December 2012 Brain Injury Litigation

Man Awarded $5 Million in Brain Injury Lawsuit

 

Illinois’ DuPage County will pay $5.1 million to a worker who suffered a traumatic brain injury in an accident at a Chicago construction site and who based his lawsuit on a cutting-edge medical study conducted on National Football League (NFL) players.

In March 2005, the 56-year- old worker, Willie Wakefield, met with an accident when a pile of lumber fell onto his head from a forklift and injured his brain, reported the Daily Herald. As a result, he suffered a traumatic brain injury and memory impairment. Wakefield worked as a heating, ventilation and air-conditioner technician.

Wakefield’s attorney successfully sued the defendants using neuropathological medical research conducted by two doctors on former NFL players’ brains, to show that the plaintiff, after the accident, showed signs of brain damage comparable to Alzheimer’s.

 

http://www.dailyherald.com/article/20121109/news/711099747/

 

 

Travelers sues NFL over brain injury lawsuits

Several subsidiaries of Travelers Companies Inc sued the National Football League and a host of other insurers, seeking to avoid paying to defend the league against a wave of brain injury-related claims by thousands of former players and their families.

The lawsuit was filed on Tuesday in New York State Supreme Court, one week after the NFL sued three dozen insurance companies in an effort to force them to cover the costs of defending the claims.

According to the Travelers lawsuit, the company provided liability coverage for NFL Properties, the league’s merchandising arm, but not the NFL and should not be required to pay for a joint defense. The insurer points out that a “master complaint” filed jointly by some 2,000 former players in June alleges 14 counts against the league, but only two against NFL Properties.

“Travelers is not required to pay any defense costs of the NFL with respect to the underlying lawsuits,” Travelers said in its lawsuit.

The insurance companies sued by the NFL and named as defendants in the Travelers lawsuit provided coverage to the NFL or one of its affiliates sometime between the 1960s and today.

http://www.reuters.com/article/2012/08/22/us-insurance-nfl-lawsuit-idUSBRE87L0WX20120822

 

Pop Warner Football Modifies Rules to Help Reduce Concussions

The Pop Warner youth football group issued new practice guidelines this week in an attempt to reduce concussions and head injuries among the more than 400,000 children who participate in youth football leagues in the United States. Pop Warner is a major source and feeder system for high school, college, and professional football – more than 70% of NFL players got their start in football through a Pop Warner league.

The new practice guidelines have two parts that are designed to reduce the chances of concussions in children who play football:

1. Eliminate full speed head-on blocking or tackling drills in which the players line up more than 3 yards apart (this reduces forward speed before the players make contact with each other)

 

1. Total contact drill time is limited to 1/3 of total practice time

The new guidelines are as much a marketing and PR effort as they are a practical attempt to begin the process of changing a deeply entrenched playing culture in football. It remains to be seen if players, coaches, parents, and fans will accept these new limits.

http://www.mybraintest.org/2012/06/pop-warner-football-modifies-rules-to-help-reduce-concussions/

 

Bret Michaels Settles Lawsuit After Brain Injury at Tony Awards

The curtain has come down on a lawsuit filed against the organizers of the Tony Awards and CBS by Bret Michaels, who said he had been injured by a piece of scenery in the awards show but has reached a settlement in the case, The Associated Press reported.

Mr. Michaels, the frontman of the rock group Poison, was performing in the opening number of the 2009 Tony Awards show at Radio City Music Hall when a descending backdrop hit him on the head as he was leaving the stage. Mr. Michaels, who broke his nose and received three stitches in his lip, filed suit against the producers of the Tonys show, saying he was not warned about the set change in the opening number and that his injury contributed to a brain hemorrhage he was treated for in 2010. His lawsuit also named CBS, which shows the Tonys ceremony, saying the network did not have to broadcast his accident, which became a widely circulated video clip on the Internet.

 

Study: War vets’, athletes’ brain injuries similar

n recent years, more than 200,000 troops have tested positive for traumatic brain injuries, including concussions.

Now, CBS News correspondent Dr. Jon LaPook reports a new study finds they may be at risk for the same kind of long-term brain damage that is turning up in football players.

Nick Colgin came back from Afghanistan in 2008 with a Bronze Star for heroism and a problem that’s destroying his life.

“A rocket-propelled grenade hit off the right side of my Humvee. I didn’t realize it at the time but I suffered a traumatic brain injury,” Colgin said. “I got home and I couldn’t spell my own name and I couldn’t read my own handwriting.”

Four years after the explosion, his traumatic brain injury, or TBI, is all-consuming.

http://www.cbsnews.com/8301-18563_162-57435890/study-war-vets-athletes-brain-injuries-similar/

 

Brain-injured plaintiffs living fuller lives after class action lawsuit

It was a clear day in June. Roads were dry. There wasn’t a single reason a car should have swerved into Raymond Puchalski’s lane as he drove on a straight-away in Erving. But it did.

