I have talked about the irony of the miracles in severe brain injury cases and the tragedies of mild for more than a decade. See http://tbilaw.com/essays.mildsevere.php That isn’t to say that every severe brain injury is a tragedy of epic proportions. Yet, the only miracle brain injury stories I know are of the severely brain injured people. This story below seems another such case. Families, keep believing, keep praying and keep talking to your loved one. There is always some hope.
In what some claim is a miracle, a Vermont youth who sustained traumatic brain injury six weeks ago is back in school, the Burlington Free Press reports.
http://www.chron.com/disp/story.mpl/hotstories/6859080.html
The teen, Josh Scaralia of West Rutland, was hit by a car in a Dec. 30 accident. He got a fractured skull and had two blood clots in his brain.
Physicians told Scaralia that he would not be able to go back to Mount St. Joseph Academy and that he would have to put his college plans on hold.
But the school prayed for him everyday, and he was back at school at the academy on Monday.
Olympics Marred by Luger Death Before The Really Dangerous Sport Kicks Off, Snowboarding
Observers feared that daredevil snowboarders might wind up dead at the Winter Olympics in Vancouver, pounding their skulls while attempting death-defying feats in the competition. But it was the luge sport that right out of the gate turned the games “into a gallows,” as one sportswriter out it.
And Olympic officials appeared more concerned about covering their asses than addressing the why of what happened.
This weekend there were many eloquent stories in the national press about the cowardice of the sports officials who blamed Nodar Kumaritashvili, the Georgian Luger killed at the Vancouver Olympics last week, for causing his own tragic death.
In its five-paragraph statement Friday, the International Luge Federation said that the Kumaritashvili came out of a curve and “did not compensate properly…there was no indication that the accident was caused by deficiencies in the track.”
http://www.vancouver2010.com/olympic-news/n/news/fil-statement-on-mens-luge-competition_274462nE.html
There was no mention of the fact that the steel pillar that the 21-year-old luger slammed his back into at racetrack speeds wasn’t padded, or that Olympic lugers were terrified of the track.
The New York Times did a Page One story Sunday on that topic, headlined “Fast and Risky, Sledding Track Drew Red Flags.”
http://www.nytimes.com/2010/02/14/sports/olympics/14track.html?ref=sports
Also on Sunday, The Times blasted the luge federation for its findings in a story headlined “Quick to Blame in Luge, and Showing No Shame.”
http://www.nytimes.com/2010/02/14/sports/olympics/14longman.html?hp
“Olympic officials treated the death of Nodar Kumaritashvili, the Georgian luge athlete, less as a tragedy than as an inconvenience,”
The Times wrote.
Back injuries aren’t the only thing to anticipate with these luge races. Last week a Romanian, Violeta Stramaturaru was knocked unconscious on Thursday and taken to a hospital after slamming into a wall several times.
http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/12/2010-02-12_luger_nodar_kumaritashvili_rushed_to_hospital.html?page=1#ixzz0fYFguzaH
Here’s the best summation we read of the tragedy over the weekend, by New York Daily News sports columnist Filip Bondy.
http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/13/2010-02-13_quit_playing_a_risky_game.html
“In the end, it wasn’t the halfpipe or the freestanding aerials that turned the Winter Olympic into a gallows,” he wrote Saturday. “It was as slippery-sloped luge track, designed by someone who didn’t know the sport and nurtured by a system that reward outrageous risk-taking.”
The New York Times Saturday said in a Page One story that the Georgian’s death “casts a pall” over the Winter games.
http://www.nytimes.com/2010/02/13/sports/olympics/13luge.html?hp
On the sports pages that same day, The Times noted that the Winter Olympics have “had ample adversity and controversy,” from too-little snow “and doping” scandals, “but genuine tragedy has been a rarity.
http://www.nytimes.com/2010/02/13/sports/olympics/13clarey.html?hp
Prompted by last week’s death, Olympics officials have taken steps to make the luge track safer. For example, they have moved the men’s start line farther down the track.
We’ll see if that helps – and hold our breath for when the supposedly really dangerous competition starts: snowboarding.
And Olympic officials appeared more concerned about covering their asses than addressing the why of what happened.
This weekend there were many eloquent stories in the national press about the cowardice of the sports officials who blamed Nodar Kumaritashvili, the Georgian Luger killed at the Vancouver Olympics last week, for causing his own tragic death.
