Princeton Freshman Football Star Dibilio Recovering From Stroke

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Posted on 1st February 2012 by Gordon Johnson in Uncategorized

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So far, the prognosis is looking good for Princeton freshman running back Chuck Dibilio, who suffered a stroke Jan. 19. But there is still no answer yet why this athlete, at the peak of his facilities, had a stroke.   

Dibilio, a 19-year-old from Nazareth, Pa., underwent surgery to have a blood clot removed from the main artery of his brain at Thomas Jefferson University Hospital in Philadelphia, according to the Associated Press. He had to be transported by helicopter to that medical facility.

Keith Groller, a columnist for the Morning Call of Allentown, Pa., interviewed Dibilio 10 days after he had his stroke, and the star player seemed to be making good progress.,0,2305917.column

Dibilio, who was the Ivy League Rookie of the Year, was back at home and undergoing therapy three times a week. He told Groller that after the stroke, he couldn’t  speak or move his right arm and leg. Now, he says he is OK physically. 

But in a disturbing aside that rings alarms, he added, “I just need to work on my speech and some mental things.”

Dibilio is still waiting for the results of tests that are trying to pin down what caused his stroke, according to Groller. But apparently, doctors think there is some kind of  link between the stroke and a spleen infection that Dibilio had last year, something that is causing “a clotting disorder.”

The young athlete’s mother said that Dibilio’s therapy is meant to improve his cognitive and language skills, as well as his reading comprehension. One would imagine he would need all those abilities to succeed at Princeton.

There is no timeline yet for when, or if, Dibilio will return to either school or football. He said that he is optimistic. I wish him well.       


Illinois Man Thinks It’s A Joke When He Learns He Shot A Nail Into His Brain


Posted on 22nd January 2012 by Gordon Johnson in Uncategorized

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Truth is sometimes stranger than fiction, especially when it comes to the brain. Take the case of Dante Autullo.

Autullo was using a nail gun to put together a shed in his hometown of Orland Park, Ill., Tuesday. According to the Associated Press, he had the nail gun above his head and fired it. He thought he felt a nail fly past his ear, and in fact his common-law-wife, Gail Glaenzer, cleaned a cut on his head afterward.

But the next day Autullo, 32, felt nauseous, and went to the hospital. Imagine his surprise when doctors showed him an X-ray of his skull, which showed a 3 1/4 nail in the middle of his brain.

AP reported that at first Autullo thought the doctors were trying to pull one over on him.

“When they brought in the picture, I said to the doctor, ‘Is this a joke? Did you get that out of the doctors’ joke file?” Autullo said, according to AP.

But it was no joke. The nail was there.

Autello remained remarkably cool even after he learned that he had a nail in his head. As an ambulance took him to a second hospital for surgery, he posted his mind-blowing X-ray on Facebook, AP reported.

Autello was apparently lucky in terms of where the nail ended up in his brain, barely missing the area that controls motor function, according to AP.

Surgeons removed the nail and Autello was doing well. As one neurosurgeon explained, being shot in the head with a nail is a lot different than being shot in the head with a bullet. The nail is thin, so does minimal damage, and doesn’t explode into pieces like a bullet.

AP’s report said that surgeons removed the nail by putting a hole in Autello’s skull near each end of the nail, and then fished out the nail. Part of the skull came out, too, and that was replaced with titanium mesh, the wire service said.

I’d suggest that Autello lay off the do-it-yourself home projects for awhile.   


Therapists Try To Find Ways To Help Married Couples Cope With TBI


Posted on 12th January 2012 by Gordon Johnson in Uncategorized

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I’m been working on a career-capping passion project: Conducting video interviews of those who have suffered traumatic brain injury, as well as their families.

One of the sad refrains I hear again and again, and have heard throughout my many years working as a lawyer,  is that they — TBI victims and their loved ones — want things to be the way they were before the car accident or fall or surgery or bomb blast or whatever that caused their injury.

In some cases, that happens. In most, it does not. 

A few days ago it was the first anniversary of the horrendous supermarket massacre in Tucson,  where Congresswoman Gabrielle Giffords was shot through the head. While Giffords has made amazing progress, it’s doubtful she will ever be the same person she once was. Yet her husband, ex-astronaut Mark Kelly, remains at her side.   