Puchalski wasn’t supposed to live through the night following the 2003 accident. Then, he wasn’t expected to come out of a monthlong coma, or to ever walk or talk again. But he did.

Credit serendipity or the mysterious ability the body has to heal itself. However, Puchalski’s severe brain injuries and resulting cognitive disabilities left his loved ones, and the state Medicaid system, struggling with how best to care for him with so much life left. After dismal stints in a nursing home in Northampton and a long-term care facility in Stoughton, Puchalski, now 63, was among four brain-injured plaintiffs who in 2007 sued the state for community-based, individual care.

Read the rest of the story:

http://www.masslive.com/news/index.ssf/2012/01/post_268.html

Will NFL Related Brain Injury Lawsuits be Consolidated?

Image via Wikipedia

The National Football League hopes to consolidate in Philadelphia a string of lawsuits filed across the country by former players who say they’ve suffered concussion-related brain injuries.

Seven former players filed the first such lawsuit last summer in Philadelphia, where a similar lawsuit filed Monday seeks more than $5 million for more than 100 ex-players. Other lawsuits are pending or expected in California, Florida, New York and elsewhere, said lawyer Sol Weiss, who’s involved in the first lawsuit.

A hearing is set for Jan. 26 in Miami for the parties to ask a federal judicial panel to consolidate the cases before a U.S. District Court judge in Philadelphia. The NFL requested the move to avoid trying related litigation in several districts, according to its motion.

The lawsuit filed Monday seeks damages for traumatic brain injuries and neurodegenerative disorders on behalf of 106 former players, including former Minnesota Vikings offensive lineman Brent Boyd and three Hall of Famers: Detroit Lions cornerback Lem Barney, Buffalo Bills offensive lineman Joe DeLamielleure and Vikings defensive back Paul Krause.

Boyd, his lawyers said, is the only living player to be diagnosed with chronic traumatic encephalopathy, a degenerative disease that is found in people who’ve had multiple head injuries and whose symptoms can include memory loss. He has started an organization called Dignity After Football to help former players who are disabled or lack league pensions.

Attorney Richard Lewis, one of those who filed the lawsuit, said in a statement that as the NFL prepares for the Super Bowl on Feb. 5, “it has forgotten about the legacy of its former players, many of whom built the league and are now suffering from the devastating consequences of on-field head injuries.”

Link: http://online.wsj.com/article/AP3b9baf3c8b744e32a4206597f8feee98.html

 

Football related head injury trial to start

A former high school football player is suing the San Marcos school district over a head injury that left him severely disabled. The long-delayed trial is expected to begin tomorrow.

Senior Scott Eveland walked off the field during a football game in 2007 and collapsed on the sideline. Witnesses in the case are expected to say Eveland told the team’s trainer before the game that he had a headache from a previous hit, but he played anyway.

The new California law doesn’t let school athletes suspected of having a head injury play again until cleared by a doctor.

http://www.kpbs.org/news/2012/jan/16/trial-starts-head-injury-lawsuit/

Our lawyers have investigated tragic cases like these, and we are happy to talk with you confidentially. In Georgia, there are strict limitations regarding when a case like this must be brought by, if a city, county or state school is where the injury occurred.

A unified science of concussion

An article worth a read:

 

 

The etiology, imaging, and behavioral assessment of mild traumatic brain injury (mTBI) are daunting fields, given the lack of a cohesive neurobiological explanation for the observed cognitive deficits seen following mTBI.

 

Although subjective patient self-report is the leading method of diagnosing mTBI, current scientific evidence suggests that quantitative measures of predictive timing, such as visual tracking, could be a useful adjunct to guide the assessment of attention and to screen for advanced brain imaging. Magnetic resonance diffusion tensor imaging (DTI) has demonstrated that mTBI is associated with widespread microstructural changes that include those in the frontal white matter tracts. Deficits observed during predictive visual tracking correlate with DTI findings that show lesions
localized in neural pathways subserving the cognitive functions often disrupted in mTBI.

 

Unifying the anatomical and behavioral approaches, the emerging evidence supports an explanation for mTBI that the observed cognitive impairments are a result of predictive timing deficits caused by shearing injuries in the frontal white matter tracts.

 

http://www.braintrauma.org/pdf/maruta2010ann_nyas.pdf

Diffuse Axonal Injury Imaging

Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients. In fact, DAI represents approximately one half of all intra-axial traumatic lesions. This lesion is the most significant cause of morbidity in patients with a traumatic brain injuries, which most commonly result from high-speed motor vehicle accidents. DAI typically consists of several focal white-matter lesions measuring 1-15 mm in a characteristic distribution.

