Date: 11/20/2008
By DENISE LAVOIE
Associated Press Writer
SPRINGFIELD, Mass. (AP) _ Prosecutors wrapped up their case Wednesday against a man accused of beating his stepdaughter into a coma, triggering a right-to-die case that was resolved when the girl began to recover.
Jason Strickland, a 34-year-old auto mechanic, is charged with abusing his stepdaughter, Haleigh Poutre, in 2005, when she was 11. Prosecutors say Strickland and his late wife, Holli, participated in abuse that culminated in a beating on Sept. 10, 2005, that left her with a severe brain injury.
Strickland is expected to take the stand in his own defense after his lawyers begin presenting their case Thursday.
His lawyer has told the jury Strickland believed his wife’s claims that Haleigh suffered from a psychological disorder that caused her to injure herself.
Dr. Christine Barron, a forensic pediatrician at Hasbro Children’s Hospital in Providence, R.I., testified Wednesday that she believes the injuries shown in photographs taken after the girl was brought to the hospital the day after the severe beating could not have been self-inflicted.
Barron reviewed photographs showing extensive bruising, lacerations and abrasions on Haleigh’s legs, chest, back and arms.
Barron said bruising on her left ankle and left wrist were consistent with a “restraint injury.” She also said lesions on the top of her left foot and upper left arm were consistent with a “non-accidental cigarette burn.”
Under cross-examination from Strickland’s attorney, Alan Black, Barron acknowledged that a nurse practitioner who saw Haleigh on a regular basis in 2005 characterized the abrasions and bruises on Haleigh’s body as self-inflicted injuries.
Days after child welfare officials received court permission to remove her feeding tube, Haleigh began showing signs of improvement. The state was criticized for failing to protect Haleigh and for moving too quickly to remove her life support, and the case sparked an overhaul of the child welfare system.
Holli Strickland, who was Haleigh’s aunt but who adopted the girl at age 7, died in an apparent murder-suicide with her grandmother after she was charged in Haleigh’s beating.
Haleigh, now 14, has improved to the point where she can feed herself and write her name. She now lives in a rehabilitation hospital.
Copyright 2008 The Associated Press.
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 hardest part of waiting for someone to emerge from a coma
From someone who felt the need to connect with our http://waiting.com community:
waiting.com began as the merging of two ideas more than 11 years ago. First, provide as much information as possible to those who were actually waiting in a trauma center waiting room. Two, create a virtual connection to those who had gone thru it before, to those who were going thru it now. When it went online in 1997, it was the first time something like it had ever been done online, not just in brain injury, but in any field. To this day, it is the idea for which I am most proud.
Thank you Y Uribe for your contribution. We will soon add it permanently to the Bridge from Despair.
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 hardest part of waiting is the feeling of being alone. No matter how many people surround me, I feel alone. I push people away, don’t feel like talking to anyone, yet I am forced to talk. I feel rudest to those closest to me. Its hard how suddenly your the center of attention and it feels inadequate. I’ve learned that people don’t know what to say to you so they offer their help. They want to do something for you, and you should let them. It is hard as all hell in the beginning, but as you go on, you learn that it will be less of a stress to you. Let your friends in. Support is what you need. Take it when you can get it. Call people, talk to people.”
waiting.com began as the merging of two ideas more than 11 years ago. First, provide as much information as possible to those who were actually waiting in a trauma center waiting room. Two, create a virtual connection to those who had gone thru it before, to those who were going thru it now. When it went online in 1997, it was the first time something like it had ever been done online, not just in brain injury, but in any field. To this day, it is the idea for which I am most proud.
Thank you Y Uribe for your contribution. We will soon add it permanently to the Bridge from Despair.
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
Vietnam Remains Our Biggest Military Health Issue
As we shift our focus of this blog to the emotional side of the synergistic neuropsychiatric disability that faces combat vets, I want to put the context of current soldier suicides and PTSD into perspective. This series of blogs began with my reaction to this news:
My first reaction to that number when I read it was that there was something wrong with the record books, because I had remembered reading a number of references over the years about suicide in Vietnam veterans with numbers as high as 250,000 people. Well, the reason 119 is a “record” is the Pentagon didn’t start recording soldier suicides until around 1980 and that number is for active duty soldiers and doesn’t include vets.
Still, the overwhelming question that seems to being missed in the political debate and news coverage of 2008 is what about the Vietnam vets? As tragic as the Iraq and Afghanistan Wars have been, their footprint of death, disability and psychosis has yet to reach 10% of the magnitude of that of Vietnam. While Vietnam is now more than 30 years in our rear view mirrors, the primary group of soldiers it affected are from 55 to 70 years old. That is a serious public and military health issue for at least another generation.
