The Injury Board Commentary - Head & Brain Injuries - Most Commented

Dry Drowning Warning For Parents

Eddie Farah — Sat, 07 Jun 2008 01:59:00 GMT

The death of a 10-year-old boy from South Carolina this week while lying in his own bed, has brought attention to the little known “dry drowning.”

Johnny Jackson had gone for a swim in his neighborhood and walked home with his mother. He seemed fine except that his mother says he soiled himself, and then started talking slowly. He was sleepy. He lay down to take a nap and about one hour later he was dead.

Parents need to understand how dry drowning works. When water gets into the lungs, and it doesn’t have to be much, a child can asphyxiate. Lungs immersed in fluid are unable to take in oxygen from the air, but even with a small amount of water, Wikipedia says the “laryngospasm reflex essentially causes asphyxiation and neurogenic pulmonary edema.”

Basically when you breath, the diaphragm contracts, increases the volume of air into the lungs from the outside. During laryngospasm the person’s larynx spasm shuts. Air does not rush into the lungs. The heart is beating the blood flowing but it is not picking up oxygen.

Dry drowning can happen when someone has forceful contact with the water, such as from high diving or a water slide. Or just from summer fun in a pool, or even from a bath.

But the signs can be delayed and doctors don't know why. Signs are extreme fatigue and strange behavior which results from a reduction in oxygen to the brain. They need to get to an emergency room and have a breathing tube inserted so oxygen can be forced into the lungs so they regain their function.

3,600 people drowned in 2005, according to the CDC. About 10 to 15 percent were dry drownings, which can occur up to 24 hours after water is breathed into the lungs.

Johnny's mother, Cassandra Jackson, just didn't know, like most of us wouldn't.

"I feel like someone reached in and grabbed my heart and just yanked it out,” she says.

Originally posted at InjuryBoard by Eddie Farah

Hidden Dangers of Theme Park Rides

Ed Normand — Sun, 29 Mar 2009 14:01:31 GMT

While standing in line at at theme park in anticipation of enjoying a ride you have seen advertised on television you read a warning. It tells you not to ride if you are pregnant or if you have a back or neck injury. No problem there and so you proceed to the ride. While on the ride something about the ride causes you to smash a vertebrae, rupture a disc, or sustain a head injury. Should the parks be held responsible for these injuries where the park "guest' did nothing wrong, obeyed all warnings and there was no foreseeable likelihood of such an injury being sustained from the advertisements about the ride? What if the theme park operator knew others were hurt before on the ride but they deliberately make no mention of it in the warning? This is the true state of facts for many theme park rides.

Sadly, in Florida the big theme parks are legally allowed to keep most ride related injuries forever secret even when the injuries are sustained in the normal operation of the ride and even when the warning mentions nothing of the known prior injury. The parks intentionally withhold from the public information about ride injuries and instead go to great lengths to keep the data secret. Look up Florida Fifth District Court opinions on the subject. You will see the theme parks keep injury data secret and they are not obligated to report injuries except in very limited circumstances (in fact, the local fair is held to a higher injury reporting standard than the big 3 parks). To prove the point out of the multitude of injuries in the lawsuits cited in an Orlando Sentinel article today : "only nine of the 101 ride-related lawsuits found in the Sentinel's review of 2004-08 court cases were reported to the state as accidents when they occurred." The parks keep secret most of the injuries sustained in amusement park ride related injuries.

The theme park industry has cadres of lawyers who are hired to keep the information on ride injuries away from the public. Why would they do that if the rides are as safe as they claim. I have represented children with horrible permanent head injuries and facial scarring, others with broken bones and ruptured discs requiring surgery. All sustained from using the ride as instructed. Tell me where the warning explains those risks. Further on some of the rides the same injuries had been caused to others already on the same ride yet the warning makes no mention of the known danger.

