A recent story from the Navy Times about a new concept in what is technically referred to as functional imaging. Functional imaging, such as a PET scan or fMRI, is an imaging technique which tells not whether there is a bleed or damage to a structure of the brain, but whether there has been a change in the way the brain is operating at a given moment. Most of the major discoveries about how the brain works has been done in the functional imaging area, particularly fMRI. While PET scans have been used for legal cases for more than a decade, fMRI is still only being used peripherally in forensic matters. We have continued to push for more utilization in our cases, but has yet to add anything significant. This new combat breakthrough might add something to the ER equation in civil cases, and could add a major new element to differentiating between the cases with good recoveries, and those where there is ongoing basis for concern.
From the Navy Times story:
“Dr. Richard Dutton heads up trauma anesthesiology at the R. Adams Cowley Shock Trauma Center at the University of Maryland and sees about 4,000 people a year who doctors believe have a brain injury.
Dutton and a team of engineers decided to see if they could use sonar to “listen” for differences in healthy brains and injured brains. They used a headband with sensors to pick up the sound transmitted through the brain with sonar and then analyzed the data fed back into a computer. The Air Force paid for the research.
“We’d ‘ping’ them with sonar and then listen,” Dutton said Feb. 20 at an American Institute for Medical and Biological Engineering conference.
They didn’t learn much from the pinging, but when they just started listening, they were able to detect significant differences, which turned about to predictive as to whether the severely injured person would awake or not. The portability of this technique is important, but that functional imaging could make such distinction is not new. PET scans for decades have been able to add significant prognostic value to differentiate between the levels of coma, because they show how much activity the brain actually has. I have complained for more than a decade that a PET scan (and now perhaps fMRI) should be used to help make decisions and inform family members about the probably that someone will awake from a coma.
But the most intriguing breakthrough in the military technique is not just that it seems to add portability to the equation (which of course is essential in combat) but also that such portability is sensitive enough to be able to detect abnormalities in even the concussed, as opposed to, comatose brain.
The Navy Times story goes on:
“When Dutton and the engineers tried out their equipment on people they believed to have mild TBIs, they found turbulent blood flow — or irregular bandwidths — on the Brain Acoustic Monitor.
“You hit your head, your BAM becomes abnormal,” Dutton said. “We think we may have an objective marker for brain injury. This is pretty exciting stuff.”
And it’s completely portable, which could be good news for troops in Iraq and Afghanistan. In Iraq, there’s one CT scan — in Balad — and no MRI machine. Medics don’t have access to the heavy, expensive equipment.”
If this BAM technology can be licensed and distributed to Emergency Room settings, it might not just help on the battlefield, it might also add significant diagnostic utility for civilian use. While the scope of the concussion/head injury issue in Iraq is important, it is a relatively small number compared to civilian use. If there have been even 5,000 concussions a year in Iraq, that is only 5% of the estimated 1,000,000 concussions in the United States alone, each year.
Of course, the challenge will remain to educate the ER personnel to even the possibility that someone who knows who they are, where they are, what day it is and how they got hurt, could still be suffering brain damage.
FOR MORE ON FUNCTIONAL IMAGING, GO TO http://subtlebraininjury.com/normalimaging.html and particularly http://subtlebraininjury.com/pet.ht
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Brain Injury Awareness Month
EDITORS NOTE: The below press release is from the Brain Injury Association, a group all who care about brain injury should be part of.
To celebrate March as Brain Injury Awareness Month, the Congressional Brain Injury Task Force is hosting a “2008 Brain Injury Awareness Day,” on Wednesday, March 12, 2008, on Capitol Hill.
Multiple events are planned, which are designed to educate Members of Congress and their staff about brain injury. These events include an Awareness Day Fair, which will feature exhibits and informational materials from individuals and organizations working in the field of brain injury. The day will also include a Congressional Briefing focused on the topic of “Traumatic Brain Injury and Community Needs.” The end of the day will feature an early-evening Congressional Reception sponsored by various national advocacy organizations, including the National Brain Injury Treatment and Training Foundation (NBIRTT), the Brain Injury Association of America (BIAA), the National Disability Rights Network (NDRN) and the National Association of State Head Injury Administrators (NASHIA).
BIAA invites all advocates to attend “2008 Brain Injury Awareness Day” events, and help educate Members of Congress and their staff. The Day also represents an important opportunity to network with others interested in helping increase brain injury awareness.
2008 Brain Injury Awareness Day Schedule of Events
Brain Injury Awareness Fair
10:00 a.m. – 2:00 p.m.
First Floor Foyer of the Rayburn House Office Building
Congressional Briefing on “Traumatic Brain Injury and Community Needs”
3:00 p.m. – 4:00 p.m.
1116 Longworth House Office Building
Congressional Reception Celebrating Brain Injury Awareness Day
5:00 p.m. – 6:30 p.m.
2105 Rayburn House Office Building
Please RSVP by Monday, March 3, 2008, to Hope Mandel in Congressman Bill Pascrell’s office if you wish to attend and/or exhibit materials during the Awareness Fair. You may also contact Hope at (202) 225-5751 or Becky Wolfkiel in Congressman Platts’ office at (202) 225-5836 with questions or for more information. In addition, as always, you may contact Laura Schiebelhut, BIAA’s Director of Government Affairs, at lschiebelhut@biausa.org, or 703-761-0750 ext. 637, for further clarification.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
To celebrate March as Brain Injury Awareness Month, the Congressional Brain Injury Task Force is hosting a “2008 Brain Injury Awareness Day,” on Wednesday, March 12, 2008, on Capitol Hill.
Multiple events are planned, which are designed to educate Members of Congress and their staff about brain injury. These events include an Awareness Day Fair, which will feature exhibits and informational materials from individuals and organizations working in the field of brain injury. The day will also include a Congressional Briefing focused on the topic of “Traumatic Brain Injury and Community Needs.” The end of the day will feature an early-evening Congressional Reception sponsored by various national advocacy organizations, including the National Brain Injury Treatment and Training Foundation (NBIRTT), the Brain Injury Association of America (BIAA), the National Disability Rights Network (NDRN) and the National Association of State Head Injury Administrators (NASHIA).
BIAA invites all advocates to attend “2008 Brain Injury Awareness Day” events, and help educate Members of Congress and their staff. The Day also represents an important opportunity to network with others interested in helping increase brain injury awareness.
2008 Brain Injury Awareness Day Schedule of Events
Brain Injury Awareness Fair
10:00 a.m. – 2:00 p.m.