 

Classically, DAI has been considered a primary-type injury, with damage occurring at the time of the accident. Research has shown that another component of the injury comprises the secondary factors (or delayed component), since the axons are injured, secondary swelling occurs, and retraction bulbs form. Of patients with DAI, 80% demonstrate multiple areas of injury on computed tomography (CT) scans.

The degree of microscopic injury usually is considered to be greater than that seen on diagnostic imaging, and the clinical findings reflect this point. DAI is suggested in any patient who demonstrates clinical symptoms disproportionate to his or her CT-scan findings. DAI results in instantaneous loss of consciousness, and most patients (>90%) remain in a persistent vegetative state, since brainstem function typically remains unaffected. DAI rarely causes death.

Januar 2012: Wyoming Brain Injury Resources

As this blog develops, we are listing state by state resources, and here is Wyoming:

 

http://www.projectbrainofwyoming.com/home/content-contentid-3.htm

 

Project BRAIN, a Brain Rehabilitation and Information Network, was developed by the Brain Injury Association of Wyoming, now the Brain Injury Alliance of Wyoming, with funding from the Division of Vocational Rehabilitation, Department of Workforce Services.  Project BRAIN is a statewide care network that utilizes existing resources, expanding connections between those resources, while building new pieces to fill gaps in the Wyoming brain injury service system.

This web site is designed to provide information to brain injury survivors and their caregivers while providing a location for service providers, medical professionals, organizations and other interested parties to find and share information. 

We hope to be able to provide a list of available resources throughout Wyoming and, eventually, to have enough users to create a list serve where professionals can share information and ask questions to others in the state.

Please sign up for one or more of our mailing lists so we can keep you up to date with the latest information available about brain injury.  Be sure to check out our documents section for printable PDF newsletters, surveys, and other valuable information.

If you have any comments or suggestions about this web site please contact us at director@projectbrainofwy.com

Jan 8, 2012: Journal of Head Trauma Rehabilitation Announces Collaboration with Center for Outcomes Measurement in Brain Injury

Here is helpful news in the continuing effort to measure, detect and treat brain injury:

 

 Philadelphia, Pa. (January 4, 2012) – Starting this month, The Journal of Head Trauma Rehabilitation(JHTR)—in partnership with The Center For Outcome Measurement in Brain Injury (COMBI)—introduces a new feature designed to support effective and informed use of standardized assessments for evaluation of brain injury. The official journal of the Brain Injury Association of America, JHTR is published by Lippincott Williams & Wilkins, a part ofWolters Kluwer Health.

Beginning with the January, 2012 issue, the journal will include regular profiles of assessments and instruments, drawn from the COMBI, for use in treatment and program evaluation for patients with brain injury. “The more complex the behavior or activity we want to document, the more important it is to have an objective instrument for quantifying our observations,” comments John D. Corrigan, PhD, ABPP, Professor of Physical Medicine and Rehabilitation at The Ohio State University and Editor-in-Chief of JHTR.

“The COMBI website has created a ‘one-stop shop’ to look for information about measurement tools, their use and how they were validated. And now, JHTR readers will have regular updates of both existing scales and new additions to the COMBI.”

Feature Highlights ‘Tools for Clinical Use’ from COMBI
The COMBI is an online resource providing detailed information and support on assessments and outcome measures used in brain injury rehabilitation and assessment. The COMBI is a collaborative project of 16 brain injury facilities or centers, most of them Traumatic Brain Injury Model Systems, funded through grants from the National Institute on Disability and Rehabilitation Research. The COMBI is coordinated at Santa Clara Valley Medical Center, San Jose, Calif.

 

Source: http://www.newswise.com/articles/journal-of-head-trauma-rehabilitation-announces-collaboration-with-center-for-outcomes-measurement-in-brain-injury

January 10, 2011: New Helmets from a Canadian Brain Injury Assocation

Helmets that were acquired in Amherstburg have made their way to the heads of children in Windsor.

The Brain Injury Association of Windsor/Essex County (BIAWE) has joined forces with Canadian Tire in Amherstburg, Green Shield Canada and the All Saints Church Skate lending program to expand the already very successful Helmets on Kids Program. Green Shield helped provide funding for the program while Canadian Tire helped provide the helmets at cost.

There was a kickoff to the program last Wednesday afternoon at Charles Clarke Square in Windsor.

“The fact is helmets reduce head injuries by over 80 per cent. We are being proactive here with our prevention messaging and expanding our program to include other types of helmets,” explained Melanie Gardin, president of the BIAWE.

The BIAWE purchase 53 new hockey helmets that will be used to protect the heads of children who are ice skating this winter. Hockey helmets are the recommended helmet for ice skating and sledding. A majority of these helmets will be used by kids skating at Charles Clarke Square this winter.