$500 million dollars for TBI research for blast injuries in the so-called War on Terror is great – but what about Vietnam? The discovery of brain injury and brain damage in Iraq by the politicos and news media is truly wonderful. But Iraq is not the first war with blast injuries, not the first war where our soldiers suffered brain injury, not the first war where the soldier who returned home is a brittle, vulnerable shadow of the vibrant young man who left.
John McCain makes great political hay out of his Vietnam heroism as a prisoner of war. But how can McCain make those claims without looking back and recognizing that the United States mental health obligations to its Vets reaches back to Vietnam, Korea and even World War II survivors?
The issue of the brain injury disability and mental health of older Vets has countless sub-issues, but the most important for this blog is that brain injury and brain damage were not even considered in what we today call mild to moderate brain injury during Vietnam. Prior to 1990, there was little belief in the medical community that a brain injury that involved less than a five minute loss of consciousness was significant. Now we recognize, and have highly sophisticated neuroimaging and neuropsychological methodologies to confirm, that brain damage can occur without a loss of consciousness.
We often hear that our modern medical interventions result in more people surviving brain injury, because soldiers who would have died in Iraq or Afghanistan are now saved because of the rapid evac and treatment. That is true, but what is implicitly missing in such a statement is the clear fact that almost no one with a mild to moderate brain injury would die from it, regardless of whether they got prompt treatment. The realities of combat in Vietnam, and all wars that preceded it, is that a soldier on the front lines who gets knocked out, dazed or confused – is not likely to die from such injuries, unless he is killed by his inability to respond to the immediacy of the combat demands at the time.
Thus, there are probably far more vets with mild brain injuries in the Vietnam era than in the current generation of soldier and vets, but there are no medical records to document that they suffered such injuries. A soldier with a short-term confusion in that combat was likely expected to shrug it off and go back to fighting. Making matters worse, the complete catastrophe that is the Vietnam military health records makes it almost a certainty that documentation of brain injury is just not there. Further, the brain damage suffered in Vietnam is considerably broader than just brain injury because of the prevalence of Cerebral Malaria, which may have caused brain damage to hundreds of thousands of U.S. soldiers in Vietnam. See http://www.va.gov/OCA/testimony/hvac/16JY98NV.asp
Without the documentation of brain damage, what came out of Vietnam were hundreds of thousands of soldiers with clear cut neuropsychiatric symptoms in search of a diagnosis. The result: PTSD. PTSD is a Vietnam era syndrome of severe emotional problems, that are tied to some type of extreme emotional stressor, such as combat. But as with most “syndromes” the purity of its diagnostic criteria is lacking. The resulting over inclusive use of it in differential diagnosis of any emotional or neuropsychiatric symptom is staggering. At its threshold criteria, it requires life-threatening terror.
See http://en.wikipedia.org/wiki/PTSD which states the threshold requirement that “the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.” The second (A2) requires that “the person’s response involved intense fear, helplessness, or horror.”
This sounds like combat, it does not sound like a rear end automobile collision. While some automobile or other accidents involve prolonged moments of terror, most do not. They are over within a few moments of beginning. I have experienced both kinds but my memory of the truly terrorizing accidents (and yes, I did have that realization that my life was about to end both times) ended abruptly at the moment of collision. Relatively few people who suffer concussions have clear enough memory of the event to be exposed to a pure PTSD terror. What most relate is a moment of surprise that an accident is about to happen and then a gap in memory.
In contrast – combat, rape, fires – involve prolonged exposure to truly terrorizing events. This is the type stressor that can actually make a hard wire change to the way the brain processes information. This is the type of stressor that can create haunting memories. This is the type of stressor that can create nightmares. Yet PTSD should never become a catchall for all emotional reactions to life changing events. The category for stressor has as its blue print combat. When there is no elongated exposure to terror, the focus should be on normal human emotional responses, not a psychiatric catchall.
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 Associated Press announced that active duty military suicides hit its highest level on record in 2007, 119 soldiers dead. See the AP story at: http://hosted.ap.org/dynamic/stories/M/MILITARY_SUICIDES?SITE=CADIU&SECTION;=HOME&TEMPLATE;=DEFAULT “
My first reaction to that number when I read it was that there was something wrong with the record books, because I had remembered reading a number of references over the years about suicide in Vietnam veterans with numbers as high as 250,000 people. Well, the reason 119 is a “record” is the Pentagon didn’t start recording soldier suicides until around 1980 and that number is for active duty soldiers and doesn’t include vets.