First Floor Foyer of the Rayburn House Office Building
Congressional Briefing on “Traumatic Brain Injury and Community Needs”
3:00 p.m. – 4:00 p.m.
1116 Longworth House Office Building
Congressional Reception Celebrating Brain Injury Awareness Day
5:00 p.m. – 6:30 p.m.
2105 Rayburn House Office Building
Please RSVP by Monday, March 3, 2008, to Hope Mandel in Congressman Bill Pascrell’s office if you wish to attend and/or exhibit materials during the Awareness Fair. You may also contact Hope at (202) 225-5751 or Becky Wolfkiel in Congressman Platts’ office at (202) 225-5836 with questions or for more information. In addition, as always, you may contact Laura Schiebelhut, BIAA’s Director of Government Affairs, at lschiebelhut@biausa.org, or 703-761-0750 ext. 637, for further clarification.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Gronwall on Amnesia
I had an idea for today’s blog, which was to pick one of my favorite books, just randomly turn to a page, and write on such topic.
The book I picked was Wrightson and Gronwall, Mild Head Injury, Oxford, 1999. Click here to order this book.
This book is one of the great literature contributions to brain damage research. Dorothy Gronwall, a neuropsychologist from New Zealand, in conjunction with her colleague Philip Wrightson, a neurologist, have truly described and captured the essence of subtle brain injury in this inexpensive, 180 page text. No one who practices in the field of brain injury should be allowed to work with any survivor of such injury, without being able to grasp every concept in this book. It would be so simple to simply add a one hour exam on the contents of this book, to the board certification in neurology, psychiatry, emergency medicine and neuropsychology. The quality of diagnosis of brain damage would go up exponentially if such requirement were added. If you have a neurolawyer, demand that he/she gets and understands this book.
I opened to page 23, and here is what I had previously highlighted from such page:
“Clinical studies of amnesia in the period immediately after injury have shown that it takes some minutes for both pre- and post-traumatic amnesia to be established. In a study in which footballers (soccer players) were tested immediately after a mild head injury there was at first good recall of what had happened before the accident; retrograde amnesia (after the event) then developed after a few minutes (Yarnell and Lynch 1970). Another study examined ‘islands’ of recollection during a period of post-traumatic amnesia. These were almost all in the first quarter of the period, suggesting that it took some time for recall to be blocked.
“Plainly the injury has set in motion processes that are much slower than the one responsible for the initial loss of consciousness…. It may be that a chain of chemical changes has been initiated that needs time for development before it can inhibit neuronal function.”
I discuss on my Concussion Clinic videos at length (sorry if it is too much length) the role of adrenaline in assisting memory of the time frame right around the event itself. As we move forward in our research of concussion, and make attempts to better determine the potential for long term deficits – or perhaps just adjustment disorders related to the interplay of organic brain damage and emotional issues – we must focus on proper tests of amnesia by those who do the first intake post injury. Why is it so hard to incorporate into the emergency room protocol detailed questions about what the person remembers from 15 minutes post accident until the point in time they are being evaluated in the ER?
All of the neuropsychological tests ever invented, could not match the diagnostic value of 10 more questions about post-injury memory, well documented and recorded on the day of the event.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
The book I picked was Wrightson and Gronwall, Mild Head Injury, Oxford, 1999. Click here to order this book.
This book is one of the great literature contributions to brain damage research. Dorothy Gronwall, a neuropsychologist from New Zealand, in conjunction with her colleague Philip Wrightson, a neurologist, have truly described and captured the essence of subtle brain injury in this inexpensive, 180 page text. No one who practices in the field of brain injury should be allowed to work with any survivor of such injury, without being able to grasp every concept in this book. It would be so simple to simply add a one hour exam on the contents of this book, to the board certification in neurology, psychiatry, emergency medicine and neuropsychology. The quality of diagnosis of brain damage would go up exponentially if such requirement were added. If you have a neurolawyer, demand that he/she gets and understands this book.
I opened to page 23, and here is what I had previously highlighted from such page:
“Clinical studies of amnesia in the period immediately after injury have shown that it takes some minutes for both pre- and post-traumatic amnesia to be established. In a study in which footballers (soccer players) were tested immediately after a mild head injury there was at first good recall of what had happened before the accident; retrograde amnesia (after the event) then developed after a few minutes (Yarnell and Lynch 1970). Another study examined ‘islands’ of recollection during a period of post-traumatic amnesia. These were almost all in the first quarter of the period, suggesting that it took some time for recall to be blocked.
“Plainly the injury has set in motion processes that are much slower than the one responsible for the initial loss of consciousness…. It may be that a chain of chemical changes has been initiated that needs time for development before it can inhibit neuronal function.”
I discuss on my Concussion Clinic videos at length (sorry if it is too much length) the role of adrenaline in assisting memory of the time frame right around the event itself. As we move forward in our research of concussion, and make attempts to better determine the potential for long term deficits – or perhaps just adjustment disorders related to the interplay of organic brain damage and emotional issues – we must focus on proper tests of amnesia by those who do the first intake post injury. Why is it so hard to incorporate into the emergency room protocol detailed questions about what the person remembers from 15 minutes post accident until the point in time they are being evaluated in the ER?
All of the neuropsychological tests ever invented, could not match the diagnostic value of 10 more questions about post-injury memory, well documented and recorded on the day of the event.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Iraq Brain Injury Research Provides More Evidence Re the Process of Brain Injury
One of the absolute cornerstone’s to my belief system as a brain injury advocate, is that brain damage is not an immediate occurrence but part of a complex and multi-factorial process that occurs not just over minutes, but as much as 24-72 hours after the trauma. This is an issue I can almost always get defense experts to admit, but not always within the type of trauma I represent people, concussions from fall and car wrecks. Last week I was blogging on the good and the bad of the huge influx of new brain injury research coming out of Iraq, but today’s new release is clearly all positive.
In research summarized at http://www.jhu.edu/~jhumag/0208web/wholly.html#apl researchers at Johns Hopkins are saying that “Blast exposure, especially repeated exposure, can cause brain damage so subtle that soldiers may not realize they’ve been wounded. Ibolja Cernak, director of the Biomedicine Business Area at the Applied Physics Laboratory, says that these mild brain injuries can lead to gradual neurodegeneration, similar to Alzheimer’s disease.
The main researcher on this work is Ibolja Cernak, director of the Biomedicine Business Area at the Applied Physics Laboratory, at Johns Hopkins.
