The Injury Board Commentary - Spinal Cord Injuries - Most Commented

What wheel chair cushions are top rated for pressure sore relief?

Wayne Parsons — Sat, 27 Aug 2011 05:15:26 GMT

For individuals who have suffered spinal cord injuries, pressure ulcers caused from wheelchair use are a serious concern during rehabilitation and are the most common long-term secondary medical complication for spinal cord injury patients. That’s why a study conducted in 2001 by researchers at the University of Florida Department of Occupational Therapy deserves attention.

The study examines how wheelchair design—and more specifically, wheelchair cushion design—helps to mange and prevent this type of complication. Because almost all wheelchairs are marketed as “the best” for pressure reduction, the researchers wanted to provide useful information to occupational therapists that would help them distinguish between wheelchairs that were actually effective at doing this versus those that were not.

This particular study focused on a single patient, with the hypothesis being that the Roho cushion, as compared to Jay or gel cushions and Pindot or polyurethane foam cushions, would provide the most pressure relief. The researchers used a computer pressure-mapping pad called Xsensor to determine and measure the patient’s pressure points on each of the three different types of cushions during the course of the study. The study concluded that the Roho cushion was in fact the most effective in relieving pressure on the seating surface for the patient who participated in the study, a conclusion that aligns with other research on the same question.

The study is purposefully not empirical. That is, the researchers note from the outset that prescribing an appropriate wheelchair cushion requires an occupational therapist to evaluate each individual separately—there is no “one size fits all” approach to preventing pressure ulcers. Instead, the study offers a methodology for therapists to use in order to prescribe the best cushion for each patient and to monitor its effectiveness over time.

This type of one-on-one treatment and the use of technology to measure pressure points with different cushions could go a long way to helping spinal cord injury patients manage the complications associated with their condition.

Originally posted at InjuryBoard by Wayne Parsons

Don't Get Stuck With the Chiropractor's Bill

Doug Landau — Mon, 29 Nov 2010 21:02:10 GMT

In yesterday's post, we discussed some of the practices that chiropractors have used on innocent victims of car crashes. When an injured plaintiff has valid health insurance coverage, they do not expect the chiropractic office to grab settlement proceeds after failing to bill the health insurer. So, what can you, as a patient, do to take control of this situation and ensure that you get billed as you wish?

* To the extent possible, do some research before you head to the chiropractor’s office. Know what your payment options are under your health insurance and under your auto insurance.
* YOU make the decision about which insurance you would like to use and communicate this decision during your first visit at the chiropractor’s office.
* Read carefully any forms that you have to fill out at the chiropractor’s office and fill them out based on the decisions you have made beforehand.
* Carefully track—and save—any records, forms, letters, notices, or other documentation that you receive from insurance companies and your chiropractor’s office.
* Take a proactive stance when dealing with your insurance claims. Don’t wait for the chiropractor or your insurance company to just take care of things for you, because they may not know what is in your best interest.

Dealing with expenses from auto accident injuries can be a frustrating experience that is made more difficult by the emotional and physical pain from a spinal cord injury or herniated disc that you might be experiencing at the same time. But, simply being aware of your options and keeping track of the process can prevent further headaches down the road. Ask up front if the Chiropractor takes your insurance and make sure the office actually bills the insurance company to whom you, your family and/or your employer has paid premiums. It may prevent worse headaches and pain at the end of your automobile crash injury case.

Originally posted at InjuryBoard by Doug Landau

Why Choose Our Firm

Sach Oliver — Mon, 05 Jan 2009 15:30:56 GMT

Every Monday morning we have a meeting to discuss our goals we intend on accomplishing for each of our clients that week. The meeting gets started early, sometimes as early as 6:30am. After we had our goals figured out this morning, I asked Leona, one of the world's greatest legal assistants, why should a person who is hurting choose our firm.

This is what she said:

"I believe that a potential client should choose our firm because we work our cases as if we were the client. We go out of our way to examine and investigate every possible avenue of compensation available to the client. We do all the investigative work and request all medical records, leaving the client able to concentrate on recovery. As a potential client, I would rather concentrate on healing and getting the rest necessary to fully recover instead of worrying about all the paperwork and phone calls that are required in pursuit of these cases. We are a full service firm and our main objective is to make the client’s life easier and to obtain the best possible outcome in every case."