In its five-paragraph statement Friday, the International Luge Federation said that the Kumaritashvili came out of a curve and “did not compensate properly…there was no indication that the accident was caused by deficiencies in the track.”
http://www.vancouver2010.com/olympic-news/n/news/fil-statement-on-mens-luge-competition_274462nE.html
There was no mention of the fact that the steel pillar that the 21-year-old luger slammed his back into at racetrack speeds wasn’t padded, or that Olympic lugers were terrified of the track.
The New York Times did a Page One story Sunday on that topic, headlined “Fast and Risky, Sledding Track Drew Red Flags.”
http://www.nytimes.com/2010/02/14/sports/olympics/14track.html?ref=sports
Also on Sunday, The Times blasted the luge federation for its findings in a story headlined “Quick to Blame in Luge, and Showing No Shame.”
http://www.nytimes.com/2010/02/14/sports/olympics/14longman.html?hp
“Olympic officials treated the death of Nodar Kumaritashvili, the Georgian luge athlete, less as a tragedy than as an inconvenience,”
The Times wrote.
Back injuries aren’t the only thing to anticipate with these luge races. Last week a Romanian, Violeta Stramaturaru was knocked unconscious on Thursday and taken to a hospital after slamming into a wall several times.
http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/12/2010-02-12_luger_nodar_kumaritashvili_rushed_to_hospital.html?page=1#ixzz0fYFguzaH
Here’s the best summation we read of the tragedy over the weekend, by New York Daily News sports columnist Filip Bondy.
http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/13/2010-02-13_quit_playing_a_risky_game.html
“In the end, it wasn’t the halfpipe or the freestanding aerials that turned the Winter Olympic into a gallows,” he wrote Saturday. “It was as slippery-sloped luge track, designed by someone who didn’t know the sport and nurtured by a system that reward outrageous risk-taking.”
The New York Times Saturday said in a Page One story that the Georgian’s death “casts a pall” over the Winter games.
http://www.nytimes.com/2010/02/13/sports/olympics/13luge.html?hp
On the sports pages that same day, The Times noted that the Winter Olympics have “had ample adversity and controversy,” from too-little snow “and doping” scandals, “but genuine tragedy has been a rarity.
http://www.nytimes.com/2010/02/13/sports/olympics/13clarey.html?hp
Prompted by last week’s death, Olympics officials have taken steps to make the luge track safer. For example, they have moved the men’s start line farther down the track.
We’ll see if that helps – and hold our breath for when the supposedly really dangerous competition starts: snowboarding.
Study To Research Impact of Progesterone on TBI Patients
Ironically, despite a strong recommendation from the authors of the Guidelines for the Management of Severe Traumatic Brain Injury that the use of steroids was NOT recommended for the treatment of severe traumatic brain injury, research in the area continues. The irony is that the Brain Trauma Foundation is supporting such research, despite the fact that they were the publishers of the Guidelines. The Guidelines were published in Journal of Neurotrauma, Volume 24, Supplement 1, 2007. http://www.braintrauma.org/site/PageServer?pagename=Guidelines
The latest guideline said this about steroids:
The majority of available evidence indicates that steroids do not improve outcome or lower ICP in severe TBI. There is strong evidence that steroids are deleterious; thus their use is not recommended for TBI.
Currently there is little enthusiasm for re-examing the use of existing formulations of steroids for treatment of patients with TBI. If new compounds with different mechanisms of action are discovered, further study may be justified.
I guess a lot has changed in less than three years. A nationwide study, named ProTECT, on the use of progesterone to treat moderate to severe brain injury will be conducted at 17 hospitals across the nation, it was announced Wednesday.
http://www.henryfordhealth.org/body.cfm?id=46335&action;=detail&ref;=1057 Progesterone also known is a steroid hormone which is part of the female reproductive cycle.
The study, funded by the National Institute of Neurological Diseases and Stroke, will track 1,100 patients nationally for at least three years. http://www.freep.com/article/20100210/BUSINESS06/100210029/1320/Hospitals-take-part-in-brain-injury-study
The goal of the research is to find out if the hormone progesterone can lessen the disability and death, that can stem from Traumatic Brain Injury, the leading cause of death and disability in those younger than 44 years old, according to the Brain Trauma Foundation.
Research with animals has found that progesterone may lessen brain damage resulting from TBI.