While there has been little controversy that blasts can cause brain damage, even without a direct blow to the head, presumably from the rapid jostling of the brain matter, inside of the skull. The Johns Hopkins story explains:
“The prevailing argument has been that waves of compressed air emanating from the blast shake the skull with enough force to strain or stretch the brain, not unlike what happens in a bad car crash. ‘It’s like a turbo-charged whiplash,” says Ross Bullock, a professor in the Department of Neurological Surgery at the University of Miami.”
But Cernak’s research posits that the blast energy is transferred in waves to the large blood vessels, which bring blood to the brain. She claims that the drastic pressure changes and rushes of blood thru these vessels from the blast, then damage the small vessels within the brain and the adjacent tissue. While not clearly more complex, analogize this to getting a bloody nose, following a series of violent sneezes.
There clearly is historical evidence to support this as an additive theory as to how the brain gets injured in combat. One of the frustrating things about modern brain injury research, is that it is done with so little historical perspective on what was known about brain damage from what I would call the “collective common sense” of centuries of working with people who were “quite right in the head” after combat. The whole concept of shell shock evolved not just because soldiers were injured by the enemies shells, but also were exposed to brain damage, from being on the sending end of shelling. Sailors on British ships of the line, were known to be at risk of getting funny, if allowed to work below deck for too long.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
In research summarized at http://www.jhu.edu/~jhumag/0208web/wholly.html#apl researchers at Johns Hopkins are saying that “Blast exposure, especially repeated exposure, can cause brain damage so subtle that soldiers may not realize they’ve been wounded. Ibolja Cernak, director of the Biomedicine Business Area at the Applied Physics Laboratory, says that these mild brain injuries can lead to gradual neurodegeneration, similar to Alzheimer’s disease.
The main researcher on this work is Ibolja Cernak, director of the Biomedicine Business Area at the Applied Physics Laboratory, at Johns Hopkins.
While there has been little controversy that blasts can cause brain damage, even without a direct blow to the head, presumably from the rapid jostling of the brain matter, inside of the skull. The Johns Hopkins story explains:
“The prevailing argument has been that waves of compressed air emanating from the blast shake the skull with enough force to strain or stretch the brain, not unlike what happens in a bad car crash. ‘It’s like a turbo-charged whiplash,” says Ross Bullock, a professor in the Department of Neurological Surgery at the University of Miami.”
But Cernak’s research posits that the blast energy is transferred in waves to the large blood vessels, which bring blood to the brain. She claims that the drastic pressure changes and rushes of blood thru these vessels from the blast, then damage the small vessels within the brain and the adjacent tissue. While not clearly more complex, analogize this to getting a bloody nose, following a series of violent sneezes.
There clearly is historical evidence to support this as an additive theory as to how the brain gets injured in combat. One of the frustrating things about modern brain injury research, is that it is done with so little historical perspective on what was known about brain damage from what I would call the “collective common sense” of centuries of working with people who were “quite right in the head” after combat. The whole concept of shell shock evolved not just because soldiers were injured by the enemies shells, but also were exposed to brain damage, from being on the sending end of shelling. Sailors on British ships of the line, were known to be at risk of getting funny, if allowed to work below deck for too long.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Iraq and Brain Damage Research
One of the great advantages of working on challenging and complicated brain damage cases is that I get exposed to some of the leading neuro-scientists in the world. This year’s common denominator amongst those minds is that I know many professionals whose research is benefitting from the huge infusion of research funds for brain injury, Iraq Style. That large sums of federal dollar is now looking into brain injury is great news. And another silver lining to the tragic cloud of a whole new generation of brain damaged veterans, is the emerging media attention to the brain injuries.
But this massive research move does come with a cost, and I am not talking about huge sums of US taxpayers dollars, which of course are being thrown at this problem, because of the political ground swell to do more for our veterans. The long range cost to this may be too much research, done too quickly, by people who don’t fully comprehend the nature and scope of the civilian post concussion syndrome problem. Already, we are seeing studies that are further muddling the line of demarcation between organic brain injury and PTSD. In a combat casualty, that line would be expected to be blurred. The whole concept of PTSD is something that arose out of combat, principally the Viet Nam war.
But when you separate Post Concussion Syndrome (or Subtle Brain Injury, as I call it) from the combat situation, there are very few cases where the PTSD is even a factor. Sure you could construct a fiction that anyone who has been thru a car wreck, has a certain risk factor for anxiety from such accident – it it was in fact life threatening and there was advance warning. Take for example the person who has the half second warning as they brake before a serious head on collision. That person may have gotten the fright of his or her life from the event. But most car wrecks aren’t like that. Most are rear end collisions where there is little or no “scare” involved until the wreck is over. Anxiety causing events and PTSD (shocking events) are different.
Personally, I don’t think that PTSD should ever have really applied outside of the combat situation, except in situations with prolonged emotionally distress (such as a rape or kidnapping). But our medical community likes to pigeon hole diagnosis into neatly defined categories, and if you don’t subscribe to the theory that concussion can cause permanent damage, then you have to look around for some sort of other convenient pigeon hole. The DSM-IV, the bible of psychiatrists, is the principal tablet from above for modern medicine when the organic diagnosis is not straightforward. PTSD has very strict diagnostic criteria, which only really make sense in the prolonged shock/stress situation. So even though this is not something you would likely see in a motor vehicle wreck and certainly not in other accidents, the diagnosis appears not only in practice, but in peer reviewed literature.
However, the biggest problem in basing our next generation of diagnosis of Iraq war head injuries is that soldiers are much like young jocks: they do not accurately represent the type of person who is typically disabled by a concussion nor the type of forces a civilian is likely to endure. Soldiers are predominantly younger individuals, in good physical condition (we certainly hope so) and who are primarily male. Those disabled from concussion are predominantly over 40, female and incapable of withstanding any where near the same type of physical trauma. This has been much of the problem with basing our current generation of research on concussion and sport studies. While the good news is that this research has predominantly moved the line as to when a concussion can occur – as young jocks are far less likely to be disabled than average – they understate the potential for disability in the civilian population.