Jennipher Gee, who sits on the local injury prevention coalition, brought her children and niece and nephew out last Wednesday. She said the message of wearing helmets has been conveyed to her children at an early age and that her children often point out others not wearing helmets.

“The messaging started very early,” said Gee.

Gee was hopeful more information and promotion would be put out to the general public so that people know the dangers of brain injury and how it’s easier to suffer a brain injury than a lot of people realize.

The original goal of the program was to provide bicycle helmets for children who came from families that can’t afford a bicycle helmet or that didn’t place an importance on purchasing a helmet for their child. The BIAWE has purchase over 2,100 helmets since the program started and distributes these through school programs, bike rodeos and other summertime events.

 

source: http://www.amherstburgecho.com/ArticleDisplay.aspx?e=3428724

Jan, 2011 Brain Injury Resources: Wisconsin

We recently came across this article from a Wisconsin paper, and it’s worth a read:

Bari York looks the same – only a tiny scar on the right side of her forehead shows a glimpse of just how much she has truly changed.

“If you don’t see the scar or know what happened, you may not know right away,” said York, who was involved in a horrific car accident at the age of 15. It left her partially paralyzed and living with the effects of a severe traumatic brain injury. Everything she ever learned was wiped out in an instant.

After exhaustive rehabilitation, York, now 22, has mostly regained the physical use of her body, but all of the elements of her personality that made her Bari have vanished.

“You don’t physically see brain injury; you experience it,” said her mother, Lois York-Lewis. “The severity of the accident changed everything from Bari’s personality to how she relates to others. With each passing day, month and year, you begin to realize this is a whole new way of life.”

That new life was devoid of many of the friends York once had.

“That was the most challenging. My friends no longer understood me,” said York, who recently graduated from Carroll University with a degree in public relations and marketing. “While I was in the hospital recuperating, their lives went on.”

The sometimes alienating world of traumatic brain injury prompted the mother and daughter, of Muskego, to create the Brain Injury Resource Center of Wisconsin nearly a year ago.

http://www.jsonline.com/news/wisconsin/group-helps-families-face-changes-after-brain-injuries-4n3nae8-136887803.html

From the group’s site:

Medical Documentation of Traumatic Brain Injury (before returning to school)
Before returning to school, it is advisable to establish traumatic brain injury through medical documentation via hospital records and/or from a doctor or clinician. Medical documentation simply confirms the presence of the traumatic brain injury. It does not and cannot automatically establish the impact of the traumatic brain injury. Confirming that an injury has occurred does not shed light upon the effect of the injury on later physical, educational, behavioral, emotional, and social outcome.

The survivor may require a Neuropsychological Evaluation prior to returning to school (and/or work as well). This evaluation is a method through which a Neuropsychologist can acquire data about a survivors cognitive, motor, behavioral, linguistic, and executive functioning

The neuropsychological evaluation is useful for measuring many function categories, including the following:

Intellectual functioning
Academic achievement
Language processing
Visuospatial processing
Attention/concentration
Verbal learning and memory
Visual learning and memory
Executive functions
Speed of processing
Sensory-perceptual functions
Motor speed and strength
Motivation/symptom validity
Personality assessment
Strategic Learning Strategies Developed for students with TBI
Education is more than just book learning, it is developing the understanding of how a student with TBI learns best. Contact the Brain Injury Resource Center of Wisconsin to inquire about and/or schedule the presentation by Kary Mirasola, MS, CCC-SLP and Bari York, former college student and TBI survivor.

Abstract of talk: Understanding what TBI is and the impact of it on learning
Connection to Universal Design: Discuss how these strategies are necessary for students with TBI but would be appropriate for all students
Structure of session: Bari will share her personal experience with TBI. Provide analogy of what it means to have TBI. Demonstrate examples and hands on use of the following strategies:
* Study Cards
* Content templates
* Higher Level Thinking and Language Skills
* Comprehension Monitoring Strategies

 

Their real-life experience offers a unique and personalized approach to their programs and services that enhances the quality of life of brain injury survivors and their families, said Angela Dentice, a family friend and longtime educator of special-needs students, including children with brain injuries.

http://www.bircofwi.org/ACADEMICS.php

Atlanta GA 2012 Brain Injury Football Lawsuit News: Levens v. NFL

Former Green Bay Packers running back Dorsey Levens is a plaintiff in lawsuits filed in federal court in Atlanta that claim the National Football League has hidden the dangers of brain injuries in football.

The suits were filed Wednesday in Atlanta in behalf of Jamal Lewis, Fulton Kuykendall, Ryan E. Stewart and Levens.

In the suits, the players claim the league knew as early as the 1920s of the potential for severe injury from concussions.

“The NFL has done everything in its power to hide the issue and mislead players concerning the risks associated with concussions,” the suits say.

Levens, who played eight years for the Packers and amassed 7,289 yards in his career over 102 games, said he suffered multiple concussions.