ProTECT is a double-bind study, and will evaluate patients with moderate to severe brain damage. The evaluation must take place within four hours of the injury, and enrolled patients will either be given a placebo or the progesterone intravenously.
The Food and Drug Administration is allowing hospitals to enroll patients without written consent because TBI patients may not be conscious or have the ability to make an informed decision right after their injury.
Four Detroit hospitals will take part in the study, namely Henry Ford Hospital, Detroit-Receiving Hospital, Sinai-Grace Hospital and Beaumont Hospital.
One of the last studies on the use of steroids for TBI was halted mid-trial because of hard evidence that it was doing more harm than good. We hope this one is monitored with extremely tight controls, with no vested stake in continuing the study if things start to go wrong.
The latest guideline said this about steroids:
The majority of available evidence indicates that steroids do not improve outcome or lower ICP in severe TBI. There is strong evidence that steroids are deleterious; thus their use is not recommended for TBI.
Currently there is little enthusiasm for re-examing the use of existing formulations of steroids for treatment of patients with TBI. If new compounds with different mechanisms of action are discovered, further study may be justified.
I guess a lot has changed in less than three years. A nationwide study, named ProTECT, on the use of progesterone to treat moderate to severe brain injury will be conducted at 17 hospitals across the nation, it was announced Wednesday.
http://www.henryfordhealth.org/body.cfm?id=46335&action;=detail&ref;=1057 Progesterone also known is a steroid hormone which is part of the female reproductive cycle.
The study, funded by the National Institute of Neurological Diseases and Stroke, will track 1,100 patients nationally for at least three years. http://www.freep.com/article/20100210/BUSINESS06/100210029/1320/Hospitals-take-part-in-brain-injury-study
The goal of the research is to find out if the hormone progesterone can lessen the disability and death, that can stem from Traumatic Brain Injury, the leading cause of death and disability in those younger than 44 years old, according to the Brain Trauma Foundation.
Research with animals has found that progesterone may lessen brain damage resulting from TBI.
ProTECT is a double-bind study, and will evaluate patients with moderate to severe brain damage. The evaluation must take place within four hours of the injury, and enrolled patients will either be given a placebo or the progesterone intravenously.
The Food and Drug Administration is allowing hospitals to enroll patients without written consent because TBI patients may not be conscious or have the ability to make an informed decision right after their injury.
Four Detroit hospitals will take part in the study, namely Henry Ford Hospital, Detroit-Receiving Hospital, Sinai-Grace Hospital and Beaumont Hospital.
One of the last studies on the use of steroids for TBI was halted mid-trial because of hard evidence that it was doing more harm than good. We hope this one is monitored with extremely tight controls, with no vested stake in continuing the study if things start to go wrong.
Certain Brain Damage Can Impact Spirituality, Study Finds
All that we are is in our brains. Heart break happens in the brain. Love happens in the brain. And yes, if you are “saved”, it is your brain that is saved. The brain is the home of the human soul. The study below is further confirmation.
A new study has found link between brain activity and spirituality by testing patients before and after they had surgery to remove brain tumors. http://www.sciencedaily.com/releases/2010/02/100210124757.htm
The study, published in the Feb. 11 issue of the journal Neuron, focused on the a personality trait, self-transcendence (ST), which is used
as a gauge of spiritual feeling and thinking in individuals. The characteristic is marked by a person feeling like he or she is a part of the larger universe.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WSS-4YC2GXT-5&_user=10&_coverDate=02%2F11%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view;=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5;=e4fb1257622032866d30264bf0a9b724
The research compared ST scores of patients before and after they had brain tumors removed, mapping their brain lesions after surgery.
The study determined that select damage to the left and right posterior parietal regions of the brain increased ST. That has lead researchers to believe that dysfunctional parietal neural activity may cause changed spiritual beliefs and actions.
A new study has found link between brain activity and spirituality by testing patients before and after they had surgery to remove brain tumors. http://www.sciencedaily.com/releases/2010/02/100210124757.htm
The study, published in the Feb. 11 issue of the journal Neuron, focused on the a personality trait, self-transcendence (ST), which is used
as a gauge of spiritual feeling and thinking in individuals. The characteristic is marked by a person feeling like he or she is a part of the larger universe.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WSS-4YC2GXT-5&_user=10&_coverDate=02%2F11%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view;=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5;=e4fb1257622032866d30264bf0a9b724
The research compared ST scores of patients before and after they had brain tumors removed, mapping their brain lesions after surgery.