OK, now that I have vented, let me be a hypocrite and tell you what my pet project would be for all of this research money: I want them to develop a detailed, standardized questionnaire that can be administered by ER personnel to test for AMNESIA. I would like to see a protocol where every ER room would have a questionnaire that they give anyone suspected of a concussion, with questions on it, that would tell you whether such person had complete memory from the period of time 5 minutes post accident, until the period of time of the examination. And by the way, at the bottom of that questionnaire, tell the medical professional to insist that the person come back in 24 hours and be asked the same questions again. See specific to this issue, my video at http://youtube.com/watch?v=dEWHgwRywtY For a general treatment of the role of amnesia in concussion diagnosis, see the full playlist of videos on this topic at http://www.youtube.com/view_play_list?p=F4E4FC0DCD4FA2E9
The repeated followups is the standard of care to release our million dollar quarterbacks to play in the next game, it hopefully will be the evolving standard of care to allow our soldiers to return to a combat situation. It must be the standard of care before ruling out a concussion in someone far more likely to be disabled by the trauma to the brain.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
But this massive research move does come with a cost, and I am not talking about huge sums of US taxpayers dollars, which of course are being thrown at this problem, because of the political ground swell to do more for our veterans. The long range cost to this may be too much research, done too quickly, by people who don’t fully comprehend the nature and scope of the civilian post concussion syndrome problem. Already, we are seeing studies that are further muddling the line of demarcation between organic brain injury and PTSD. In a combat casualty, that line would be expected to be blurred. The whole concept of PTSD is something that arose out of combat, principally the Viet Nam war.
But when you separate Post Concussion Syndrome (or Subtle Brain Injury, as I call it) from the combat situation, there are very few cases where the PTSD is even a factor. Sure you could construct a fiction that anyone who has been thru a car wreck, has a certain risk factor for anxiety from such accident – it it was in fact life threatening and there was advance warning. Take for example the person who has the half second warning as they brake before a serious head on collision. That person may have gotten the fright of his or her life from the event. But most car wrecks aren’t like that. Most are rear end collisions where there is little or no “scare” involved until the wreck is over. Anxiety causing events and PTSD (shocking events) are different.
Personally, I don’t think that PTSD should ever have really applied outside of the combat situation, except in situations with prolonged emotionally distress (such as a rape or kidnapping). But our medical community likes to pigeon hole diagnosis into neatly defined categories, and if you don’t subscribe to the theory that concussion can cause permanent damage, then you have to look around for some sort of other convenient pigeon hole. The DSM-IV, the bible of psychiatrists, is the principal tablet from above for modern medicine when the organic diagnosis is not straightforward. PTSD has very strict diagnostic criteria, which only really make sense in the prolonged shock/stress situation. So even though this is not something you would likely see in a motor vehicle wreck and certainly not in other accidents, the diagnosis appears not only in practice, but in peer reviewed literature.
However, the biggest problem in basing our next generation of diagnosis of Iraq war head injuries is that soldiers are much like young jocks: they do not accurately represent the type of person who is typically disabled by a concussion nor the type of forces a civilian is likely to endure. Soldiers are predominantly younger individuals, in good physical condition (we certainly hope so) and who are primarily male. Those disabled from concussion are predominantly over 40, female and incapable of withstanding any where near the same type of physical trauma. This has been much of the problem with basing our current generation of research on concussion and sport studies. While the good news is that this research has predominantly moved the line as to when a concussion can occur – as young jocks are far less likely to be disabled than average – they understate the potential for disability in the civilian population.
OK, now that I have vented, let me be a hypocrite and tell you what my pet project would be for all of this research money: I want them to develop a detailed, standardized questionnaire that can be administered by ER personnel to test for AMNESIA. I would like to see a protocol where every ER room would have a questionnaire that they give anyone suspected of a concussion, with questions on it, that would tell you whether such person had complete memory from the period of time 5 minutes post accident, until the period of time of the examination. And by the way, at the bottom of that questionnaire, tell the medical professional to insist that the person come back in 24 hours and be asked the same questions again. See specific to this issue, my video at http://youtube.com/watch?v=dEWHgwRywtY For a general treatment of the role of amnesia in concussion diagnosis, see the full playlist of videos on this topic at http://www.youtube.com/view_play_list?p=F4E4FC0DCD4FA2E9
The repeated followups is the standard of care to release our million dollar quarterbacks to play in the next game, it hopefully will be the evolving standard of care to allow our soldiers to return to a combat situation. It must be the standard of care before ruling out a concussion in someone far more likely to be disabled by the trauma to the brain.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Neuro Docs, the Difficulty in Keeping them Straight
I once started a lecture with this joke: the most important thing to being a brain injury lawyer, is learning how to type neuro.
It sometimes feels to me, and I am sure as often to the readers of my various web pages, that there are just too many specialities with the word neuro in them. I sometimes have a hard time sorting out the neuro this’s from the neuro thats. Sometimes the specialities can’t even agree on how to spell their speciality. Take for example, the neurootologists, who are specialists in the vestibular system. The same peer reviewed literature will spell the word: neuro-otologist, neurootologist (my preferred spelling) and neurotologists.
Any way, here is my “frontal lobe test” for myself: Name all of the neuro docs I can type in 30 seconds:
neurologist
neuropsychologist
neurootologist
neuroradiologist
If you gave me extra time, I would add… neurosurgeon, neuropsychiatrist, neurobehavioral scientist, and neurolawyer. But I am not sure that the last two are in the actual book (if there were one.)
Neurologist. Most people understand what a neurologist is – a medical doctor who specializes in the neurological system. Most people interested in brain injury don’t understand that the study of neurology is so broad that brain injury only makes up about 1% of what these doctors do. To improve your odds, try to find a “behavioral neurologist.”
Neuropsychologists – these are not medical doctors, but psychologists, who at their best are neurobehaviorists, and at their worst, are test administers, who will take the concept of lieing with statistics to obscene proportions. Neuropsychology is fundamentally based upon the theory that brain pathologies, even though they cannot be directly seen in live subjects, leave behind patterns of behavior that can pinpoint where the pathology is. In its most basic form, it is based on written tests, which will show a pattern of results, where the areas of the brain affected by the pathology, will cause the test subject to do abnormally worse on the test. But any neuropsychologist worth your time, will clearly realize that the role of neuropsychology is not to administer and interpret tests, but to do a full “neuropsychological assessement” that is not a statistical process, but an analysis of all of the “footprints of pathology”, that the written test patterns, are only a small proportion of. In the coming days, I will devote an entire blog (or perhaps series of blogs) to neuropsychology, the hope of my youth as a plaintiff’s lawyer, and the bain of my maturity as one. For more on my theory of the “footprints of pathology”, click here.
Neurootologists are doctors who specialize in the vestibular system, the remarkable and complex way in which your inner ear provides the body with a gyroscope. For more on the vestibular system, click here. Some of the best neurootologists are the ones that started as neurologists, and became more specialized in the disorders of balance and vertigo, but EMT doctors who did a fellowship in the vestibular system qualify as neurootologists as well.