“Levens was not warned by defendants of the risk of long-term injury due to football-related concussions or that the league-managed equipment did not protect him from such injury,” Levens’ suit says. “This was a substantial factor in causing his current injuries.”

The suit says Levens suffers from multiple past traumatic brain injuries with symptoms including, but not limited to, memory loss, headaches and sleeplessness.

Levens played 11 seasons in the league. In addition to the Packers, Levens also played for the Philadelphia Eagles and the New York Giants. He now lives in the Atlanta area.

The NFL released this statement on Thursday: “The NFL has long made player safety a priority and continues to do so. Any allegation that the NFL intentionally sought to mislead players has no merit. It stands in contrast to the league’s actions to better protect players and advance the science and medical understanding of the management and treatment of concussions.”

This week, the league said all games would include an independently certified athletic trainer designated to watch for concussion-related injuries.

Brain Injury Classifications and Care- Coup -Contrecoup Injury

We’ve been writing about the different types of diagnostic tests used to assess brain function and injury. This post discussed trauma, specifically Coup-Contrecoup

• Coup-Contrecoup Injury describes contusions that are both at the site of the impact and on the complete opposite side of the brain.
• This occurs when the force impacting the head is not only great enough to cause a contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, which causes the additional contusion.

A a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was impacted. Coup  and contrecoup injury is associated with a cerebral contusion, which is a type of trauma involving brain bruising. Coup and contrecoup injuries can occur individually or together. When a moving object impacts the stationary head, coup injuries are typical while contrecoup injuries are produced when the moving head strikes a stationary object.

In a contrecoup injury, the head stops abruptly and the brain collides with the inside of the skull. .

Are African Americans & Hispanics Less Likely To Receive CT Scans Following Head Trauma

An interesting read from a blog post regarding CT scans and minorities – do you agree or disagree?

 

 

African-American and Hispanic children are less likely to receive a cranial computed tomography (CT) scan in an emergency department (ED) following minor head trauma than white children, according to an abstract presented Friday, Oct. 14 at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston.

While racial disparities in adult health care are well documented, less is known about the variations in pediatric, and specifically, ED care.

Appropriate CT scan use can ensure optimal diagnosis; however, as CT scans emit “appreciable radiation,” potentially increasing cancer risk, their overuse can be harmful and expensive.

In the study, “Cranial CT Use for Minor Head Trauma in Children is Associated with Race/Ethnicity,” researchers reviewed existing data on children seeking care at one of 25 Pediatric Emergency Care Applied Research Network trauma centers.

The study looked at CT use following a head injury, based on the child’s potential for traumatic brain injury.

Of the 42,412 children enrolled in the main study, all of whom were evaluated for head trauma, 39,717 (94 percent) had a documented race/ethnicity of Hispanic, African-American or white.

Of these, 13, 793 children (35 percent) were imaged with a CT. While there was no significant difference by race/ethnicity in the likelihood that a child deemed at higher risk for a traumatic brain injury would receive a CT scan, white children at the lowest risk were significantly more likely to receive a CT scan.

“Our study demonstrates that among children with minor head trauma, but at low risk for clinically important brain injury, white children received cranial CT scans more frequently than black or Hispanic children,” said Alexander Rogers, MD, FAAP. “In this low-risk population, higher rates of cranial CT may represent overuse in white children, leading to increased radiation exposure and health care costs.

“The cause of this disparity is likely multi-factorial, but this study highlights the importance of strong, evidence-based guidelines to assure equal and optimal care,” said Dr. Rogers.

 

Link:  

http://www.eurekalert.org/pub_releases/2011-10/aaop-mcl100711.php

Brain Injury Testing: What is the “Automated Neuropsychological Assessment Metric, or ANAM?”

Back in 2007, congressional lawmakers passed a measure requiring the military to test soldiers’ brain function before they deployed and again when they returned. The test was supposed to ensure that soldiers received proper treatment.

Racing to satisfy Congress’ mandate, the military chose a test that wasn’t actually proven to detect TBI: the Automated Neuropsychological Assessment Metric, or ANAM.

Four years later, more than a million troops have taken the test at a cost of more than $42 million to taxpayers, yet the military still has no reliable way to catch brain injuries. When such injuries are left undetected, it can delay healing and put soldiers at risk for further mental damage.