Even after it is proved that the injury was caused by the ride, many times the parks do not do the right thing. Most people just want their medical bills paid but they get stonewalled by the parks. Often these are tourists from out of the country who do not have health insurance for U.S injuries. Other times U.S. health insurance does not cover the injury and so when the parks refuse to pay for even the medical bills indisputably caused by the ride "guests" must then come to a lawyer out of desperation.

The big parks make billions from advertising inviting guests to ride their rides. In turn, when an invited guest heeds all warnings, uses a ride in the manner intended, and yet sustains serious injury on a ride shouldnt the park pay for the damage caused by the ride? In my mind, that is simply the right thing to do.

Ed Normand.

Originally posted at InjuryBoard by Ed Normand

Rick Santorum's Tort Reform Agenda

Brett Emison — Wed, 02 Nov 2011 17:13:40 GMT

Rick Santorum was profiled by William Petroski at the Des Moines Register.

Based on his responses, it certainly appears that Rick Santorum is more a socialist than capitalistic conservative. Santorum talks the talk about states' rights, capitalism, responsibility and accountability, reigning in deficits, and reducing tax burdens on you and me, but like too many of thos who call themselves Republicans - including Gov. Rick Perry - fails to walk the walk when it comes to practice. Instead, Santorum, Perry, and others want to create bigger government, strip away state rights, raise the tax burden on regular people and give a government sponsored bailout to those who negligently injury and kill others. You see, Rick Santorum is "a big tort reform guy."

Many conservatives understand the importance of the 7th Amendment right to civil jury trial. Conservatives understand that the founding fathers inserted this amendment into the Bill of Rights for a reason. Conservatives understand that a civil jury trial is the ultimate check and balance against corporate and government intrusion. This is why leading conservative legal groups have begun to question the need for tort reform because of concerns about tort reform's encroachment on fundamental civil liberties, increasing the size and burden of government, encroachment of states' rights, and tort reform's failure to promote accountability and personal responsibility.

Andrew Cochran, Fred Thompson, Rand Paul, Clarence Thomas, and other leading conservatives have come out against tort reform.

Carter Wrenn offers this excellent example for why conservatives should reject tort reform proposals like those championed by Santorum and Perry:

A jury may still hear a medical malpractice case but it will not be told about Senator Rucho's cap on how much restitution it can award for disfigurement, loss of limb and so on. Instead, the jury will hear the evidence, reach its verdict, determine damages, award whatever it decides is fair restitution and go home.

But, then, something odd happens.

If the jury awards a victim (say, for the loss of his legs) over $250,000, Senator Rucho reaches out of the State Senate and into the jury box and changes its verdict and the judge cuts the restitution to $250,000.

Now Bob Rucho will tell you he's for less government and less government power but his bill extends the power of the State Senators and Representatives into a place (the jury box) where common sense and the North Carolina Constitution says politicians ought not to be meddling.

In the end it boils down to this: Who do we trust to decide verdicts? Juries who hear evidence or politicians like Senator Rucho who take contributions from the Medical Society?

Anti-justice politicians like Santorum and Perry attack the constitution in order to promote policies to strip victims of their fundamental right "endowed by our Creator" to trial by jury. Such politicians or industry special interests deride this fundamental right as "frivolous" lawsuits, "playing the odds", and "jackpot justice".

I have never had a client or potential client who asked to be injured by someone else's negligence. I have never met a client who would not forgo any verdict in exchange for getting back the life that was stolen from them. Lumping injured victims, their spouses, their children, and their parents together as "greedy", "frivolous", and "playing the odds" is despicable.

What's the real effect of tort reform? Wrongdoers are not held accountable. Victims are penalized. And tax payers pay the bill.

When you grant amnesty to negligent corporations and other wrongdoers, the perverse effect is that the federal government bloats and taxpayers or forced to bailout the negligent conduct through government funded bailouts of negligent actors. Imagine someone is paralyzed by a defective product, a negligent doctor or a drunk driver. Tort reform either excludes the plaintiff completely from the court system or limits the recovery to only a portion of the plaintiff's actual life care needs. The bad actor is relieved of personal (or corporate responsibility) and the burdens of the bad actions are borne by taxpayers in the form of Medicare, Medicaid and disability payments.