Neuroradiologists are radiologists who specialize in the brain and spine. Radiologists are doctors who specialize in reading diagnostic tests such as XRay, CT scans and MRI. Most of the work of the modern neuroradiologist is in CT and especially high field strength MRI. For more on neuroradiology, click here.
Neurosurgeons are surgeons who do brain and spinal surgery.
Neuropsychiatrists are psychiatrists who cross over into the field of neurology and neurobehavior, where there is an interplay between emotional/psychiatric disease and organic processes within the brain. The irony of course in that definition is that it should apply to all brain specialties, as it is “all in the head”. Again, a topic for a blog of its own, more properly a book of its own.
Neurobehavioral scientist is somewhat my own term. I think it is the role that neuropsychologists should play, on an increasing level. The most important “footprint of pathology” is the change in a person’s behavior, and particularly that change in behavior in the real world. The problem with neurobehavioral science, is that it doesn’t reduce itself to statistical analysis, doesn’t make for definitive research studies and requires subjective analysis. Well, the reason these doctors went to school for all these years, is that they could use subjective judgment to make complicated diagnosis. The human mind is far too complex to diagnose the interplay between organic pathology and emotions, without subjective judgments of trained and experienced professionals. If you doctor is not a neurobehavioral scientist, you have the wrong doctor.
Neurolawyer? There is no such specialization, at least not a recognized one. I consider myself to be a neurobehavioral expert, but not a medical expert, nor a psychological one. I work almost exclusively in the field of brain damage, and have learned from and challenged the best medical/psychological minds in the country with my inquiries, questions and depositions. But most of what I have learned has been from you – the survivors of brain injury and the family members of those survivors. I keep learning, I keep writing, I keep asking the tough questions, the questions that because I cannot be pigeon holed into any of the above specialities, often are questions that require thought, and hopefully research to answer.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
It sometimes feels to me, and I am sure as often to the readers of my various web pages, that there are just too many specialities with the word neuro in them. I sometimes have a hard time sorting out the neuro this’s from the neuro thats. Sometimes the specialities can’t even agree on how to spell their speciality. Take for example, the neurootologists, who are specialists in the vestibular system. The same peer reviewed literature will spell the word: neuro-otologist, neurootologist (my preferred spelling) and neurotologists.
Any way, here is my “frontal lobe test” for myself: Name all of the neuro docs I can type in 30 seconds:
neurologist
neuropsychologist
neurootologist
neuroradiologist
If you gave me extra time, I would add… neurosurgeon, neuropsychiatrist, neurobehavioral scientist, and neurolawyer. But I am not sure that the last two are in the actual book (if there were one.)
Neurologist. Most people understand what a neurologist is – a medical doctor who specializes in the neurological system. Most people interested in brain injury don’t understand that the study of neurology is so broad that brain injury only makes up about 1% of what these doctors do. To improve your odds, try to find a “behavioral neurologist.”
Neuropsychologists – these are not medical doctors, but psychologists, who at their best are neurobehaviorists, and at their worst, are test administers, who will take the concept of lieing with statistics to obscene proportions. Neuropsychology is fundamentally based upon the theory that brain pathologies, even though they cannot be directly seen in live subjects, leave behind patterns of behavior that can pinpoint where the pathology is. In its most basic form, it is based on written tests, which will show a pattern of results, where the areas of the brain affected by the pathology, will cause the test subject to do abnormally worse on the test. But any neuropsychologist worth your time, will clearly realize that the role of neuropsychology is not to administer and interpret tests, but to do a full “neuropsychological assessement” that is not a statistical process, but an analysis of all of the “footprints of pathology”, that the written test patterns, are only a small proportion of. In the coming days, I will devote an entire blog (or perhaps series of blogs) to neuropsychology, the hope of my youth as a plaintiff’s lawyer, and the bain of my maturity as one. For more on my theory of the “footprints of pathology”, click here.
Neurootologists are doctors who specialize in the vestibular system, the remarkable and complex way in which your inner ear provides the body with a gyroscope. For more on the vestibular system, click here. Some of the best neurootologists are the ones that started as neurologists, and became more specialized in the disorders of balance and vertigo, but EMT doctors who did a fellowship in the vestibular system qualify as neurootologists as well.
Neuroradiologists are radiologists who specialize in the brain and spine. Radiologists are doctors who specialize in reading diagnostic tests such as XRay, CT scans and MRI. Most of the work of the modern neuroradiologist is in CT and especially high field strength MRI. For more on neuroradiology, click here.
Neurosurgeons are surgeons who do brain and spinal surgery.
Neuropsychiatrists are psychiatrists who cross over into the field of neurology and neurobehavior, where there is an interplay between emotional/psychiatric disease and organic processes within the brain. The irony of course in that definition is that it should apply to all brain specialties, as it is “all in the head”. Again, a topic for a blog of its own, more properly a book of its own.
Neurobehavioral scientist is somewhat my own term. I think it is the role that neuropsychologists should play, on an increasing level. The most important “footprint of pathology” is the change in a person’s behavior, and particularly that change in behavior in the real world. The problem with neurobehavioral science, is that it doesn’t reduce itself to statistical analysis, doesn’t make for definitive research studies and requires subjective analysis. Well, the reason these doctors went to school for all these years, is that they could use subjective judgment to make complicated diagnosis. The human mind is far too complex to diagnose the interplay between organic pathology and emotions, without subjective judgments of trained and experienced professionals. If you doctor is not a neurobehavioral scientist, you have the wrong doctor.
Neurolawyer? There is no such specialization, at least not a recognized one. I consider myself to be a neurobehavioral expert, but not a medical expert, nor a psychological one. I work almost exclusively in the field of brain damage, and have learned from and challenged the best medical/psychological minds in the country with my inquiries, questions and depositions. But most of what I have learned has been from you – the survivors of brain injury and the family members of those survivors. I keep learning, I keep writing, I keep asking the tough questions, the questions that because I cannot be pigeon holed into any of the above specialities, often are questions that require thought, and hopefully research to answer.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Winter Kills – Carbon Monoxide Claims Many More
This winter of 2008, there have been two well publicized mass shootings in my part time home state of Illinois, and many more mass killings from Carbon Monoxide. Even the election cycle news had to take a pause for the Northern Illinois tragedy. Nary a peep, except in the local media, about Carbon Monoxide’s rampages.