 What is their marriage like now?

The New York Times Tuesday did a fascinating story on the impact, and strain, that life-changing TBI puts on what was once marital bliss. The headline was “When Injuries To The Brain Tear At Hearts: Marriage Counseling Is Evolving To Help Couples Survive Personality Changes And Physical Challenges.”

The Times story said, “Contrary to conventional wisdom, many relationships do survive  after a spouse suffers a brain injury.”  In fact, the paper claimed that research indicates that the divorce rate was 17 percent for couples where one spouse had TBI, a statistic that’s below the national average.

But researcher and psychologist Jeffrey Kreutzer of Virginia Commonwealth University in Richmond put a  damper on that good news.  He told The Times that the quality of the relationships two people once had can be “seriously diminished.” Wives and husbands can feel like they are living with a stranger because of the profound impact of brain injury. 

Kreutzer is part of a group of therapists at Virginia Commonwealth who are trying to tailor marriage counseling to couples impacted by TBI.

The story offers two cases studies: One of a couple where the wife is struggling to cope with her husband’s personality changes and depression, and a second couple that seems to be adapting fairly well to the husband’s TBI.     

It circles back to what I said at the beginning of this blog, that most people with TBI will never be the same as they were before their injuries, and that the emotional tenor of their relationships will likely not stay the same.

Kreutzer’s role “means teaching uninjured spouses to forge a relationship with a profoundly changed person — and helping injured spouses to accept that they are changed people.”

The idea is to keep people looking to the future, not the past.

I wish Kreutzner and his colleagues success in their work, helping troubled couples impacted by TBI.

Ex-Sen. George McGovern Hospitalized After Hitting Head In Fall


Posted on 3rd December 2011 by Gordon Johnson in Uncategorized

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Former Democratic presidential nominee George McGovern remained in stable condition Saturday after falling and sustaining a head injury on the way to a TV telecast yesterday, according to numerous press reports.

McGovern was hospitalized and resting Saturday at Avera McKennan Hospital & University Health Center in Sioux Falls, S.D.

The 89-year-old ex-senator was airlifted to the hospital Friday night after he fell down and struck his head outside Dakota Wesleyan University’s McGovern Library, according to The Daily Republic. McGovern was going there to appear on a live broadcast of “The Contenders,” a C-SPAN series about candidates who unsuccessfully ran for President but still had a dramatic impact on politics and history. 

McGovern was the Democratics candidate for President in 1972, losing to Richard Nixon.

According to The Daily Republic, Dr. Michael Elliott, chief medical officer at Avera McKennan Hospital, said, “Sen. McGovern is alert and resting comfortably but, as with any head injury, it is important that we observe the situation closely.” 

In a press release, Avera McKennan said that McGovern’s family extended its gratitude and appreciation for the many prayers and well wishes it has received.

But the family also requested privacy so it can focus on McGovern’s recovery.

McGovern is a native and part-time resident of Mitchell, S.D., and a DWU alumnus.

C-SPAN went forward with its two-hour “Contenders” episode without McGovern.  A panel discussed McGovern’s 1972 race, and the series aired video clips of him, according to The Daily Republic.





Former Green Bay Packer Forrest Gregg Has Parkinson’s Disease, Which Has Been Linked To Head Injuries


Posted on 24th November 2011 by Gordon Johnson in Uncategorized

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Forrest Gregg, an ex-Green Bay Packer Hall of Famer, has been diagnosed with Parkinson’s Disease. Is that malady linked to he concussions and brain injuries that he sustained during his career?

That’s the intriguing question raised by sports columnist Brooke McGee of the Bleacher Report.

Right now Gregg has developed hand tremors, a stooped posture and smaller stride, according to McGee.  A Parkinson’s expert, Dr. Rajeev Kumar, has diagnosed Gregg with the disease.

The columnist then goes on to cite research from the Mayo Clinic, which says, “those who have experienced a head injury are four times more likely to develop Parkinson’s Disease than those who have never suffered a head injury. The risk of developing Parkinson’s increases eightfold for patients who have had head trauma requiring hospitalization, and it increases 11-fold for patients who have experienced severe head injury.”

