adolescence may be an important factor. (Bold facing added.)
The ridiculous part of Casson’s argument is that he is also saying that not all relevant concussions that happen to football players happen while they are in the NFL. The point is that all football, not just NFL football leads to brain damage. For Casson to defend the NFL because football players could have injured their brains before their professional career began is absurd. What is needed is reform in the way in which all concussions are diagnosed and treated, not just those that happen in the NFL or in football.
But these hearings are not about criticizing the NFL for not doing something sooner. The NFL has made significant change this year, even to the point that one of the big controversies of the fall was players criticizing team officials for not allowing players to return to the game. As pointed out in the NY Times story, the NFL has changed its concussion policy since the first round of these hearings in October. House Democrat John Conyers Jr. of Michigan, gets kudos here for his work.
I do agree with Dr. Casson that more research needs to be done, but that research needs to be far broader than his focus on “tau pathology”. Understanding and treating concussion is not about finding the objective scientific proof of the pathology, but of understanding the inherently subjective nature of a disability that involves a total synergistic change in the way in which the brain and emotions work. In the days ahead, I will focus on the more substantive aspects of the testimony at this weeks hearings.
Post Concussion Syndrome – Diagnosing and Treating for All Risk Factors
I said this last week on my Justice and American Politics blog, http://subtlebraininjury.com/blog:
In the days after a concussion, the brain is trying mightily to rewire itself to deal with the new challenges. That rewiring is not always positive. Add panic or emotional distress and the plasticity that we all hope will avoid negative consequences, can rewire the brain in the wrong ways. I call this “negative plasticity” and I believe it is one of the strongest arguments for better and more thorough diagnosis and follow-up for concussion.
To answer that question one must first define the term “plasticity.” I found a great definition of it at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526649/
Brain plasticity refers to the brain’s lifelong capacity for physical and functional change; it is this capacity that enables experience to induce learning throughout life. Research in this field has demonstrated that the adult brain continuously adapts to disproportionately represent relevant sensory stimuli and behavioral outputs with well coordinated populations of neurons. This adaptation is achieved by engaging competitive processes in brain networks that refine the selective representations of sensory inputs or motor actions, typically resulting in increased strengths of cortical resources devoted to, and enhanced representational fidelity of, the learned stimulus or behavior.
In severe brain injury lingo, plasticity is the capacity of one part of brain to take on the function of a part of the brain which is damaged. But as the brain has the capacity to rewire itself in positive ways, so can it in negative ways.
As long as I have been doing Post Concussion Syndrome cases, I have been asking myself this question: Why is there this significant subset of people who have such bad results from an injury that the majority of people have apparent full recoveries, within days if not hours? This small minority of people that fall into the symptomatic category have been referred to most often as either the “miserable minority” (Ron Ruff, neuropsychologist) or as suffering from the Persistent Post Concussive Syndrome. “PPCS” (Michael Alexander, M.D. , Neurology, 1995). That “miserable minority” of people consistently make up between 5 and 15% of those who suffer a concussion or mild traumatic brain injury. What explains this divergent outcome for this PPCS group?
I believe there are a number of issues. First, some of them have far more than a “simple concussion.” This portion have fairly serious brain injuries but because the symptoms of those concussions occurred when they were not being monitored by medical professionals, the severity of the brain injury is grossly underrated.
Second, some of them have other neurological injuries, which again, went misdiagnosed. The most common among this group are those with vestibular disorders. See http://vestibulardisorder.com Symptoms of dizziness, balance and vertigo can put significant demands upon the brains attentional resources and account for many of the cognitive and emotional complaints associated with the post concussion syndrome. In my career, I have found nearly a 50% incidence of vestibular disorder among my clients.
Third, there may be an artery dissection that happened contemporaneously with the head injury or as a result of treatment for the head injury, particularly from a chiropractor. Artery dissections can cause a stroke, with resultant moderate to severe brain damage.
Fourth, the brain injured person may be emotionally more vulnerable than the 85 to 90% of those who have good recoveries. This is likely the most significant factor and is the area where my term of “negative plasticity” comes into play. While the evidence of this particular component of concussion pathology is incomplete, I believe that as we learn more about the limbic system and the axonal connections between it and the lower frontal lobes, the emotional component of concussion recovery will become a huge field of discovery and potentially treatment.
What is the reason this is important in a week when a football coach gets fired for locking an athlete with a concussion up in a dark place? There is a major overlap between PTSD and the post concussion syndrome. After all, both are “all in the head”. “All in the head” means it is in the brain. There is not a bright line of demarcation between emotional injury and organic or “hard wire” injury in the brain. In all likelihood, there is no line at all. If you damage a person’s emotional center, regardless of whether you do so by direct trauma or via emotional rewiring, the hard wiring change is the same.
Concussion survivors need the best treatment, not just to protect them from repeat trauma’s, but also to protect the vulnerable brain from negative rewiring. A concussion in its infancy can become a life long disability if the vulnerable brain is neglected or abused. We worry about “shaken baby syndrome”. We should also worry about the neglected emotional state of all brains that are injured.
In the days after a concussion, the brain is trying mightily to rewire itself to deal with the new challenges. That rewiring is not always positive. Add panic or emotional distress and the plasticity that we all hope will avoid negative consequences, can rewire the brain in the wrong ways. I call this “negative plasticity” and I believe it is one of the strongest arguments for better and more thorough diagnosis and follow-up for concussion.
To answer that question one must first define the term “plasticity.” I found a great definition of it at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526649/
Brain plasticity refers to the brain’s lifelong capacity for physical and functional change; it is this capacity that enables experience to induce learning throughout life. Research in this field has demonstrated that the adult brain continuously adapts to disproportionately represent relevant sensory stimuli and behavioral outputs with well coordinated populations of neurons. This adaptation is achieved by engaging competitive processes in brain networks that refine the selective representations of sensory inputs or motor actions, typically resulting in increased strengths of cortical resources devoted to, and enhanced representational fidelity of, the learned stimulus or behavior.