The 7th Amendment is the ultimate lynch pin for all other constitutional rights - including religious freedom, 2nd Amendment rights, life issues, contractual rights, and others. What is your remedy if someone violates your constitutional rights to free speech, to religious freedom, to keep and bear arms, to contract, etc.? These are civil law (or civil justice) claims in which you take the bad actor to court in order to have your rights protected. What happens when access to courts is limited? What happens when access to court is so lopsided that the average person cannot gain access? What happens when powerful lobbyists control the courts like they control other branches of government?

Fundamental rights, the 7th Amendment, and individual freedom and liberty will continue to be part of the race for the presidency. However, this is not a Democrat vs. Republican issue or even a trial lawyer vs. US Chamber issue. It is a constitutional issue.

Santorum and Gov. Perry - and others in favor of tort reform - are wrong. Freedom, Liberty and Civil Justice are issue our founders fought and died for. They are issues that should unite us as citizens rather than divide us as partisans. Join those on both sides of the political aisle in standing up for our Constitution and for preserving Civil Justice rights and accountability.

Santorum backs tort reform in final push to campaign in all 99 Iowa counties [William Petroski at Des Moines Register]
Conservative Legal Experts Oppose "Federal Tort Reform" [Andrew Cochran at The 7th Amendment Advocate]
Randy Barnett: are Senate GOP Tort Reformers "Federalists in Name Only"? [Cochran at 7AA]
Religious Liberty Needs Open Courtrooms to Survive [Cochran at 7AA]
Tort Reform, The Constitution and Limited Government [me at IB]
Tort Reform, Liberty & Presidential Politics [me at IB]

[More on your 7th Amendment Rights]

Follow @BrettEmison on Twitter.

Originally posted at InjuryBoard by Brett Emison

13 month-old girl bitten by Pit Bull in Virginia Beach, Virginia

Emily Mapp Brannon — Mon, 04 May 2009 02:52:00 GMT

Friday evening, May 1, 2009 a 13 month-old girl was bitten on the head by a pit bull mix dog. News channel 13 reported that Virginia Beach, VA EMS transported the little girl to the local hospital via the Nightingale. According to police the girls injuries were not life threatening. Animal Control was called and is investigating the incident. The pit bull mix was the family’s pet.

Many dog bites happen with a family pet, it just so happens that this particular pet was a pit bull mix. Lately there has been much attention drawn in the Eastern Virginia and North Carolina area because of the pit bull attack and death to an Outer Banks, NC family's golden retriever. This was popular news because it fueled many comments from both supporters and those who feel a ban on pit bulls is necessary.

The incident on the Outer Banks happened in Kitty Hawk and many residents have prompted the local government to ban pit bull breeds. On the other hand, pit bull owners and advocates across the Outer Banks are speaking out on behalf of the breed stating that the fears against the dogs are unfounded.

No matter which side you choose to take concerning pit bulls there are precautionary measures that a family can take with any type of dog to insure safety for your children. The Animal Planet website has some great tips on keeping your children safe around dogs. Some of their tips are to always keep an eye on your dog when it is around your children. Adequate supervision is the parent’s responsibility. Never allow your child to tease your dog or bother it while the dog is sleeping or eating. Any dog should never be viewed as a toy but as an animal which may be unpredictable.

About the Editors: Shapiro, Cooper, Lewis & Appleton personal injury law firm (VA-NC law offices ) edits the injury law blogs Virginia Beach Injuryboard, Norfolk Injuryboard, as well as the Northeast North Carolina Injuryboard as a pro bono service to consumers. Lawyers licensed in: VA, NC, SC, WV, DC, KY, who handle car, truck, railroad, and medical negligence cases and more.