The sounds like pretty convincing data to make one believe that Gregg’s Parkinson’s was prompted by the many concussions that the NFL veteran suffered while playing for Green Bay and Dallas, according to McGee.

And we’d have to agree.

It’s unfortunate that the league stuck its head in the sand, and then was in utter denial for so long, about the long-term impact of head injuries and concussions on players.   



Sports Writer Frank Deford Offers His Analysis Of Cincinnati Bengal Chris Henry’s Brain Damage


Posted on 7th July 2010 by Gordon Johnson in Uncategorized

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Veteran sports writer Frank Deford takes up the story of Chris Henry, the deceased Cincinnati Bengal player who was found to have sustained brain damage, in a story for NPR Wednesday.

Deford poses an interesting question: Are some athletes more susceptible to brain damage than others?

And he talks about efforts to find a way to determine if someone has a predisposition to brain damage.

I’ve written in-depth about the significance of Henry’s case, and Deford goes over it as well. Henry died several months ago after falling off the back of a pick-up truck. Apart from the injury from his fall, an autopsy determined that Henry  had CTE, chronic traumatic encephalopathy, which is essentially brain trauma.

Right now CTE can only be positively diagnosed by an autopsy, “in the brain tissue of cadavers,” as Deford puts it. So far 22 deceased ex-National Football League players have been found to have suffered from CTE,  he notes.

Henry’s case is a landmark because his death occurred while he was still in the prime of his career (had he not had all of the behavioral issues) and he never even sustained any documented concussions.

Deford writes about efforts to find a test that will detect CTE in the brains of the living. Lisa McHale, the widow of deceased NFL player Tom McHale, and McHale’s friend Jim Joyce are pushing for that.

McHale, suffering from depression and self-medicating with drugs, died of an overdose when he was just 45. His widow  Lisa blames his problems on brain damage he sustained while playing pro ball.

Joyce, himself an ex-player, is chairman of Aethlon Medical in San Diego. Joyce is doing research to determine if there are biomarkers that could be used to find those with a predisposition to CTE, according to Deford.

The question is asked could such a test convince parents to steer their kids away from sports like football and soccer if in fact they do have a predisposition to CTE.

The concern I have as I hear the chorus about CTE from more and more voices is that they seem to confuse the issue.  The issue is not whether there is an after death marker of brain injury, CTE, but whether there has been brain injury.  We can’t find a test for CTE because it is a particular thing that is only found on autopsy.  While we can’t find a litmus test for brain injury, experienced doctors can make the diagnosis with the proper consideration of all of the medical evidence, including the story of the life of the injured person.

Chris Henry’s life told such a story.  The tragedy is that no one ever listened to it in context that he was an athlete, playing a violent game.



Chris Henry and TBI: Would Dr. House have Diagnosed Brain Injury in Time?

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Posted on 29th June 2010 by Gordon Johnson in Uncategorized

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Brain injury is a condition that involves microscopic damage to brain tissue that can only be seen in life through the lens of the patterns of the injured person’s life.  Chris Henry, the former NFL wide receiver whose autopsy results confirmed he was living with brain damage, may have finally made that clear.  See yesterday’s blog Mike Wilbon of Espn’s PTI ( called the Henry story the most important sports story of the day and even went so far as to say that because of this story, his two year old child would never play football.  This story is important not just because it warns us of the dangers of playing football, but because it tells us we must think “brain injury” when looking at the patterns of troubled people’s lives.  This story also tells us that it is time that autopsy returned to head of the research class in understanding about all pathology, but especially that in the brain.

Since I posted yesterday’s blog, I have done some research on Chris Henry’s life, not just to see the pattern of behavior issues, but also to see if anyone had ever considered a diagnosis of “brain damage” at any time prior to his death. I could find no references to any physician, trainer, NFL official or commentator (including myself)  ever suggesting that Henry was suffering from Post Concussion Syndrome.  When doctors make a diagnosis, they should engage in something called a differential diagnosis, which involves a consideration of all the possible diseases.  I always think of this as a Doctor House (from the TV series) process of putting diseases on a whiteboard, then crossing out the ones that don’t fit.  I strongly suspect that no doctor had ever put TBI on Chris Henry’s whiteboard, or if they ever did, quickly dismissed it because there was no single concussion that he was treated for.