In severe brain injury lingo, plasticity is the capacity of one part of brain to take on the function of a part of the brain which is damaged. But as the brain has the capacity to rewire itself in positive ways, so can it in negative ways.
As long as I have been doing Post Concussion Syndrome cases, I have been asking myself this question: Why is there this significant subset of people who have such bad results from an injury that the majority of people have apparent full recoveries, within days if not hours? This small minority of people that fall into the symptomatic category have been referred to most often as either the “miserable minority” (Ron Ruff, neuropsychologist) or as suffering from the Persistent Post Concussive Syndrome. “PPCS” (Michael Alexander, M.D. , Neurology, 1995). That “miserable minority” of people consistently make up between 5 and 15% of those who suffer a concussion or mild traumatic brain injury. What explains this divergent outcome for this PPCS group?
I believe there are a number of issues. First, some of them have far more than a “simple concussion.” This portion have fairly serious brain injuries but because the symptoms of those concussions occurred when they were not being monitored by medical professionals, the severity of the brain injury is grossly underrated.
Second, some of them have other neurological injuries, which again, went misdiagnosed. The most common among this group are those with vestibular disorders. See http://vestibulardisorder.com Symptoms of dizziness, balance and vertigo can put significant demands upon the brains attentional resources and account for many of the cognitive and emotional complaints associated with the post concussion syndrome. In my career, I have found nearly a 50% incidence of vestibular disorder among my clients.
Third, there may be an artery dissection that happened contemporaneously with the head injury or as a result of treatment for the head injury, particularly from a chiropractor. Artery dissections can cause a stroke, with resultant moderate to severe brain damage.
Fourth, the brain injured person may be emotionally more vulnerable than the 85 to 90% of those who have good recoveries. This is likely the most significant factor and is the area where my term of “negative plasticity” comes into play. While the evidence of this particular component of concussion pathology is incomplete, I believe that as we learn more about the limbic system and the axonal connections between it and the lower frontal lobes, the emotional component of concussion recovery will become a huge field of discovery and potentially treatment.
What is the reason this is important in a week when a football coach gets fired for locking an athlete with a concussion up in a dark place? There is a major overlap between PTSD and the post concussion syndrome. After all, both are “all in the head”. “All in the head” means it is in the brain. There is not a bright line of demarcation between emotional injury and organic or “hard wire” injury in the brain. In all likelihood, there is no line at all. If you damage a person’s emotional center, regardless of whether you do so by direct trauma or via emotional rewiring, the hard wiring change is the same.
Concussion survivors need the best treatment, not just to protect them from repeat trauma’s, but also to protect the vulnerable brain from negative rewiring. A concussion in its infancy can become a life long disability if the vulnerable brain is neglected or abused. We worry about “shaken baby syndrome”. We should also worry about the neglected emotional state of all brains that are injured.
Mike Leach Firing Clearly Justified by Evidence of Abuse of Brain Injured Athlete
Texas Tech has won its bowl game without the Concussion abuser Mike Leach as its head coach. Leach was fired on Thursday, just before his hearing to force reinstatement. The court case was odd, especially since Leach chose to try his case in the media with out of context claims of support from the team doctor and trainer. As reported by the New York Times, neither the trainer nor the team doctor are supporting his treatment of Adam James. See http://www.nytimes.com/2010/01/03/sports/ncaafootball/03leach.html?hp
A Texas Tech athletic trainer said he was told by the fired coach Mike Leach to lock wide receiver Adam James in the dark after doctors determined that he had a concussion, according to an affidavit released Saturday by the university.
According to the NY Times story:
Despite Leach’s media claims, the team doctor did not support the treatment of James, either. According to the NY Times:
A Texas Tech athletic trainer said he was told by the fired coach Mike Leach to lock wide receiver Adam James in the dark after doctors determined that he had a concussion, according to an affidavit released Saturday by the university.
According to the NY Times story:
In a Dec. 21 interview with a university investigative attorney looking into James’s treatment, Steve Pincock, Texas Tech’s head football trainer, said he told James he was sorry about placing him inside an equipment shed on Dec. 17 near the practice field. According to the affidavit, Pincock also said he was not aware that any other player had ever been treated in such a manner.
“I do not agree with this form of treatment for anyone,” Pincock said in the affidavit.
In describing what Leach told him to do, Pincock quoted the coach as using graphic and profane language about locking James in a dark place, according to the affidavit. Pincock also told the investigator that Leach “wanted James to be uncomfortable,” the affidavit said. Pincock did not return a message left on his cellphone or reply to a text message Saturday.
Despite Leach’s media claims, the team doctor did not support the treatment of James, either. According to the NY Times:
In another affidavit released Saturday by the university, the team physician Michael Phy told the investigator on Dec. 22 that James “may not have been harmed,” but that Phy considered “this practice inappropriate.” In the statement announcing Leach’s firing, Texas Tech said Leach’s actions put James “at risk for additional injury.”As I said on one of my other blogs last week, while isolation does not necessarily expose the injured brain to any new physical forces, it can expose the brain to additional stress, which can result in further Post Concussion Syndrome problems. See http://blog.subtlebraininjury.com/2009/12/texas-tech-isolation-for-concussed.html
Last year was a remarkable year for concussion awareness, but we are only scratching the surface of treating the secondary effects of concussion, especially those that involve emotional stressors. I hope the Leach chapter stays in the media focus long enough to get some of the leading thinkers on concussion to educate on this issue further.