The first string of cases, was so predictable, I almost blame myself for not having found a bigger mountain top to have raised my cry of alarm: household generators. Any time there is a flame, and it is in an unventilated place, there will be a risk of CO exposure. Well the last few weeks has seen many storms. With storms, comes power outages. With power outages, comes the use of portable electric generators. My father spent his life designing such generators. Electric generators, when used properly, should not be a serious risk. But they were never intended to be set up in the kitchen, to operate the microwave.
More severe weather is sweeping across the nation this week. I fear that will be more power outages, more death from this silent killer. If you are in the business of selling portable generators, I believe you must include a CO detector with each purchase. That should be the law. I am sure the good businessmen who sell them warn people, but you can buy the little portable units almost anywhere now, and the corporate executives at Home Depot or Walmart, ought to just package the CO detector right with the product.
For more information on the dangers of portable generators, click here: http://www.usfa.dhs.gov/citizens/all_citizens/co/generator.shtm
Here are the basic rules to avoid CO exposure when using a portable generator:
Always use generators outdoors.
Keep generator exhaust away from air that flows into a building. But also make sure it is away from windows, doore and vents. The venting part can be critical. Many of the tragic stories we have heard this winter was from indirect exposure because an engine source (like a generator) was too close to an air intake vent.
Garages, basements, crawl spaces, are not OUTDOORS.
Follow manufacturer’s instructions. This presumes you can still find the instructions. Hopefully they are printed right on the generator itself. If not, look them up online. Keep in mind that exhaust that can get into your living area can kill you.
Use CO detectors, and make sure they are working, that the batteries are replaced when needed. Remember that smoke detectors, are not CO detectors. You can have CO exposure with no smell of smoke and without a smoke detector going off.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
The first string of cases, was so predictable, I almost blame myself for not having found a bigger mountain top to have raised my cry of alarm: household generators. Any time there is a flame, and it is in an unventilated place, there will be a risk of CO exposure. Well the last few weeks has seen many storms. With storms, comes power outages. With power outages, comes the use of portable electric generators. My father spent his life designing such generators. Electric generators, when used properly, should not be a serious risk. But they were never intended to be set up in the kitchen, to operate the microwave.
More severe weather is sweeping across the nation this week. I fear that will be more power outages, more death from this silent killer. If you are in the business of selling portable generators, I believe you must include a CO detector with each purchase. That should be the law. I am sure the good businessmen who sell them warn people, but you can buy the little portable units almost anywhere now, and the corporate executives at Home Depot or Walmart, ought to just package the CO detector right with the product.
For more information on the dangers of portable generators, click here: http://www.usfa.dhs.gov/citizens/all_citizens/co/generator.shtm
Here are the basic rules to avoid CO exposure when using a portable generator:
Always use generators outdoors.
Keep generator exhaust away from air that flows into a building. But also make sure it is away from windows, doore and vents. The venting part can be critical. Many of the tragic stories we have heard this winter was from indirect exposure because an engine source (like a generator) was too close to an air intake vent.
Garages, basements, crawl spaces, are not OUTDOORS.
Follow manufacturer’s instructions. This presumes you can still find the instructions. Hopefully they are printed right on the generator itself. If not, look them up online. Keep in mind that exhaust that can get into your living area can kill you.
Use CO detectors, and make sure they are working, that the batteries are replaced when needed. Remember that smoke detectors, are not CO detectors. You can have CO exposure with no smell of smoke and without a smoke detector going off.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Do you have the Right Brain Injury Lawyer?
I first wrote the an essay on this topic in 1997, and my list has remained mostly unchanged since: http://tbilaw.com/essays/choiceoflawyer.html I still think these questions which are listed below are good questions to start with. But of course, one could argue that those questions were self serving then, as I of course fit all such criteria. I hope I am no less qualified today, but my perspective on things has changed, with more than 100 brain injury cases settled or tried to verdict.
In too many cases, this was a lawyer who had TV ads that told about how much he could recover, with no substance. Way too many times, the lawyers staff knew little or nothing about brain injury. There are undoubtedly great TBI lawyers out there who I do not know of. But a few questions from you should be able to give you a good idea of whether this attorney is involved in the brain injury field.
This is my suggested list of questions:
1. What brain injury seminars has he or she attended?
2. At what brain injury seminars has he or she spoken?
3. Is he or she a member, and check this out, of your state brain injury association?
4. What service and financial contributions has he or she made to their state brain injury association?
5. What trial lawyer groups that deal with brain injury, is he or she a member of?
6. Do they have the kind of knowledge about brain injury that you have found on these webpages?
But my perspective on these issues has changed some over time. A simple list of questions will only point you in the right direction. Doing the best you can for a brain injured client is as much to do with how competent you are in dueling with the misdirection of Defense hired brain injury experts, as how much time you spend with advocacy groups. My current advocacy project is a “For Plaintiff Lawyers Only” web page, which shares many of the hard lessons I have learned over the years in my battles with deceitful Defense experts. Topics on such page will include the experts a plaintiff lawyer must retain, the interplay of medical and economic experts, understanding the advances in neuro-imaging, understanding the vestibular system and understanding the art and the science of neuropsychology.
The medical part of these pages will detail the role played by the neurologist and or other diagnosing M.D. The neuroimaging portions will discuss improvements in field strength, the relevancy of new pathologies identified on the stronger 3 Tesla MRI’s, diffusion tensor imaging (DTI) and the role for tailored protocols in the forensic evaluation process.
The most difficult to tackle (and the reason these pages are still under construction) are the pages that deal with neuropsychology. The role of neuropsychology has changed as neuroimaging has improved, and defense paid for research has exagerated the role of so called “malingering” and “somatoform disorders.” One portion of this page will be devoted exclusively to what I call “MMPI abuse”, the improper use of the MMPI to label people with legitimate medical problems, as people suffering from psychiatric disease.
When completed these pages will included detailed deposition excerpts taken from actual cases which demonstrate the issues discussed and the knowledge that plaintiff counsel must have to beat back the Defense efforts at misdirection. When completed, they will be available only to plaintiff counsel, on a password restricted basis, with only those lawyers willing to sign an affidavit that they do exclusively plaintiff work, being allowed access.