Here (with the easy job of Monday morning quarterbacking the diagnosis) is how I picture Dr. House and his cast approaching the problem.  It is the fall of 2009 and Henry is again asking Commissioner Goodell for reinstatement and Goodell orders a full assessment on Henry.  Because Henry is such a special case, Goodell enlists the services of Dr. House. (If you are not familiar with the show, the cast and plot is explained here: ) House pulls his team together and starts writing on the whiteboard the following potential conditions:

  • Nutcase;
  • Jerk;
  • Spoiled jock; and
  • Bi-polar.

Dr.  “Thirteen” Hadley throws out “brain injury.”  He is a football player she says, a wide receiver, he does get hit often.  Dr. Chase states “it can’t be brain damage, the CT was clean.”  (He actually did say that in an episode in Season 6;summary ).  Dr. Foreman, a neurologist, puzzled  by Thirteen’s suggestion, argues that Henry was never knocked out. Dr. Taub points out that according to the CDC you can have brain injury without ever losing consciousness and that CT’s show virtually no evidence of brain damage when done post-acutely.  House steps in and orders an MRI.

After the commercial, our cast reassembles, normal MRI in hand and now Dr. Foreman derisively dismisses the TBI theory, stating that this is all psychiatric and Henry should be shipped off for an inpatient evaluation at a psychiatric hospital.  House who has some experience with such places says to hold off on that until they have ruled out all “organic causes.”

Taub raises the possibility of Carbon Monoxide poisoning or toxins and House dispatches Chase and Foreman to search Henry’s apartment, where they find nothing.   Meanwhile, Thirteen has not abandoned her initial theory of TBI and pours over the history of Henry’s on the field and off the field problems in his NFL file (for a detailed history see ).  Here is what she finds:

  • During Henry’s sophomore season in college at West Virginia , he was ejected from a game at Rutgers University due to multiple unsportsmanlike conduct penalties and was suspended for the season finale against the University of Pittsburgh. His former Mountaineers coach, Rich Rodriguez, stated that he was “an embarrassment to himself and the program” for his conduct.[6]
  • On December 15, 2005, Henry was pulled over in northern Kentucky for speeding. During a search, marijuana was found in his shoes. He was also driving without a valid driver’s license or valid insurance.[19] He pleaded guilty and avoided a jail sentence.
  • One month later, on January 30, 2006 he was arrested in Orlando, Florida for multiple gun charges including concealment and aggravated assault with a firearm.[20] He was reported to have been wearing his #15 Bengals jersey at the time of his arrest. He pleaded guilty to this charge and avoided jail time.
  • On April 29, Henry allowed three underage females (ages 18, 16 and 15) to consume alcohol at a hotel in Covington, Kentucky.[21] One of the three, an 18-year-old woman, accused Henry of sexually assaulting her; she later retracted her story and was charged with filing a false police report.[22] On January 25, 2007, Henry pleaded guilty to a misdemeanor violation of a city ordinance commonly referred to as a “keg law.” He was sentenced to 90 days in jail, with all but two of those days being suspended.[21]
  • He was pulled over on Interstate 275 in Ohio on June 3 at 1:18 A.M. by Ohio Highway Patrol trooper Michael Shimko for surmised drunk driving. He voluntarily submitted to a breathalyzer test at 2:06 A.M. at the Milford Police Department and registered a .092 blood-alcohol level, .012 above the level permitted in the state of Ohio.[23]
  • Henry allegedly assaulted a valet attendant at Newport on the Levee in Newport, Kentucky on November 6, 2007.[26] He was arrested for a second time in Orlando on December 3 for violating his probation he was on from a January 30, 2006 arrest. On February 21, 2008, he was found not guilty.
  • On March 31, 2008, Henry punched a man named Gregory Meyer, 18, and threw a beer bottle through the window of his car. Henry claimed it was a case of mistaken identity and also that he thought it was somebody else that owed him money. Henry was waived by the Bengals a day after this arrest and was then served a house arrest sentence.

What Thirteen concludes from this conduct history is that Henry never seems to grasp that there are rules or that there will be consequences to  his actions.  Even if he does, he doesn’t seem to be able to conform his actions.  The multiple unsportsmanlike conduct penalties in one game in college stands out as a precursor of all that followed.