Wow! It is wonderful to work with such caring people such as Leona. After hearing this, it makes it easier to understand why she works so hard for our clients.

Originally posted at InjuryBoard by Sach Oliver

Social Security Disability claimants: know your lawyer, know you're ready for your day in court

Doug Landau — Fri, 19 Nov 2010 10:58:00 GMT

Trying two Social Security Disability cases on the same morning in DC requires a lot of preparation. We had invested time, resources and money in our clients' spinal cord injury cases and felt ready to go to trial. Special medical reports were secured from the treating doctors and a highly regarded vocational expert was retained, interviewed the disabled and prepared evidence for the Federal Administrative Law Judge.

But having met with the families, the disabled claimant and the expert vocational witness, my clients and I were shocked to see a lawyer walk into the waiting room and ask if "Mrs. X" was there. Mrs. X asked if he was her lawyer ! We could not believe what we were seeing. The lawyer said he was covering for another lawyer. Mrs. X said she had never spoken to the lawyer he was "covering" for; she only spoked to a paralegal ! They then met, for the first time, moments before they had to appear before the judge. We felt so sorry for them. Mrs. X looked so nervous and their lawyer appeared so unprepared. I don't think they were going to get a "fully favorable" opinion. I hope they did, but we do not think that they will. If you, someone in your family or a friend, is seeking Social Security disability benefits, then get a good, experienced lawyer that you can visit with, prepare with and win with. You, your family and your friends deserve to be ready for the "day in court."

Originally posted at InjuryBoard by Doug Landau

Spinal Cord Injury

Sach Oliver — Wed, 08 Apr 2009 17:45:33 GMT

Spinal Cord Injury

I am reading a very informative and interesting book about spinal cord injuries. The book is titled Spinal Cord Injury: Functional Rehabilitation. The author is Martha Freeman Somers with the Department of Physical Therapy, Duquesne University in Pittsburgh, PA. My wife, Codi, is an occupational therapist and this was one of her text books in OT school. I bet she never thought she would marry a man so nerdy that he would read her college text books. Some folks just luck out.

Back on point, this book is perfect if you want to learn about spinal cord injuries. It paints the picture of what it takes for spinal cord injured patients to get back to a functional life. I plan on blogging about different topics throughout the book over the upcoming weeks.

As an introduction, every year almost 10,000 people receive a spinal cord injury in the United States.[1] The causes for spinal cord injuries are below:[2]

1. Motor vehicle accidents: 37.2%
2. Acts of violence: 26.8%
3. Falls: 21.0%
4. Sports injuries: 7.1%
5. Other causes: 7.9%

[1] National Spinal Cord Injury Statistical Center.(1999). Spinal Cord Injury: Facts and Figures at a Glance. Available from: www.spinalcord.uab.edu/docs/factsfig.htm

[2] Id.

Originally posted at InjuryBoard by Sach Oliver

Hospital Gowns: Are We Finally Going To Get A Cover Up?

Mike Bryant — Sun, 28 Mar 2010 09:19:00 GMT

Anyone who has been to the doctor for a full examination understands the discomfort of hospital "peek-a-boo" gowns. I have always been bothered by stories of plaintiff, who are injured and are subjected to examinations by "Independent" doctors who the insurance companies hire and who are asked to get into gowns. Yes, neck and back injures and the "doctor" needs to undress them.

There may be some help on the horizon. Ben de Lisi, the fashion designer, is looking into a new design.

The BBC News reported Ben De Lisi's idea as:

Ben de Lisi's early concepts met with great approval

"The old hospital gown was hideous, embarrassing, ill-fitting and probably ill-making too.

"You are away from home, ill, and in hospital and you have to wear this horrific garment with your arse hanging out. Give me a break.

"I wanted the new gowns to feel fabulous and aspirational.

"They are made from beautiful cotton shirting which is very smooth, cool and lux."

The idea is that the patients will be more comfortable and that may help with their care. It will be interesting to see if these changes toward modesty and sensitivity will also mean that less of our clients will be placed in the open door gowns.

Originally posted at InjuryBoard by Mike Bryant

A True Story

Joe Crumley — Sat, 19 Sep 2009 18:48:00 GMT

A crisp and bright October Sunday morning. The kind of morning that inspires drives out of the city seeking clear air and crimson and amber leaves by roads and rivers.