In the meantime, I continue to be available to any plaintiff lawyer who needs help, both in terms of the general information contained on our seminal web pages http://tbilaw.com http://subtlebraininjury.com and http:waiting.com and thru formal or informal consulting. I learned as soon as I first uploaded http://tbilaw.com in 1996, that my capacity to help brain injured people would be leveraged many times, were I allowed to work with other lawyers, to help on multiple brain injury cases. I have continued to devote as much of my practice to co-counseling cases with other lawyers as to those where I am the primary lawyer involved. If you read this and feel that you or your lawyer would be benefit from our assistance, please ask your lawyer to call us at 800-992-9447.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
In too many cases, this was a lawyer who had TV ads that told about how much he could recover, with no substance. Way too many times, the lawyers staff knew little or nothing about brain injury. There are undoubtedly great TBI lawyers out there who I do not know of. But a few questions from you should be able to give you a good idea of whether this attorney is involved in the brain injury field.
This is my suggested list of questions:
1. What brain injury seminars has he or she attended?
2. At what brain injury seminars has he or she spoken?
3. Is he or she a member, and check this out, of your state brain injury association?
4. What service and financial contributions has he or she made to their state brain injury association?
5. What trial lawyer groups that deal with brain injury, is he or she a member of?
6. Do they have the kind of knowledge about brain injury that you have found on these webpages?
But my perspective on these issues has changed some over time. A simple list of questions will only point you in the right direction. Doing the best you can for a brain injured client is as much to do with how competent you are in dueling with the misdirection of Defense hired brain injury experts, as how much time you spend with advocacy groups. My current advocacy project is a “For Plaintiff Lawyers Only” web page, which shares many of the hard lessons I have learned over the years in my battles with deceitful Defense experts. Topics on such page will include the experts a plaintiff lawyer must retain, the interplay of medical and economic experts, understanding the advances in neuro-imaging, understanding the vestibular system and understanding the art and the science of neuropsychology.
The medical part of these pages will detail the role played by the neurologist and or other diagnosing M.D. The neuroimaging portions will discuss improvements in field strength, the relevancy of new pathologies identified on the stronger 3 Tesla MRI’s, diffusion tensor imaging (DTI) and the role for tailored protocols in the forensic evaluation process.
The most difficult to tackle (and the reason these pages are still under construction) are the pages that deal with neuropsychology. The role of neuropsychology has changed as neuroimaging has improved, and defense paid for research has exagerated the role of so called “malingering” and “somatoform disorders.” One portion of this page will be devoted exclusively to what I call “MMPI abuse”, the improper use of the MMPI to label people with legitimate medical problems, as people suffering from psychiatric disease.
When completed these pages will included detailed deposition excerpts taken from actual cases which demonstrate the issues discussed and the knowledge that plaintiff counsel must have to beat back the Defense efforts at misdirection. When completed, they will be available only to plaintiff counsel, on a password restricted basis, with only those lawyers willing to sign an affidavit that they do exclusively plaintiff work, being allowed access.
In the meantime, I continue to be available to any plaintiff lawyer who needs help, both in terms of the general information contained on our seminal web pages http://tbilaw.com http://subtlebraininjury.com and http:waiting.com and thru formal or informal consulting. I learned as soon as I first uploaded http://tbilaw.com in 1996, that my capacity to help brain injured people would be leveraged many times, were I allowed to work with other lawyers, to help on multiple brain injury cases. I have continued to devote as much of my practice to co-counseling cases with other lawyers as to those where I am the primary lawyer involved. If you read this and feel that you or your lawyer would be benefit from our assistance, please ask your lawyer to call us at 800-992-9447.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Severe Versus Mild Prognosis
I got this email exchange this week, about something I wrote more than a decade ago:
Is this a typo?
http://www.waiting.com/recoveryexpect.html
A so-called “mild” brain injury may result in substantial deficits which may affect a person’s life permanently, while a person who has suffered a “severe” brain injury may be able to return to a life that is, while not identical to, close to the one they had before the accident.
I answered this email as follows:
No, I don’t think it was a typo. What did you think was the mistake?
That sometimes people with mild injuries can have worse results than someone with a severe injury?
Attorney Gordon Johnson
I got this response back:
Yes, the MILD = worse recovery than SEVERE. Its not something I wanted to hear I guess. My sister was diagnosed with Diffuse Axonal Injury. I guess even though there is no visible damage there is the possibility that more of her brain was actually damaged in comparison to a blunt force. Thank you for your help. Your site has been informative and I am sure it will be a tool we use going foreword.
Today, this news story came across the wire.
Assault and Battery – Florida
Man gets $12.8M for punch that resulted in severe head injury
A jury awarded $12.8 million to a man who nearly died after he was punched in the head at the University of Florida. In 2003, Brandon McArthur, then an 18-year-old baseball player at the school, was struck by Jonathan Head just outside a bar and grill on University Avenue. The attack was unprovoked and without warning. Head pleaded no contest to assault charges, but didn’t appear at the civil trial. McArthur sustained a severe head injury that required surgeries to remove blood clots and relieve presssure on the brain. He was injured when his head struck the sidewalk several times during a grand mal seizure. He remained in the hospital for about a month. He eventually recovered and was able to continue playing college baseball.
That someone got a substantial reward is wonderful, and the lawyer involved should be greatly congratulated. But what struck me about the story was the part in boldface, He eventually recovered and was able to continue playing college baseball.
I had a friend, who was a survivor of a severe brain injury, who rose to a leadership role in the Brain Injury Association, both on the national and state level. I was new to this field when I met her, and I have never forgotten a statement she said: “You know the goal of brain injury rehab is to get severe brain injury survivors to the level of mild brain injury survivors. ” This was the first time I ever thought about this issue, but in my experience, too often the lines of recovery don’t start to run parallel near each other, they cross over in opposite directions. My theory is that severe brain damage, that does also involve diffuse damage, is easier to rehabilitate, because the brain’s capacity for plasticity gives us something to focus on in rehab. On the other hand, mild injury, which often involves significant but not visible injury to the brain’s connective communication network, is hard to pinpoint and even harder to rewire.
A good example which many people will understand: a small electical fire will often completely total a car, because of the difficulty in rewiring an entire car. A high speed front end collision, will often not, because those parts are on the surface and easy to repair or replace.
The other lesson from today’s news story, is you cannot base brain research on the pattern of recovery of young jocks. They just do better in terms of recovery. Far too much of our research, our brain modeling is done based on what we learned about young jocks. They survive much better than do 40 something women. Basic fact. When they start studying 40 something women, then we will learn something about mild brain damage. See http://youtube.com/watch?v=E2Tml2QaSEM
Watch for my coming blog on the good and the bad about basing the next generations brain injury research on Iraq war injuries.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Is this a typo?
http://www.waiting.com/recoveryexpect.html
A so-called “mild” brain injury may result in substantial deficits which may affect a person’s life permanently, while a person who has suffered a “severe” brain injury may be able to return to a life that is, while not identical to, close to the one they had before the accident.