Thirteen Googles “criminal behavior and tbi”.  What she finds is the articleAcquired Brain Injury and Criminal Behavior by Inés Monguió, Ph.D and our blog

What she finds in Dr. Monguió’s paper:

Brain injury, particularly to the frontal lobes or to the connecting circuits of frontal areas to other brain centers, can affect the ability to form criminal intent. Deficits in executive function result in poor self monitoring, planning, judgment, and forethought. The rigidity or impulsivity often seen in traumatic brain injuries make the formation of criminal intent quite a challenge for the individual. Following are general areas to consider when evaluating a criminal defendant to provide information during the trial. The question of legal insanity will be explored in more detail as neuropsychological data may provide information to the courts regarding a defendant’s state of mind at the time of the commission of the crime.

She compares the paper to Henry’s behavior and finds poor self-monitoring, judgment, forethought, as well as impulsivity.   Thirteen renews her argument for TBI.  House points out that you need a traumatic event for a Traumatic Brain Injury.  Where was the event?  Thirteen, argues back that repeated sub-clinical blows, like boxers receive, can cause long term encephalopathy, without a specific concussion – Muhammad Ali was never knocked out.  She argues for a neuropsychological assessment.

This of course would be one of those episodes where House couldn’t walk in at the last instant with the miracle cure.  In the “fact is stranger than fiction” category, Henry actually dies of a traumatic brain injury when he falls from the back of his fiancé’s truck after another neurobehavioral event, a domestic squabble.  All of the circumstances leading up to his death point to brain injury – temper control, violence and judgment in getting into the back of the pickup.  We would hope that this would be one of those cases where House, haunted by the death he couldn’t solve. would order the autopsy.

Fortunately for the future of TBI research, the autopsy was ordered here.  The best thing that has come out of the NFL head injury awareness program is the move to enlist current and former players in this autopsy project.  What we don’t yet have and maybe never will is the answer as to what to do when the in vivo (during life) half of the diagnostic tree points to TBI in someone who makes his living getting hit.  Would treatment for TBI have saved Chris Henry’s career, his life?  Probably not the first, potentially the second.


Prior Combat Stressors Adds One More Trap for TBI

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Posted on 18th June 2010 by Gordon Johnson in Uncategorized

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In our last blog, we introduced the reader to the potentially disastrous combination of TBI and PTSD conditions in a combat survivor. But the problem in combat is not just the intersection of these two “co-morbidities”, but the likelihood that a third complicating factor- preexisting anxiety – will also be found in combat veterans.

As we outlined yesterday, the Limbic System is the part of the brain which regulates anxiety and memory. Just as the corpus callosum is the collection of axonal fibers that connects the two hemispheres of the brain, the uncinate fasciculous is the collection of axonal tracts that connect the principal memory and anxiety centers of the brain to the frontal lobes – the thinking and maturity parts of our brain.


The principal structures involved include the following;

Hippocampus. The brain’s save button is the hippocampus. It is the part of the brain most important to converting immediate memory to long term memory.

Amygdala. The brain’s anxiety center is the amygdala. It is the amygdala that protected us from predators in the pre-historic times. It triggers our startle reflex in modern times and is the principal culprit in anxiety disorders.

Frontal Lobes. The frontal lobes are where we learn to become adults, where all activity is initiated, decisions made, emotions modulated and judgment’s made. The orbital frontal part of the frontal lobe, on the underside, is essentially the conductor of the brain’s symphony, the part that tells the other instruments when to start and stop playing. The frontal lobes coordinate all activity.

Uncinate Fasciculous. Connecting the above critical structures is the uncinate fasciculous, the axonal tracts that run from one end of the lower brain structures to the underside of the frontal lobes.

A person with a pre-injury anxiety disorder is far more vulnerable to post concussional problems (PCS). In a person with an anxiety disorder, the amygdala is already overreacting to potential anxious moments. It runs “hot” so to speak. When, as a result of trauma, such as a blast, damage occurs to the hippocampus, frontal lobes and the uncinate fasciculous, the information that gets moved across this lower brain circuit gets garbled. When information between the limbic system and the frontal lobes gets garbled, anxiety can become panic, depression can become organic rather than just reactive and the person’s ability to modulate emotions and make decisions, seriously impaired. The combination of pathologies in these areas -coupled with inefficient communication between them – creates a synergistic pathology far more functionally impairing than any one of those impairments might have been alone.