First things first, though. Mom teaches Sunday School and starts her class prep an hour before. Dad is in charge of the kids until class starts, and when the weather is good, a nature walk along the creek fills the time. Today, however, something different.

It's the morning of the marathon. Dad has been drafted by best friend James to handle snack, first-aid, and petroleum jelly for socks at Milepost 18, which James won't reach for a couple hours. There will be plenty of time to reach Milepost 18 after Sunday School. The church is near Milepost 4, and a check of his watch tells Dad the race is just starting, a few miles away.

Dad shepherds the kids to a bridge where the marathon route crosses the creek. Beyond, the parkway is a broad, sweeping curve. Dad has done this before, and remembers the joy of clapping and cheering on the runners. But always in the middle of the course, arriving only in time to see the middle speed runners, like James. For once, he wants to see the first runners, and taste the excitement of the leaders. Dad has told the kids about this. But Dad has forgotten who usually leads the marathon.

The kids began to get bored after a few minutes, as the runners don't appear right away. They cavort and roll in leaves. A few more minutes and a whisper of clapping and cheering is heard in the distance, then builds. At Dad’s yell, the kids come running back to the bridge. They huddle by him at the curb, all leaning out over the pavement, squinting into the distance.

The clapping gets ever closer, as do indistinct yells of encouragement. My eight-year-old boy looks intently down the road. He often does not care or pay much interest in sport, and his attention span may again soon wander.

Suddenly, a small, low-to-the-ground form comes sweeping past the trees through the beginning of the curve. There is a moment of confusion, then recognition. Not a runner, but a man in a wheelchair ... and he's going fast.

Another man in a wheelchair is coming up the outside, gaining on him. They're almost neck and neck as they sweep through the turn, across the bridge toward us.

I look at my son and note the gradual recognition of what he's seeing. His eyes grow big. It’s a wheelchair. Eyes grow bigger.

His legs are really tiny. Atrophied, tucked almost like an afterthought into a pouch on the racing wheelchair beneath a paradoxically strong, rippling, upper body. He really can't walk or run.

My son is a sensitive boy, and his face begins to screw up at the immensity of what he's seeing. A man who cannot walk; a man who cannot run … is … flying. My boy’s eyes gleam and tears form at the corners of his eyes. Enviably large churning biceps, sweating forearms, and gloved hands literally beat power into the spinning rear wheels.

Men who cannot walk are going to win this marathon.

Misreading his expression, I move to comfort him but he brushes me back and responds quickly, almost as quick as the two men now sweeping by us tucked into their machines.

"Go, Wheelchair Guy, Go!” at the top of his lungs, his voice just cracking. I don’t know which of the two racers he is cheering, but it doesn’t matter. Both racers react immediately to the childish sincerity of that yell, which easily pierces the cheers of the other onlookers. The strain of their Herculean duel notwithstanding; both faces break into broad grins at the cheer.

In a moment they have swept around another corner, still neck and neck. Many more wheelchaired racers sweep by; men and women. Tears are streaming down my face, my son’s face, and his older sister.

A quiet interval, and the running men arrive. All their muscles are lean, and their strides rhythmic and effortless. They are some of the most impressive athletes in the world; some have crossed oceans to run and ‘win’ this race. But they are not so impressive as they might have been just a moment before.

The effort, the striving, indeed the full and complete meaning of sport, encapsulated in one innocent, sincere and robust cheer of an eight year old child. A simple expression of what we often struggle to explain in our closing arguments; the value of strength, the value of physical effort and competition. Not tears of sympathy for them, but a shout of encouragement and tears of joy and wonder.

The 2009 Twin Cities Marathon will be run October 4.

Go, wheelchair guy, go.

Originally posted at InjuryBoard by Joe Crumley

Is The Blue Mice Group Going To Help With Spinal Injuries?

Mike Bryant — Sat, 05 Sep 2009 16:56:00 GMT

Doctors are now looking to blue mice to deal with spinal injuries. Apparently, through the injection of Brilliant Blue G into injured mice, researchers are seeing substantial signs of healing. The tested mice are more active and moving about, as compared to the control group which showed no improvement and couldn't walk. The mice also turn blue.