Based on corporate and government records, confidential documents, scores of interviews and emails obtained under the Freedom of Information Act, at least one investigation has found these:

 

• The people who invented ANAM and stood to make money from it were involved in the military’s decision to use it, prompting questions about the impartiality of the selection process. No other tests received serious consideration. A reportby the Army’s top neuropsychologist circulated last year to key members of Congress labeled the selection process “nepotistic.”
• The Pentagon’s civilian leadership has ignored years of warnings, public and private, that there was insufficient scientific evidence the ANAM can screen for or diagnose traumatic brain injury. The military’s highest-ranking medical official said the test was “fraught with problems.” Another high-ranking officer said it could yield misleading results.
• Compounding flaws in the ANAM’s design, the military has not administered the test as recommended and has rarely used its results. The Army has so little confidence in the test that its top medical officer issued an explicit order that soldiers whose scores indicated cognitive problems should not be sent for further medical evaluation.
• Top Pentagon officials have misrepresented the cost of the test, indicating that because the Army invented the ANAM, the military could use it for free. In fact, because the military licensed its invention to outside contractors, it has paid millions of dollars to use its own technology.
• The military has not conducted a long-promised head-to-head study to make sure the ANAM is the best available test, delaying it for years. Instead, a series of committees have given lukewarm approval to continue using the ANAM, largely to avoid losing the data gathered so far.

(Source: http://www.propublica.org/article/testing-program-fails-soldiers-leaving-brain-injuries-undetected)

If you are concerned, write to your congressman and ask that he or she read the Pro Publica program. 

 

 

Military’s Brain-Testing Program A Debacle

From NPR:

The U.S. military has spent more than $42 million to test every service member’s brain to find out who suffered a traumatic brain injury, or TBI, during the Iraq and Afghanistan wars. But an investigation by NPR and ProPublica has found that military leaders are refusing to carry out the testing program as Congress ordered. Partly as a result, the program that was supposed to fix things has hardly helped any of the troops.

The NPR/ProPublica investigation found that the TBI testing program was plagued with problems before it even began. When members of Congress told the military to test all the troops to see how well their brains work, Congress was giving an order that’s difficult to carry out.

Read more here: http://www.npr.org/2011/11/28/142662840/militarys-brain-testing-program-a-debacle

NFL To Test Players for Brain Injuries of Symptoms

There is news that the National Football League will conduct a comprehensive of brain diagnostics in a full steady.

 

The study, called DETECT, is the first on CTE funded by the National Institutes of Health. The goal is to find differences between the NFL players and the athletes who haven’t experienced repeated blows to the head.

Subjects are flown into Boston for a wide variety of tests. On the first day, they spend a total of about two hours in scanners at Brigham and Women’s Hospital for different kinds of neuroimaging. The second day takes place at BU’s medical school and includes a spinal tap, a lengthy psychiatric interview, neurological and cognitive testing and blood work.

The NFL players must be offensive and defensive linemen, linebackers or defensive backs, because those positions involve the most repeated brain trauma. The subjects are between the ages of 40 and 69 and suffer from some symptoms associated with CTE. They all had long football careers to ensure an extensive history of blows to the head. Multiple concussions are not a requirement — partly because players may not even know they had a concussion, and partly because the evidence suggests CTE can occur simply through play after play of knocks to the head.

The NFL and the players’ union are helping the center to contact former players. Stern said the initial response had been “extremely positive.”

“There’s a sense that former players want to be able to do something to not only potentially help themselves but also to help get the research moving quickly to help others in the future,” he said.

The athletes in the comparison group will include retired swimmers and tennis players among others, recruited through college alumni associations and sports leagues.

“You’d be surprised at how many sports we exclude because we don’t know for sure there’s not a problem,” Stern said, such as distance running, with the jolting of the head at every step.

Two more subjects are lined up for December, then the pace will pick up in January. The athletes are promised confidentiality.

The researchers hope genetic testing and other analyses help them eventually determine why some athletes who receive repeated blows to the head develop CTE and others don’t. Dr. Robert Cantu and Chris Nowinski, a former Harvard football player and professional wrestler, are the other co-directors of the center.

Stern, a professor of neurology and neurosurgery at BU’s medical school, also studies Alzheimer’s. The recent progress made in diagnosing that disease during life encouraged him that the same could happen with CTE.

The grant, received in August, is also supported by the National Institute of Neurologic Diseases and Stroke, the National Institute on Aging, and the National Institute of Child Health and Human Development. There are 20 co-investigators, including researchers at Harvard, Penn and Columbia. The center is still seeking additional funding to complete the study.

The center is also conducting a study called LEGEND of more than 1,000 athletes from a variety of sports using yearly telephone interviews, online questionnaires and a saliva sample for genetic testing to try to learn more about the development of CTE.

 

Source is here:  http://espn.go.com/nfl/story/_/id/7248268/new-study-brain-injuries-test-100-former-nfl-players

Florida, Dec. 2011 Seniors and Traumatic Brain Injuries

As you may know, falls are the leading cause of traumatic brain injury (TBI) and people ages 75 and older have the highest rates of TBI-related hospitalizations and death.  The Centers for Disease Control and Prevention (CDC) wants to improve the ability of children and other caregivers of older adults to prevent TBI from occurring and to recognize and respond appropriately should their loved one sustain a TBI.