Originally posted at InjuryBoard by Emily Mapp Brannon

Managing Liability for Athletic Trainers

Nathaniel Ehrlich — Tue, 12 Jul 2011 11:28:40 GMT

It won’t be long before athletes report for fall sports practices. One of the most difficult problems facing athletic trainers and team physicians is the recognition and treatment of sport-related concussion. Over 300,000 sports- related traumatic brain injuries occur annually in the United States. In addition to football-related concussions, there is significant risk for concussions for athletes in other sports, including soccer. In fact, female athletes actually have been found to sustain a higher percentage of concussions during games than their male counterparts.

Providing medical clearance for sports participation, return to participation and treatment of athletic injuries therefore involves significant medical issues, and because of the consequences, significant legal issues as well. The NATA has defined an athletic trainer’s responsibilities to an athlete. From that relationship flows recognized legal duties including:

· The duty to properly assess the athlete’s condition;

· The duty to provide or properly refer the athlete for medical treatment; and

· The duty to ensure that there has been proper clearance to participate or return to participation and that the athlete has been properly advised of any risks of participation.

In many instances the athletic trainer is the only trained observer of the initial injury or of the onset of subsequent symptoms. Failing to properly respond to the injury may have significant adverse consequences for the athlete. However determining the appropriate medical standard is difficult, as there is no universally accepted standard for proper assessment and/or prescribed treatment of the injury. Therefore the legal standard to which an athletic trainer will be held is also unclear.

However, criteria is easier to find for what constitutes an appropriate pre-participation examination. If the athletic trainer and team physicians conducted a thorough pre-participation examination, then objective criteria would exist to assist in the evaluation for return to play. Since it is foreseeable that athletes who compete in contact sports may suffer head injury, one would expect an appropriate neuropsychological testing as part of that pre-participation examination. The athletic trainer would then have objective baseline data with which to compare after injury.

Use this off-season to develop a comprehensive risk management program. The athletic trainer should use this time to:

· Identify shortcomings in the current program;

· Evaluate the types of injuries likely to occur in your program, taking into consideration the seriousness of the injuries and the frequency with which those injuries will occur;

· Evaluate the options that exist to reduce risk; and

· Implement appropriate risk reduction policies and procedures.

Your procedures should be sufficient to withstand scrutiny when measured against the standard of care that a reasonably prudent athletic trainer would do in the same or similar circumstance.

Additionally, to further protect yourself from litigation:

· Do you have a good relationship with your athlete? Work to ensure that you act in a manner that shows the athlete and his/her family that you care about them.

· Do you have good record keeping practices? A good record that details the facts and treatment provided to the athlete is essential to a good defense if your treatment is called into question.

· Are you current? You need to be current to ensure that your care is what a reasonable athletic trainer would have done.

Originally posted at InjuryBoard by Nathaniel Ehrlich

Fatigue As The Result of Personal Injury

Wayne Parsons — Fri, 24 Jul 2009 16:26:20 GMT

Everyone knows about broken bones, lacerations, traumatic brain injury, loss of vision, spinal cord injury and other physical injuries that follow automobile accidents, medical malpractice, construction site accidents and product defects. One often ignored after effect is fatigue that can become chronic: chronic fatigue syndrome (CFS). Surveys of injured persons often show that fatigue is one of the most significant long term permanent effects of an injury and in particular injury that results in chronic pain. Fatigue, like pain, doesn't show up on an x-ray and doctors rarely spend any time trying to help with fatigue. Even when the pain is recognized as an issue, fatigue is often left out of the list of disabilities.

Chronic fatigue syndrome (CFS) is an illness defined by disabling physical and mental fatigue and physical and mental symptoms that are not explained by conventional medical and psychiatric diagnoses. CFS affects between 400,000 and 800,000 people in the United States and has an average duration of 5 years, but symptoms can persist as long as 20 years. The prognosis for recovery of severely ill CFS patients is poor. Despite CFS's disabling, enduring, and prevalent nature, scant studies have quantified its impact on the health and well-being of those affected, on the health care system, or on society as a whole.