It is thought that the Brilliant Blue G blocks the problem that creates inflammation in the injured spinal cord. Limiting or preventing the inflammation is understood to prevent extensive irreversible damage. The researchers from the University of Rochester will be continuing the research with clinical trials. The blue dye is found in M and M's, Jell-O, candy, and drinks thus is approved for human consumption.

In our practice we see a number of these types of injuries. It would be great if they could find more remedies to help these people. As lead researcher Maiken Nedergaard pointed out "Even a moderate improvement in functional performance of the patient is a big, big event for these patients,...They can control their bladder. If they can just take small steps instead of sitting in a wheelchair all the time, it's a tremendous benefit for these patients," Hopefully, this research will help a lot.

Originally posted at InjuryBoard by Mike Bryant

Coping With Spinal Injuries: A Positive Outlook

Sach Oliver — Thu, 27 Aug 2009 12:29:31 GMT

Many people are aware of who Christopher Reeves was. The man who was Superman to so many Americans suffered a spinal injury which resulted in paralysis, when he fell from a horse. For many people it was a tragic scene to see a man who had leaped burning buildings spend the rest of his life in a wheelchair. While I am in no way downplaying the seriousness of such an injury (they are life-changing), it is important to know that for many people who suffer spinal cord injuries, life afterwards is not always tragic.

It is interesting to note that while a variety of serious emotions are felt by those who suffer spinal cord injuries, most people adapt well to their injury over time.[1] Research notes that after a period of adjustment the injured tend to have positive-self concepts, are in general satisfied with life, and are not more depressed than the non-injured.[2] One spinal cord injury sufferer noted that “We are the living demonstration that even if life circumstances become tough, life satisfaction can remain high. We’re proof that things can be hard, but good. People need to know that.”[3]

After a serious spinal injury it is typical for those injured to feel sadness, anger, hostility, anxiety, panic, feelings of inadequacy, shame, helplessness, and vulnerability.[4] It takes strong support to overcome these feelings and issues, but it can be done with the right help.

[1] Martha Somers, Spinal Cord Injuries: Functional Rehabilitation (New Jersey: Prentice-Hall, 2001), 59.

[2] Id.

[3] Quote by Barry Corbet; Martha Somers, Spinal Cord Injuries: Functional Rehabilitation (New Jersey: Prentice-Hall, 2001), 60.

[4] Id, at 59.

Originally posted at InjuryBoard by Sach Oliver

Americans Looking To Alternative Medicines

Mike Bryant — Tue, 18 Aug 2009 09:04:00 GMT

Last week, I wrote about the issues of pain killers and the advantages of chiropractic options. It's nice to see the recent study of the CDC’s National Center for Health Statistics (NCHS) which indicates that many Americans are looking other places than pain killers.

Highlights of the study include:

In 2007, 38 million adults made an estimated 354 million visits to CAM practitioners, at an estimated cost of almost $12 billion dollars.
Two-thirds of the out-of-pocket spending was for treatments that did not involve a practitioner, such as over-the-counter herbal therapies and other therapies, classes and materials. About $12 billion was spent on visits to practitioners such as chiropractors, acupuncturists, and homeopathic specialists.
The biggest single expenditure was for non-vitamin, non-mineral herbal supplements and other products (almost $15 billion) followed by practitioner visits ($12 billion), stretching and meditation-related classes such as yoga, tai chi, and qigong ($4 billion), homeopathic medicines ($2.9 billion) and relaxation techniques ($0.2 billion).

WebMD also noted some interesting findings about a type of injuries that we deal with a lot in the office:

Chronic pain, especially back pain, is by far the biggest reason that people turn to alternative treatments, Briggs said.

She cited previously released data from the 2007 survey showing that of the top 20 conditions for which CAM treatments are used, nine involve chronic pain.

“Americans turn to treatments like acupuncture, chiropractic care, and massage therapy to deal with these painful conditions,” she said, adding that groups like the American College of Physicians and the American Pain Society are on record as endorsing these therapies as useful options for the treatment of chronic back pain.

Briggs said assessing the safety and effectiveness of these and other alternative therapies used to treat chronic pain is a major focus of NCCAM’s research efforts.

“I think everyone would agree that we don’t know as much as we should, and need to know more, about how to manage back pain,” she said.

I see this as very good news. Hopefully, these numbers will be considered as the health insurance debate continues. People need to have options and deadly painkillers aren't the answer.

Originally posted at InjuryBoard by Mike Bryant