Therefore, CDC has developed the “Help Seniors Live Better, Longer: Prevent Brain Injury” initiative, an exciting new communication campaign designed to raise awareness about ways to prevent, recognize, and respond to fall- related TBI in older adults.  CDC plans to launch the initiative in March
2008 during Brain Injury Awareness Month.  To support local activities surrounding the “Help Seniors Live Better Longer: Prevent Brain Injury” initiative, CDC has developed the “Event Planning” and “Media Access” guides, which are available here:

http://www.cdc.gov/traumaticbraininjury/

 

 

A Decent Read on Testing for those who have suffered a Mild Traumatic Brain Injury

After a systematic, yet focused history and physical exam, the treating provider must make decisions about appropriate diagnostic testing for the person with suspected MBI. For a diagnostic test to yield reliable information, it must be relatively free of bias and random error. The test must also be sensitive enough to detect an intracranial lesion, yet safe and cost-effective. The World Health Organization Collaborating Centre Task Force recently conducted a systematic review concerning the evidence about diagnostic tools available to detect MBI (Borg et al., 2004). A summary of their findings follows.

Twenty-nine studies provided evidence for the use of CT scans as a diagnostic tool in cases of MBI. Only injured persons who were hospitalized were included in this review, thus not fully representing persons with MBI. The review reported that CT scans can detect unsuspected lesions in patients with MBI. However, pediatric facilities and community and teaching hospitals were noted to have variability in their use of CT testing. Only 8% of those with GCS scores of 15 had abnormal CT results. As the GCS score declined, the likelihood of abnormal CT results increased. For example, 30% of patients with GCS scores of 13 had abnormal CT results. Similar prevalence rates were reported in CT studies with children.

The use of skull X rays was also considered in this review. Fifteen studies reported the use of skull X rays to detect lesions in MBI. X rays were capable of detecting skull fractures known to increase the likelihood of an intracranial lesion. When a depressed skull fracture was present along with vomiting, nausea, and headache, there was increased likelihood of intracranial lesions. No conclusions about the diagnostic value of MRI in detecting abnormalities among those with MBI were delineated in this review.

The review also considered whether cognitive assessments were sensitive in the detection of MBI. Reviewers concluded that although there is limited evidence supporting the benefit of specific cognitive assessments in the detection of MBI, there is beginning evidence that specific cognitive tests may detect sport-related concussive injuries (Lovell & Collins, 2002).

Reviewers also concluded that for persons with MBI, there was good evidence predicting those at risk for complications. Surgical intervention was more likely within 2 hours of admission for those with MBI who were 65 years of age or older, vomiting twice or more, with evidence of basal skull fracture, suspected open or depressed skull fracture, dangerous injury mechanism, or anterograde amnesia of more than 30 minutes (Borg et al., 2004). Consequently, careful clinical assessment coupled with diagnostic tests can predict those patients likely to have MBI complications.

There are studies correlating more sensitive diagnostic tests, such as MRI, single photon emission computed tomography (SPECT), and quantitative magnetic resonance (QMR) imaging with brain abnormalities in those with milder injuries (Kesler, Adams, & Bigler, 2000; Umile, Plotkin, & Sandel, 1998; Wallesch et al., 2001). However, findings are unclear about their sensitivity and relevance because of limited ability to recruit persons with similar injuries and length of time since the injury. Gowda and associates (2006) suggested that SPECT was able to detect significant hypoperfusion in the frontal lobes of adults who had evidence of PTA, loss of consciousness, or PCS. In addition, it is likely that persons with milder injuries and persistent symptoms have increased likelihood of temporal lobe injury as evidenced with animals and human studies of MBI (Umile, Sandel, Alavi, Terry, & Plotkin, 2002). Further research is being conducted about these relationships.

http://www.medscape.com/viewarticle/554963_5

December 2011: Discussion about Childrens’ Brain Injuries and Computed Topography (CT)

Brain injury is the leading cause of death and disability in pediatric trauma victims. Head injuries in children account for 250 000 hospital admissions each year, whereas nearly 5 million children present to hospital emergency departments seeking evaluation and care of head injuries. The morbidity and mortality associated with significant intracranial injury may be ameliorated by early diagnosis and treatment.

Despite the frequent occurrence of head injury in children, diagnostic strategies differ among individuals and institutions. Skull radiographs have been used as part of the evaluation for children with head trauma, yet their value remains controversial.

 Head computed tomography (CT) has become the diagnostic method of choice for identification of intracranial disorders in patients with head trauma. However, CT is expensive, not always readily available, sometimes requires sedation of the patient, and always requires skilled interpretation. A defined set of clinical screening criteria for the evaluation of head injury does not exist for children but would be valuable in the decision-making process.