The burden of CFS is poorly recognized, and the illness remains an inadequately managed health problem. Two population-based studies of CFS have been conducted in the United States, and both found that CFS is one of the more common chronic illnesses among women across all racial/ethnic groups and that less than 20% of those who suffer from CFS have been diagnosed by a health care provider. Only three studies, all of which were clinic based, have attempted to quantify the impact of CFS, and each showed that people with the syndrome were likely to have lost their job or to be unemployed. In addition, it was shown that persons with CFS pose a disproportionate burden on the health care system and their families since they are sick for long periods of time and since there is no known cure for the illness.

The ability of an injured person to get back to a functional life is often affected most severely by fatigue. even when a person is physically able to lift and bend and do the tasks of many jobs, the consequence of fatigue is that the person can't keep any job because fatigue takes them out of a 40 hour work week. As reported in the study The economic impact of chronic fatigue syndrome by Kenneth J Reynolds, Suzanne D Vernon, Ellen Bouchery and William C Reeves, SRA International, Inc., Arlington, U.S.A, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, U.S.A, The Lewin Group, Falls Church, U.S.A:

The magnitude of the economic impact imposed on the individual and on society by CFS is substantial. Approximately one-quarter of persons with CFS, who would otherwise have participated in the labor force, ceased working. For those who continued to work, average income declined by one-third. This represents an estimated annual loss of almost $20,000 for the individual suffering from CFS. This magnitude of loss approximates half of their labor force and household productivity in a given year. The $9.1 billion national loss is comparable to that estimated for other illnesses, such as digestive system illnesses ($8.4 B) and infectious and parasitic diseases ($10.0 B) [19] and is greater than the estimated productivity losses from immunity disorders ($5.5 B), nervous system disorders ($6.4 B), or skin disorders ($1.3) [23]. This estimate does not include health care costs, which are likely to be substantial and does not address reductions in quality of life, which are likely to be large due to the debilitating fatigue.

We estimated annual lost productivity. However, CFS is a chronic illness. The average duration of CFS identified in population studies is 5 years and most patients with CFS seen by health care providers have been ill for more than 6 years. Thus, productivity losses, health care expenses, and reductions in quality of life continue for many years for most affected individuals and thus would have a substantial long-term impact on the standard of living of individuals with CFS and their family members.

It often starts with pain that doesn't go away and lingers and tortures the injured person 24 hours a day, 7 days a week as reported in a Time Magazine feature article The Right (and Wrong) Way to Treat Pain by Claudia Wallis

With chronic pain, however, the alarm continues to shriek uselessly long after the physical danger has passed. Somewhere along the line--maybe near the initial injury, maybe in the spinal cord or brain--the alarm system has broken down. What researchers have only recently come to understand is that prolonged exposure to this screaming siren actually does its own damage. "Pain causes a fundamental rewiring of the nervous system," says Dr. Sean Mackey, director of research at Stanford University's Pain Management Center. "Each time we feel pain, there are changes that occur that tend to amplify our experience of pain." That is why it is a mistake, despite our grin-and-bear-it tradition, to ignore or under treat severe pain.

Fatigue is often the most disabling feature of chronic pain. The injured person is often told by the insurance company, their employer or even their own attorney that they can go back to work and so they have no claim for future wage loss. On top of that their fatigue is ignored and not understood to be a part of the injury. It is treated like a form of laziness or lack of initiative. The treating doctor has probably told them that they can physically do the work at their old job or at least at some other less strenuous job. What is missing in this analysis is that if the injured person suffers from fatigue they cannot do the work if it involves a 40 hour job.

Unless a careful workup is done of the existence of fatigue and the connection of fatigue to the injury, the injured person will not be compensated for what can be a significant loss of future earnings.

What needs to be done is an analysis of the injured person by a neuropsychologist or other doctor using The Universal Work Skills Evaluation test. Below is a video showing a truck driver taking the test. Although there is no sound the test shows that the person has chronic fatigue.

http://www.youtube.com/watch?v=DphPP1EHj9M

Doctors have several ways of validating fatigue as a disabling factor resulting from personal injury.