The study determined that select damage to the left and right posterior parietal regions of the brain increased ST. That has lead researchers to believe that dysfunctional parietal neural activity may cause changed spiritual beliefs and actions.
Vegetative Patients Display Consciousness, Ability To Communicate, New Study Finds
A groundbreaking study, raising troubling medical ethics issues, has found that patients in a vegetative state showed signs of brain activity, indicating not only consciousness but even the ability to communicate.
The study, published online Wednesday by The New England Journal of Medicine, http://content.nejm.org/cgi/content/full/NEJMoa0905370, created an immediate debate about how serious head injuries should be treated, as well as the ethical issue of whether attempts should be made to ask comatose patients what kind of care they want.
In other words, should vegetative patients, once considered unresponsive, now be asked whether they want to live or die?
In the study, 54 patients with vegetative brain injury in England and Belgium were assessed with functional magnetic resonance imaging (MRI), to determine if they could respond to two established imagery tasks. And an additional technique was developed to determine “whether such tasks could be used to communicate yes-or-no answers to simple questions,” according to The New England Journal.
Five patients (five of whom were diagnosed with traumatic brain injury, and four diagnosed as being in a vegetative state) were “willfully able to modulate their brain activity,” the Journal said, “In three of these patients, additional bedside testing revealed some signs of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment.”
Imaging tests involving one woman showed she had brain activity, in her motor cortex, when she was asked to think about playing tennis, the study found.
One patient was able to answer yes or no questions during the MRI, “however, it remained impossible to establish any form or communications at bedside,” according to the New England Journal article.
The study’s conclusion was that “these results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.”
The study had two goals: The first was to determine whether patients in a vegetative or minimally conscious state retain the capacity for a purposeful response to stimulation, however inconsistent. “Such a capacity, which suggests at least partial awareness, distinguishes minimally conscious patients from those in a vegetative state and therefore has implications for subsequent care and rehabilitation, as well as for legal and ethical decision making,” the New England Journal article said.
The second goal of the study was “to harness and nurture any available response, through intervention, into a form of reproducible communication, however rudimentary. The acquisition of any interactive and functional verbal or nonverbal method of communication is an important milestone. Clinically, consistent and repeatable communication demarcates the upper boundary of a minimally conscious state.”
In introducing the study’s findings, the New England Journal said, “ In recent years, improvements in intensive care have led to an increase in the number of patients who survive severe brain injury. Although some of these patients go on to have a good recovery, others awaken from the acute comatose state but do not show any signs of awareness. If repeated examinations yield no evidence of a sustained, reproducible, purposeful, or voluntary behavioral response to visual, auditory, tactile, or noxious stimuli, a diagnosis of a vegetative state — or “wakefulness without awareness” — is made. Some patients remain in a vegetative state permanently. Others eventually show inconsistent but reproducible signs of awareness, including the ability to follow commands, but they remain unable to communicate interactively.”
That term “minimally conscious state” was used in 2002 by the Aspen Neurobehavioral Conference Work Group to describe the condition of these kinds of patients, “thereby adding a new clinical entity to the spectrum of disorders of consciousness,” the article says.
One of the five patients that showed brain activity, the study found “had the ability to apply the imagery technique in order to answer simple yes-or-no questions accurately. Before the scanning was performed, the patient had undergone repeated evaluations indicating that he was in a vegetative state…the functional MRI approach allowed the patient to establish functional and interactive communication.”
The article went on, “Indeed, for five of the six questions, the patient had a reliable neural response and was able to provide the correct answer with 100% accuracy. For the remaining question — the last question of the imaging session — the lack of activity within the regions of interest precluded any analysis of the results. Whether the patient fell asleep during this question, did not hear it, simply elected not to answer it, or lost consciousness cannot be determined. Although the functional MRI data provided clear evidence that the patient was aware and able to communicate, it is not known whether either ability was available during earlier evaluations.”
The study received wide coverage in the press, with a Page One story in The New York Times http://www.nytimes.com/2010/02/04/health/04brain.html?hp
and The Star-Ledger of Newark, which ran The Washington Post’s story on the surprising study results, http://www.washingtonpost.com/wp-dyn/content/article/2010/02/03/AR2010020302887.html.