I answered this email as follows:
No, I don’t think it was a typo. What did you think was the mistake?
That sometimes people with mild injuries can have worse results than someone with a severe injury?
Attorney Gordon Johnson
I got this response back:
Yes, the MILD = worse recovery than SEVERE. Its not something I wanted to hear I guess. My sister was diagnosed with Diffuse Axonal Injury. I guess even though there is no visible damage there is the possibility that more of her brain was actually damaged in comparison to a blunt force. Thank you for your help. Your site has been informative and I am sure it will be a tool we use going foreword.
Today, this news story came across the wire.
Assault and Battery – Florida
Man gets $12.8M for punch that resulted in severe head injury
A jury awarded $12.8 million to a man who nearly died after he was punched in the head at the University of Florida. In 2003, Brandon McArthur, then an 18-year-old baseball player at the school, was struck by Jonathan Head just outside a bar and grill on University Avenue. The attack was unprovoked and without warning. Head pleaded no contest to assault charges, but didn’t appear at the civil trial. McArthur sustained a severe head injury that required surgeries to remove blood clots and relieve presssure on the brain. He was injured when his head struck the sidewalk several times during a grand mal seizure. He remained in the hospital for about a month. He eventually recovered and was able to continue playing college baseball.
That someone got a substantial reward is wonderful, and the lawyer involved should be greatly congratulated. But what struck me about the story was the part in boldface, He eventually recovered and was able to continue playing college baseball.
I had a friend, who was a survivor of a severe brain injury, who rose to a leadership role in the Brain Injury Association, both on the national and state level. I was new to this field when I met her, and I have never forgotten a statement she said: “You know the goal of brain injury rehab is to get severe brain injury survivors to the level of mild brain injury survivors. ” This was the first time I ever thought about this issue, but in my experience, too often the lines of recovery don’t start to run parallel near each other, they cross over in opposite directions. My theory is that severe brain damage, that does also involve diffuse damage, is easier to rehabilitate, because the brain’s capacity for plasticity gives us something to focus on in rehab. On the other hand, mild injury, which often involves significant but not visible injury to the brain’s connective communication network, is hard to pinpoint and even harder to rewire.
A good example which many people will understand: a small electical fire will often completely total a car, because of the difficulty in rewiring an entire car. A high speed front end collision, will often not, because those parts are on the surface and easy to repair or replace.
The other lesson from today’s news story, is you cannot base brain research on the pattern of recovery of young jocks. They just do better in terms of recovery. Far too much of our research, our brain modeling is done based on what we learned about young jocks. They survive much better than do 40 something women. Basic fact. When they start studying 40 something women, then we will learn something about mild brain damage. See http://youtube.com/watch?v=E2Tml2QaSEM
Watch for my coming blog on the good and the bad about basing the next generations brain injury research on Iraq war injuries.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Venting at Emergency Room Doctors
Is it really so unreasonable to expect someone who is working in an Emergency Room, to know a few simple things about concussion and amnesia.
Here is what it says in the medical record I am reviewing now, a record from an emergency room, three days post accident:
“This patient was involved in an accident in a different state. She was evaluated at an ED (emergency department) near the scene of the accident, that is not as full service as our facility. Because of ongoing complaints, she and her husband present here for evaluation.”
OK, so what were the complaints? Did you ask her about her memory? Did you make any attempt to document whether she had amnesia?
I have a series of videos on amnesia and concussion, which I call the Concussion Clinics. Everything in those videos is based upon clear cut medical theory and common sense. Yet, no one invites me to speak at medical schools. I don’t do in-services at hospitals. Why would they? I am only a lawyer. What do I know about medicine? Sadly, infinitely more than the doctor who wrote that report. The only impact I can hope to have on medical professionals is asking tough questions of doctors in depositions and the words I write on blogs and web pages like this.
DAMN IT ALL DOCTORS. LEARN SOMETHING ABOUT HOW TO DOCUMENT AMNESIA. Ask the patient (or the person who brought them back to the ER) about what they remember between 5 minutes after the accident, and the NOW. Almost everyone will remember the accident – it is called adrenaline. It helps with memory. But do they remember the ambulance ride? The intake person? Describe one other person in the waiting room?
And when you are done, don’t refer the concussed to some indefinite family physician for a follow-up. Give them the same care you would if they were quarterbacking your football team. Have the patient come back to see you tomorrow and see if there is any change, and every day until it is clear that they are better. If they aren’t better, continue to document the specific complaints and then the referral to the next doctor will carry with it the presumption that there really is something wrong, not that this is a person with some fundamental psychological flaw. One simple example of amnesia would make justice so much easier to obtain.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Here is what it says in the medical record I am reviewing now, a record from an emergency room, three days post accident:
“This patient was involved in an accident in a different state. She was evaluated at an ED (emergency department) near the scene of the accident, that is not as full service as our facility. Because of ongoing complaints, she and her husband present here for evaluation.”
OK, so what were the complaints? Did you ask her about her memory? Did you make any attempt to document whether she had amnesia?
I have a series of videos on amnesia and concussion, which I call the Concussion Clinics. Everything in those videos is based upon clear cut medical theory and common sense. Yet, no one invites me to speak at medical schools. I don’t do in-services at hospitals. Why would they? I am only a lawyer. What do I know about medicine? Sadly, infinitely more than the doctor who wrote that report. The only impact I can hope to have on medical professionals is asking tough questions of doctors in depositions and the words I write on blogs and web pages like this.
DAMN IT ALL DOCTORS. LEARN SOMETHING ABOUT HOW TO DOCUMENT AMNESIA. Ask the patient (or the person who brought them back to the ER) about what they remember between 5 minutes after the accident, and the NOW. Almost everyone will remember the accident – it is called adrenaline. It helps with memory. But do they remember the ambulance ride? The intake person? Describe one other person in the waiting room?
And when you are done, don’t refer the concussed to some indefinite family physician for a follow-up. Give them the same care you would if they were quarterbacking your football team. Have the patient come back to see you tomorrow and see if there is any change, and every day until it is clear that they are better. If they aren’t better, continue to document the specific complaints and then the referral to the next doctor will carry with it the presumption that there really is something wrong, not that this is a person with some fundamental psychological flaw. One simple example of amnesia would make justice so much easier to obtain.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
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