Originally posted at InjuryBoard by Wayne Parsons

Doctors Will Be Looking At Potential Head Injury With Billy Mays' Death (Updated 07/02/2009).

Mike Bryant — Mon, 29 Jun 2009 00:34:16 GMT

We saw it with Natasha Richardson. A death after suffering what seemed like a inconsequential head injury. In that case, there is no doubt that she needed immediate medical care. Apparently, on Saturday Billy Mays hit his head when he was involved in a very bumpy plane flight. That night he went to bed not feeling well and the next morning he was found dead. Much more will need to be found out about what happened and if there is a link. Doctors are now opining it was heart disease. But, if nothing else this may again remind people about the importance of checking out head injuries.

The issue that was important to keep in mind following the Richardson's death, is that it wasn't immediately obvious. She struck her head and got up like nothing was wrong. People who fall are embarrassed and feel dumb for having fallen. What doctors have found is that with injuries to the brain there will be swelling and bleeding. There simply isn't enough room inside the skull. The resulting damage to brain tissue will be irreversible and can lead to death if it goes unchecked.

Any person concerned about a head injury should get into the doctors and be looked at thoroughly and immediately. Wayne Parsons, a fellow Injuryboard member, covered why in a way that all people should take the time to read.

Sympathy goes out to the Mays family and friends. He will be remembered as a consummate pitchman that seemed to love his work. Hopefully, many people will remember and learn from his passing.

Originally posted at InjuryBoard by Mike Bryant

National Plan for Pediatric Acquired Brain Injury/Pediatric Closed Head or Traumatic Brain Injury

Timothy Smith — Tue, 04 Aug 2009 09:53:15 GMT

As some of my readers know, I recently accepted a position on the legal advisory board to the Sara Jane Brain Foundation. It's is an amazing group, founded by an amazing father who wanted a better approach to the diagnosis and treatment of his infant daughter who suffered a severe brain injury as an infant. This article will educate you the reader on how this group came about and how we plan to implement a uniform and standardized approach to the diagnosis and treatment of Pediatric Acquired Brain Injury on a nationwide basis.

On June 5, 2005, Sarah Jane Donohue was born. When she was just five days old, she was shaken by her "baby nurse" and sustained three broken rips, both collar bones and a severe brain injury. This nurse pled guilty and was sentenced to 10 years in prison but young Sarah Jane was sentenced to a lifetime of difficulties due to the damage to her brain. Just last month, Sarah Jane turned four years old. She cannot crawl, walk, speak words or eat solid foods. She receives weekly physical therapy, occupational therapy, vision therapy, feeding therapy, and speech therapy. She also attends a special full time preschool where she receives special instruction.

The injury sustained by young Sarah Jane is a "Pediatric Acquired Brain Injury". A traumatic brain injury is an injury to the brain caused by external physical forces. Other brain injuries are caused by an internal occurrence which damage the structure of the brain itself from the inside.

What prompted the launch of the Sarah Jane Brain Project was the tireless efforts of Sarah Jane's father, Patrick B. Donohue. What Mr. Donohue has come to learn is that we, as a society, know less than 5% of what we will eventually know about the brain itself. The field of neurology is very fractured worldwide. When I say fractured, I mean there is very little shared knowledge going on between the different locations of research and investigation. If you think of the computer science field back in the 1950s, there were many brilliant people working worldwide, yet no one knew what everyone else was doing. Today, in the field of computer science, there are open source principals and concepts involving shared knowledge such as Wikipedia and Linux Operating System. This allows many people who are researching or investigating the same issue to share their knowledge so that other researchers aren't "reinventing the wheel". As of today, no one is really using these same principals in the field of pediatric neurology. It was the idea of Mr. Donohue when he launched the Sarah Jane Brain Project in October 2007 to begin an open source initiative by placing all of the Sarah Jane's medical records and therapy sessions on line in an open source forum. Mr. Donohue felt that the more "eyeballs" that were on her case, the more likely she was to benefit from all of the information out there worldwide.