The Wall Street Journal http://online.wsj.com/article/SB10001424052748704259304575043494009308442.html, Los Angeles Times
http://www.latimes.com/news/nationworld/nation/la-sci-vegetative4-2010feb04,0,4078396.story
and the Associated Press also did coverage of the study.
The New York Times wrote, “The experts agreed that the new study exposed the limits of the current bedside test for diagnosing mental state: checking whether patients’ eyes can track objects, and carefully looking for any signs – eye blinks, finger twitches – in response to questions or commands.”
The study, published online Wednesday by The New England Journal of Medicine, http://content.nejm.org/cgi/content/full/NEJMoa0905370, created an immediate debate about how serious head injuries should be treated, as well as the ethical issue of whether attempts should be made to ask comatose patients what kind of care they want.
In other words, should vegetative patients, once considered unresponsive, now be asked whether they want to live or die?
In the study, 54 patients with vegetative brain injury in England and Belgium were assessed with functional magnetic resonance imaging (MRI), to determine if they could respond to two established imagery tasks. And an additional technique was developed to determine “whether such tasks could be used to communicate yes-or-no answers to simple questions,” according to The New England Journal.
Five patients (five of whom were diagnosed with traumatic brain injury, and four diagnosed as being in a vegetative state) were “willfully able to modulate their brain activity,” the Journal said, “In three of these patients, additional bedside testing revealed some signs of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment.”
Imaging tests involving one woman showed she had brain activity, in her motor cortex, when she was asked to think about playing tennis, the study found.
One patient was able to answer yes or no questions during the MRI, “however, it remained impossible to establish any form or communications at bedside,” according to the New England Journal article.
The study’s conclusion was that “these results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.”
The study had two goals: The first was to determine whether patients in a vegetative or minimally conscious state retain the capacity for a purposeful response to stimulation, however inconsistent. “Such a capacity, which suggests at least partial awareness, distinguishes minimally conscious patients from those in a vegetative state and therefore has implications for subsequent care and rehabilitation, as well as for legal and ethical decision making,” the New England Journal article said.
The second goal of the study was “to harness and nurture any available response, through intervention, into a form of reproducible communication, however rudimentary. The acquisition of any interactive and functional verbal or nonverbal method of communication is an important milestone. Clinically, consistent and repeatable communication demarcates the upper boundary of a minimally conscious state.”
In introducing the study’s findings, the New England Journal said, “ In recent years, improvements in intensive care have led to an increase in the number of patients who survive severe brain injury. Although some of these patients go on to have a good recovery, others awaken from the acute comatose state but do not show any signs of awareness. If repeated examinations yield no evidence of a sustained, reproducible, purposeful, or voluntary behavioral response to visual, auditory, tactile, or noxious stimuli, a diagnosis of a vegetative state — or “wakefulness without awareness” — is made. Some patients remain in a vegetative state permanently. Others eventually show inconsistent but reproducible signs of awareness, including the ability to follow commands, but they remain unable to communicate interactively.”
That term “minimally conscious state” was used in 2002 by the Aspen Neurobehavioral Conference Work Group to describe the condition of these kinds of patients, “thereby adding a new clinical entity to the spectrum of disorders of consciousness,” the article says.
One of the five patients that showed brain activity, the study found “had the ability to apply the imagery technique in order to answer simple yes-or-no questions accurately. Before the scanning was performed, the patient had undergone repeated evaluations indicating that he was in a vegetative state…the functional MRI approach allowed the patient to establish functional and interactive communication.”
The article went on, “Indeed, for five of the six questions, the patient had a reliable neural response and was able to provide the correct answer with 100% accuracy. For the remaining question — the last question of the imaging session — the lack of activity within the regions of interest precluded any analysis of the results. Whether the patient fell asleep during this question, did not hear it, simply elected not to answer it, or lost consciousness cannot be determined. Although the functional MRI data provided clear evidence that the patient was aware and able to communicate, it is not known whether either ability was available during earlier evaluations.”
The study received wide coverage in the press, with a Page One story in The New York Times http://www.nytimes.com/2010/02/04/health/04brain.html?hp
and The Star-Ledger of Newark, which ran The Washington Post’s story on the surprising study results, http://www.washingtonpost.com/wp-dyn/content/article/2010/02/03/AR2010020302887.html.