Few prospective studies have addressed radiographic diagnosis of head trauma exclusively in children. These prospective studies have examined the value of imaging in a series of patients selected for head CT on the basis of unspecified criteria.

Independent predictors of intracranial injury include altered mental status, focal neurologic deficit, signs of a basilar skull fracture, seizure, and skull fracture. However, intracranial injury may also occur with few or subtle signs and symptoms, especially in infants younger than 1 year. Furthermore, the majority of patients with intracranial injury were neurologically intact; therefore, CT scans should be considered in children with symptoms such as vomiting, headache, drowsiness, amnesia, and a history of loss of consciousness, even in the absence of the independent predictors of intracranial injury we identified

What is PET Imaging?

Positron Emission Tomography
• Measures emissions from radioactively
labeled tracer that is injected into the
bloodstream
– A form of glucose that is not metabolized by
the brain and has a reasonable half-life
• Uses coincidence data to produce two- or
three-dimensional images of the
distribution of the chemicals throughout
the brain and body.
• Shows blood flow, oxygen and glucose
metabolism, and drug concentrations in the
tissues of the working brain.

Recap of Brain Injury Diagnostic Modalities

BRAIN IMAGING MODALITIES
• Autopsies
• X-ray and CT – Lesion data
• MR Angiography
• PET and SPECT
• MRI and fMRI
• DWI, DTI, Tractography
• Ultrasound
• Optical Coherence Tomography
• MEG and EEG

Diagnostic Brain Imaging 101: FMRI, CT, PET and EEG

Brain imaging techniques allow doctors and researchers to view activity or problems within the human brain, without invasive neurosurgery. There are a number of accepted, safe imaging techniques in use today in research facilities and hospitals throughout the world.

fMRI

Functional magnetic resonance imaging, or fMRI, is a technique for measuring brain activity. It works by detecting the changes in blood oxygenation and flow that occur in response to neural activity – when a brain area is more active it consumes more oxygen and to meet this increased demand blood flow increases to the active area. fMRI can be used to produce activation maps showing which parts of the brain are involved in a particular mental process.

CT

Computed tomography (CT) scanning builds up a picture of the brain based on the differential absorption of X-rays. During a CT scan the subject lies on a table that slides in and out of a hollow, cylindrical apparatus. An x-ray source rides on a ring around the inside of the tube, with its beam aimed at the subjects head. After passing through the head, the beam is sampled by one of the many detectors that line the machine’s circumference. Images made using x-rays depend on the absorption of the beam by the tissue it passes through. Bone and hard tissue absorb x-rays well, air and water absorb very little and soft tissue is somewhere in between. Thus, CT scans reveal the gross features of the brain but do not resolve its structure well.

PET

Positron Emission Tomography (PET) uses trace amounts of short-lived radioactive material to map functional processes in the brain. When the material undergoes radioactive decay a positron is emitted, which can be picked up be the detector. Areas of high radioactivity are associated with brain activity.

EEG

Electroencephalography (EEG) is the measurement of the electrical activity of the brain by recording from electrodes placed on the scalp. The resulting traces are known as an electroencephalogram (EEG) and represent an electrical signal from a large number of neurons.

EEGs are frequently used in experimentation because the process is non-invasive to the research subject. The EEG is capable of detecting changes in electrical activity in the brain on a millisecond-level. It is one of the few techniques available that has such high temporal resolution.

Image via Wikipedia

Are you undergoing Diffusion Tensor Imaging?

(DTI) Diffusion tensor imaging is the more sophisticated form of DWI, which allows for the determination of directionality as well as the magnitude of water diffusion. This kind of MR imaging can estimates damage to nerve fibers that connect the area of the brain affected by the stroke to brainregions that are distant from it, and can be used to determine the effectiveness of stroke prevention medications. 

DTI (FiberTrak) enables to visualize white matter fibers in the brain and can map (trace image) subtle changes in the white matter associated with diseases such as multiple sclerosis and epilepsy, as well as assessing diseases where the brain’s wiring is abnormal, such as schizophrenia.
The fractional anisotropy (FA) gives information about the shape of the diffusion tensor at each voxel. The FA is based on the normalized variance of the eigenvalues. The fractional anisotropy reflects differences between an isotropic diffusion and a linear diffusion. The FA range is between 0 and 1 (0 = isotropic diffusion, 1 = highly directional). 
The development of new imaging methods and some useful analysis techniques, such as 3-dimensional anisotropy contrast (3DAC) and spatial tracking of the diffusion tensor tractography (DTT), are currently under study.

Welcome to our blog, the Brain Injury Resource Center

Welcome to our blog, a site with information, links to resources, and news. Why did we start this blog? Simple – because there are so many diffuse and at times confusing sites that seem miss the focus of providing resources for those whose lives have been changed forever because of a traumatic brain injury.

 

Stay tuned.

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