As serious as this premorbid vulnerability is in a civilian, it is far more serious in a soldier. Think of it this way. The amygdala is there to get us to run, without stopping to think. Fortunately for peace time activities in the modern world, our socialization has taught us when not to panic. A civilian has few times when he or she needs to rely on the amygdala. There are few great predators, few brushes with real danger. Thus, our frontal lobes and other emotional centers have tamed our amygdala, in not so different of a way than we tame a pet.

Yet, the amygdala is needed for combat. To survive, a soldier must rely on his instincts and must put his mind into a hypervigilant state. One of the biggest problems that soldiers have reintegrating into civilian life is learning how to stop this hypervigilance. PTSD is primarily a disease where the traumatic emotional stress has so changed the amygdala that it never entirely goes back to its peace time role.

Thus even before a TBI, a combat veteran is likely to have a heightened anxiety. Without that anxiety- the hypervigilance – the soldier may not survive. Depending on the level of previous battle stresses, that anxiety may have elevated itself to PTSD levels prior to the TBI. Thus, the risk of emotional dysfunction is not only increased by the very battle in which the soldier is injured, but also by the pre-injury emotional state.

The irony of all of this is that this convergence of co-morbities is laid upon those we expect to be the toughest. “The Few, the Proud” are those at greatest risk of becoming the homeless, the disturbed, the arrested. Sadly, I can offer no solution other than peace.


Much-Needed Update Of Guidelines To Determine Brain Death Are Released


Posted on 7th June 2010 by Gordon Johnson in Uncategorized

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There’s lots of injustice in this world, and declaring somone brain dead who isn’t would be high on the top of the list of such tragedies. 

 That’s why I think it’s a good idea that new guidelines for determining if a patient is brain dead have just been issued.  

Essentially saying it wants to take the guesswork out of the process, the American Academy of Neurology Monday released those new guidelines — the first update in 15 years.

 The new guides tell physicians to do a extensive evaluation of a patient, with a check list of about 25 tests that must be performed and specific criteria that must be met.

The new guidelines were co-written by Dr. Panayiotis Varelas, director of the Neuro-Intensive Care Service at the Henry Ford Hospital in Detroit.

The U.S. Uniform Determination of Death Act does define when death takes place: When a person permanently stops breathing; the heart stops beating; and all brain functions, including those in the stem, stop.

The problem is that doctors differently determine who meets those criteria.

A 2008 study that included 41 of the country’s top hospitals, done by Varelas, found a lot of variability in how doctors and hospitals judged who fit the criteria. 

 Under the revised guidelines, the three signs of brain death are coma with a known cause; abscence of brain stem reflexes and the permanent cessation of breathing.  

Being in a vegetative state does not equate to being brain dead, according to the new rules.

Brain death is caused by severe traumatic brain injury, stroke or oxygen deprivation following cardiac arrest.         

President Obama Signs Veterans Traumatic Brain Injury Bill


Posted on 8th May 2010 by Gordon Johnson in Uncategorized

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Some say that ” the signature wound” of the wars in Iraq and Afghanistan is traumatic brain injury (TBI), and last Wednesday President Barack Obama took action to try to help veterans with that malady.

Obama signed legislation into law that is trying to improve the kind of care military veterans receive for TBI.

The bipatisan law seeks to develop guidelines for better treatment and rehabilitation of veterans with TBI, in that it establishes a panel that will determine what kind of job the Veterans Administration is doing when it cares for veterans with brain injury.

 The panel will also make yearly recommendations for VA improvements and set up a TBI education and training program for VA professionals.

The bill was sponsored by Rep. Jerry McNerney, D-Pleasonton, who has been working on the legislation since he went  to Congress three years ago to represent California’s Stockton and San Joanquin County.

War-zone blasts, gunfire and shrapnel in Iraq and Afghanistan are driving up the number of brain injuries that soldiers are sustaining. In 2000, the number of those with TBI was 10,963. But back in December that number had more than doubled, jumping to 27,862, said the Defense and Veterans Brain Injury Center.