Once Sarah Jane's medical records were placed online in an open source forum (www.thebrainproject.org), Phase II of the National PADI Plan commenced. In this phase, Mr. Donohue and those involved in the Sarah Jane Brain Project began to recruit families to develop a national advisory board. Mr. Donohue felt that the more families who had a child with a pediatric acquired brain injury, the more information that can be shared and the more change that can occur within the field. It was clear at the time that every family, when they are first confronted with a child who has sustained a closed head injury or traumatic brain injury, has the exact same learning curve and must reinvent the wheel. It was believed that 85% of what all families go through in the care, treatment and understanding of pediatric brain injury is identical. This National Familial Advisory Board was developed to "standardize the wheel". But, not only were families recruited, but also medical practitioners within the field and attorneys within the field. Almost every single major medical institution and research university is represented currently on the National Advisory Board to the Sarah Jane Brain Project.

Once the National Advisory Board was cemented, Phase III began, where this same Board developed a National PABI Plan. Over 65 leading experts gathered in New York City to draft a PABI Plan. The intent was to create a seamless, standardized, evidence based system of care which would be universally accessible for all PABI families regardless of where they live in the United States. The first draft of this Plan was sent as "the First Official Letter to President Barack Obama" on January 20, 2009.

Phase IV of the National PABI Plan commenced just last month. Within each state, a lead center of excellence was established. These centers within each state would be a resource for families to look to when a child sustains a traumatic brain injury or closed head injury. The implementation date was June 5, 2009 which happened to be Sarah Jane's fourth birthday present. At that same time, the Sarah Jane Brain Project began funding the state lead centers and case management systems to assist families in need.

Some of you at this point may be asking, "Why does each state need a lead center and what responsibilities and/or categories of care would those centers have?" Well, despite the existence of generic "medical standards", there is chaos when it comes to the diagnosis and treatment of pediatric brain injury. There is no uniformity of approach, there is extreme regional variation, there are varying degrees of interest and commitment between states, there is confused nomenclature, there are poorly defined and understood immediate therapeutic goals, and there are unnecessary procedures being implemented as well as wasted money and time, which ultimately leads to incomplete family care.

The question then is: "What can the Sarah Jane Brain Pediatric Acquired Brain Injury Plan do?". In a nutshell, it is a network built on commitment. By putting this network to work, we can define priorities for evidence based improvement, we can coordinate efforts among disparate centers with similar strengths and we can facilitate integrative research efforts through grant writing support staff, coordinated federal and private support work as well as assistance in orchestrating the national priority itself. Attorneys here at Smith & Johnson are glad to be not only a part of the National Legal Advisory Board, but also proud to be spear heading the construction of this network here in the State of Michigan.

The mission or goal of the National PABI Plan is to disseminate via each state a master plan. There will be collaboration within each state and with other states to teach, train and track public awareness, citizen involvement and the long term needs of the victims and survivors of pediatric acquired brain injury. Each state will staff a center representative, an individual in charge of basic science, a staff person in charge of education, one in charge of training, one in charge of prevention, one in charge of case management, and the last to be in charge of registry. Within each regional center, there will be a national center with each state having a representative to the national center. That regional center will be charged with staffing the following areas: prevention, acute injury, reintegration, adult transition, mild TBI, rural needs and family registry. The concept will be that families, through the internet, can reach out and find the Sarah Jane Brain Project via the internet and then be assigned to their lead center within their respective state. The lead center will then be able to direct the family immediately to the assistance they need as it relates to education, training, case management, etc.

Stay tuned as I plan on going into greater detail regarding these phases and what it will mean to Michigan families who are dealing with these issues.

Originally posted at InjuryBoard by Timothy Smith

Have you read the warning on your football helmet?