Still, the overwhelming question that seems to being missed in the political debate and news coverage of 2008 is what about the Vietnam vets? As tragic as the Iraq and Afghanistan Wars have been, their footprint of death, disability and psychosis has yet to reach 10% of the magnitude of that of Vietnam. While Vietnam is now more than 30 years in our rear view mirrors, the primary group of soldiers it affected are from 55 to 70 years old. That is a serious public and military health issue for at least another generation.
$500 million dollars for TBI research for blast injuries in the so-called War on Terror is great – but what about Vietnam? The discovery of brain injury and brain damage in Iraq by the politicos and news media is truly wonderful. But Iraq is not the first war with blast injuries, not the first war where our soldiers suffered brain injury, not the first war where the soldier who returned home is a brittle, vulnerable shadow of the vibrant young man who left.
John McCain makes great political hay out of his Vietnam heroism as a prisoner of war. But how can McCain make those claims without looking back and recognizing that the United States mental health obligations to its Vets reaches back to Vietnam, Korea and even World War II survivors?
The issue of the brain injury disability and mental health of older Vets has countless sub-issues, but the most important for this blog is that brain injury and brain damage were not even considered in what we today call mild to moderate brain injury during Vietnam. Prior to 1990, there was little belief in the medical community that a brain injury that involved less than a five minute loss of consciousness was significant. Now we recognize, and have highly sophisticated neuroimaging and neuropsychological methodologies to confirm, that brain damage can occur without a loss of consciousness.
We often hear that our modern medical interventions result in more people surviving brain injury, because soldiers who would have died in Iraq or Afghanistan are now saved because of the rapid evac and treatment. That is true, but what is implicitly missing in such a statement is the clear fact that almost no one with a mild to moderate brain injury would die from it, regardless of whether they got prompt treatment. The realities of combat in Vietnam, and all wars that preceded it, is that a soldier on the front lines who gets knocked out, dazed or confused – is not likely to die from such injuries, unless he is killed by his inability to respond to the immediacy of the combat demands at the time.
Thus, there are probably far more vets with mild brain injuries in the Vietnam era than in the current generation of soldier and vets, but there are no medical records to document that they suffered such injuries. A soldier with a short-term confusion in that combat was likely expected to shrug it off and go back to fighting. Making matters worse, the complete catastrophe that is the Vietnam military health records makes it almost a certainty that documentation of brain injury is just not there. Further, the brain damage suffered in Vietnam is considerably broader than just brain injury because of the prevalence of Cerebral Malaria, which may have caused brain damage to hundreds of thousands of U.S. soldiers in Vietnam. See http://www.va.gov/OCA/testimony/hvac/16JY98NV.asp
Without the documentation of brain damage, what came out of Vietnam were hundreds of thousands of soldiers with clear cut neuropsychiatric symptoms in search of a diagnosis. The result: PTSD. PTSD is a Vietnam era syndrome of severe emotional problems, that are tied to some type of extreme emotional stressor, such as combat. But as with most “syndromes” the purity of its diagnostic criteria is lacking. The resulting over inclusive use of it in differential diagnosis of any emotional or neuropsychiatric symptom is staggering. At its threshold criteria, it requires life-threatening terror.
See http://en.wikipedia.org/wiki/PTSD which states the threshold requirement that “the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.” The second (A2) requires that “the person’s response involved intense fear, helplessness, or horror.”
This sounds like combat, it does not sound like a rear end automobile collision. While some automobile or other accidents involve prolonged moments of terror, most do not. They are over within a few moments of beginning. I have experienced both kinds but my memory of the truly terrorizing accidents (and yes, I did have that realization that my life was about to end both times) ended abruptly at the moment of collision. Relatively few people who suffer concussions have clear enough memory of the event to be exposed to a pure PTSD terror. What most relate is a moment of surprise that an accident is about to happen and then a gap in memory.
In contrast – combat, rape, fires – involve prolonged exposure to truly terrorizing events. This is the type stressor that can actually make a hard wire change to the way the brain processes information. This is the type of stressor that can create haunting memories. This is the type of stressor that can create nightmares. Yet PTSD should never become a catchall for all emotional reactions to life changing events. The category for stressor has as its blue print combat. When there is no elongated exposure to terror, the focus should be on normal human emotional responses, not a psychiatric catchall.
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
From an Old Contributor to waiting.com
Attorney Johnson:
Hello. Thank you very much for the tbi law website and for the waiting.com page. It helped me a great deal to be able to communicate to others that *there is hope*.
I had forgotten about waiting.com until I asked the “high functioning” TBI online support group to which I belong for some recommendations for someone new to TBI. TBI Law was one of the recommendations.