The Wall Street Journal http://online.wsj.com/article/SB10001424052748704259304575043494009308442.html, Los Angeles Times
http://www.latimes.com/news/nationworld/nation/la-sci-vegetative4-2010feb04,0,4078396.story
and the Associated Press also did coverage of the study.
The New York Times wrote, “The experts agreed that the new study exposed the limits of the current bedside test for diagnosing mental state: checking whether patients’ eyes can track objects, and carefully looking for any signs – eye blinks, finger twitches – in response to questions or commands.”
Zackery Lystedt Brain Project To Be Announced at the Super Bowl, New York Times Reports
The Zackery Lystedt Brain Project will be announced at the Super Bowl, The New York Times reported Sunday. http://www.nytimes.com/2010/01/31/sports/31concussions.html?ref=sports
The Lystedt initiative, lead by the Sarah Jane Brain Foundation and the American College of Sports Medicine, will push to convince more states to pass legislation protecting young sports players from concussions and their after effects.
Washington and Oregon enacted the first concussion-specific laws related to concussion protection for school athletes. The law that Washington passed is named after Zackery Lysedt, who sustained serous brain injury in 2006 playing football, according to The Times.
The Washington legislation has become a model for other states. The law requires that coaches be educated on concussions; that players be taken off the field immediately if it’s suspected they’ve sustained a concussion; and that a doctor must clear an athlete before he or she can return to play.
There could be as many as two dozen states that may pass laws related to concussions and youth sports, The Times says. Florida, New Jersey, New York and Massachusetts have bills in the works.
A House Judiciary Committee forum, the third one, will be held Monday, Feb. 1, in Houston to discuss brain injuries in football.
There have been two prior committee meetings, which discussed the poor treatment of concussions by the NFL. The league responded by adopting some new rules, including one that bans players suspected of having a concussion from returning to a game or practice.
Editor’s Note: You cannot tell the difference between a mild concussion and a serious concussion until you wait hours. While there is arguably a cost benefit analysis to returning the quarterback of an NFL team to the game, there is no cost to holding out a scholastic player from that game. This is especially true because there will is no guarantee of a sideline medical professional trained to clear the player. But as brain injury is a process not an event that takes a minimum of 24 hours to fully manifest itself, any return is risky. Sit the injured player and test them the next day, when you can give a sensitive test for amnesia. See http://www.youtube.com/profile?user=braininjuryattorney%22%3Ehttp://youtube.com/profile?user=braininjuryattorney%3C/a#p/u/11/dEWHgwRywtY
The Lystedt initiative, lead by the Sarah Jane Brain Foundation and the American College of Sports Medicine, will push to convince more states to pass legislation protecting young sports players from concussions and their after effects.
Washington and Oregon enacted the first concussion-specific laws related to concussion protection for school athletes. The law that Washington passed is named after Zackery Lysedt, who sustained serous brain injury in 2006 playing football, according to The Times.
The Washington legislation has become a model for other states. The law requires that coaches be educated on concussions; that players be taken off the field immediately if it’s suspected they’ve sustained a concussion; and that a doctor must clear an athlete before he or she can return to play.
There could be as many as two dozen states that may pass laws related to concussions and youth sports, The Times says. Florida, New Jersey, New York and Massachusetts have bills in the works.
A House Judiciary Committee forum, the third one, will be held Monday, Feb. 1, in Houston to discuss brain injuries in football.
There have been two prior committee meetings, which discussed the poor treatment of concussions by the NFL. The league responded by adopting some new rules, including one that bans players suspected of having a concussion from returning to a game or practice.
Editor’s Note: You cannot tell the difference between a mild concussion and a serious concussion until you wait hours. While there is arguably a cost benefit analysis to returning the quarterback of an NFL team to the game, there is no cost to holding out a scholastic player from that game. This is especially true because there will is no guarantee of a sideline medical professional trained to clear the player. But as brain injury is a process not an event that takes a minimum of 24 hours to fully manifest itself, any return is risky. Sit the injured player and test them the next day, when you can give a sensitive test for amnesia. See http://www.youtube.com/profile?user=braininjuryattorney%22%3Ehttp://youtube.com/profile?user=braininjuryattorney%3C/a#p/u/11/dEWHgwRywtY
Veterans With PTSD Win Review of Their Rejected Benefit Claims
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.
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