Nathaniel Ehrlich — Wed, 03 Aug 2011 10:15:24 GMT

Concussions are a hot topic in sports. During the course of a normal year, it has been shown that a high school football player will receive 700 - 1,000 blows to the head. Athletes who initiate contact with their head when they tackle or block are at even greater risk of suffering a concussion or catastrophic injury. For that reason, the National Federation of High School Sports has made it illegal to initiate contact with the head or facemask during games. But, participants in sports that involve contact like football, hockey and lacrosse, are wearing helmets, why do they still sustain concussions? Because helmet manufactures don’t design them to prevent concussion.

Riddell helmets contain a warning that “Contact in football may result in CONCUSSION-BRAIN INJURY which no helmet can prevent…” Similarly, Schutt helmets contain a warning that “NO HELMET SYSTEM CAN PROTECT YOU FROM SERIOUS BRAIN AND/OR NECK INJURIES INCLUDING PARALYSIS OR DEATH. TO AVOID THESE RISKS, DO NOT ENGAGE IN THE SPORTOF FOOTBALL.”

So, the athlete straps on his helmet and yet it can’t protect against concussion or brain injury? What’s up with that?

Is there one style or brand of helmet that is better than another?

Is there a way to determine if one helmet is safer than another? All football helmets contain a NOCSAE sticker or imprint to verify that it has met at least NOCSAE’s minimal protective standards. But, that’s just not enough. This is one instances where newer and more expensive is better. Only use the newest models. And, while manufacturers recommend that helmets be re-conditioned each year, and shouldn’t be used if they are more than 9 years old, reconditioning is really meaningless—except to replace broken parts. That is the case because the reconditioner is not improving the design of the helmet, but rather simply assuring schools that each helmet has all the right parts in it.

Having an athletic trainer or a trained professional available to fit the helmet is advisable to ensure that the helmet fits properly. Also, the helmet needs to be periodically re-checked for fit and unusual wear which may indicate helmet damage or faulty technique. Do what you can to maximize the protection afforded by your helmet. The best way to be assured maximum protection is to only buy the most expensive helmets. Also, check for the rating of helmets now published by Virginia Tech University, College of Engineering.

Originally posted at InjuryBoard by Nathaniel Ehrlich

Tricare Puts Profits Over Health of Brain Damaged Soldiers

Michael Phelan — Thu, 23 Dec 2010 10:53:22 GMT

The signature injury to our brave soldiers fighting the wars in Iraq and Afghanistan is traumatic brain injury, which is often the result of blast waves from roadside bombs. Studies suggest that as many as 15% of blast victims go on to suffer long-term cognitive problems. All Americans should agree that the soldiers who risked their lives for their country and came home with traumatic brain damage deserve cognitive rehabilitation therapy to help them achieve the best possible recovery. Shockingly, after nearly a decade at war there is still no good plan to treat these wounded warriors.

Last month, the Pentagon sent a letter to Congress in response to members’ concerns about the medical treatment of soldiers who suffered brain injuries in the war on terror. The letter from George Peach Taylor, Jr., acting assistant defense secretary for health, told Congress that the military was still studying the efficacy of cognitive rehabilitation therapy, which is a lengthy program designed to retrain victims of traumatic brain injury to do activities of daily living, which, due to their brain damage, they can no longer do. Examples include remembering tasks, recalling words, and recalling names. The letter also reports that the military’s health plan for troops and other vets, Tricare, does not covery cognitive rehabilitation. Tricare justifies its unpatriotic denial of coverage by citing work done by a contractor hired by Tricare which claims to have found limited evidence that cognitive rehab works.

Leading brain injury specialists have cried BS and criticized the Tricare study as deeply flawed and unacceptable. One expert stated the obvious, calling the Tricare study a “misuse” of science designed to hold down costs by depriving soldiers of care. Critics also note that Aetna and Humana already cover the treatment, and that the Pentagon’s own panel of experts convened more than a decade ago by the Institues for Medicine recommended its use. I’ll bet that the health plan that we pay for for members of Congress covers this therapy. Make it know to your Congressional representatives that our soldiers deserve the same, if not better, coverage.

Originally posted at InjuryBoard by Michael Phelan