I don’t know how many people view my and Megan’s story, but if possible, could you please change my contact email address to jodymo@pobox.com ? I hate to think that someone tried to contact me and thought I just didn’t answer because the email address is out of date.
http://www.waiting.com/jody.html
Thank you in advance for your time.
Jody Silvey Goppelt
—–
EDITOR’S NOTE: Twelve years ago, my co-author Rebecca Martin and I created http://waiting.com and its Bridge from Despair. The Bridge from Despair was perhaps the first collection of a series of anecdotal comments from those who had lived thru the ordeal of a loved one in a coma. In an interesting post note, I got this email today from one of its contributors. It is a nice reminder of the efforts we put in at the beginning of our advocacy, when brain injury information on the web was still a new idea.
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
Hello. Thank you very much for the tbi law website and for the waiting.com page. It helped me a great deal to be able to communicate to others that *there is hope*.
I had forgotten about waiting.com until I asked the “high functioning” TBI online support group to which I belong for some recommendations for someone new to TBI. TBI Law was one of the recommendations.
I don’t know how many people view my and Megan’s story, but if possible, could you please change my contact email address to jodymo@pobox.com ? I hate to think that someone tried to contact me and thought I just didn’t answer because the email address is out of date.
http://www.waiting.com/jody.html
Thank you in advance for your time.
Jody Silvey Goppelt
—–
EDITOR’S NOTE: Twelve years ago, my co-author Rebecca Martin and I created http://waiting.com and its Bridge from Despair. The Bridge from Despair was perhaps the first collection of a series of anecdotal comments from those who had lived thru the ordeal of a loved one in a coma. In an interesting post note, I got this email today from one of its contributors. It is a nice reminder of the efforts we put in at the beginning of our advocacy, when brain injury information on the web was still a new idea.
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
What is a Mild Brain Injury?
Head injuries (or otherwise called brain injuries) have been traditionally classified into three categories, mild, moderate and severe. Mild head injuries are typically brain injuries that do not involve loss of consciousness for more than 20 minutes. Moderate involve significant loss of consciousness, but not do not involve extended coma. Severe brain injuries are those that involve a coma for a substantial length of time. For our treatment of severe brain injury, see http://waiting.com
The problem with these classifications schemes that define the severity of the brain injury in terms that relate to a period of loss of consciousness, is that they severely understate the risk factors associated with mild brain injury. Mild brain injury, which is also synonymous with concussion, can leave a person completely and totally disabled. Even though a brain injury may not involve a significant disruption of the part of the brain that triggers consciousness, it can involve severe damage to either specific parts of the cerebral cortex, or disruptive damage to the white matter of the brain.
Focal versus Diffuse Brain Damage. Brain injury is usually broken out into two geographic classes, focal and diffuse. A focal brain injury involves damage to a specific area of the brain, and in mild brain injuries, this can be a very small area. Diffuse damage means the damage is spread out throughout the brain, but the pathology in any one area is large enough for specific pathology in that one area to be identifiable.
Mild Focal Injury. Again the term mild here is something of a misnomer. The type of focal injury which would be classified as mild, would typically be a focal injury that does not involve a significant portion of one of the major lobes of the brain, but can still be identified as existing, because it has compromised a specific function of that particular part of the brain. Most of the significant mild focal injuries, involve injuries to the frontal lobes, particularly the underside of the frontal lobes. The reason these relatively small areas of damage can become disabling, is that the underside of the brain hold particularly important functions in terms of adult like behaviors and productivity.
Diffuse Injury. Diffuse injury to the white matter is referred to as diffuse axonal injury. An axon the long skinny wire like part of a neuron, that transmits the electrical impulse from the cell nucleus of the neuron, to the next part of the brain or nervous system, that must receive that signal, for the appropriate function to occur. Neuron’s are microscopic, and axons, even smaller. Typically an axon can only be seen by an electronic microscope. While there are massive numbers of these microscopic axons transmitting signals throughout the white matter of the brain, injury to even thousands of these axons in the same area, may not be concentrated enough pathology for it to show up on even a high resolution MRI. For more information on Diffuse Axonal Injury, click here.
Most of the controversy in brain injury cases involves battles about whether or not a mild brain injury even occurred and if so, whether it was severe enough to leave any last deficits. The reason such controversy exists is that most mild brain injuries do not involve clear cut loss of consciousness. For most of the 20th century, a identifiable loss of consciousness was required in order for there to be the diagnostic possibility of a brain injury. While this issue began to change as considerable research on axonal injury evolved between 1971 and 1990, the significant definition change occurred in 1992, with the publishing by the American Congress of Rehabilitation Medicines definition of Mild Traumatic Brain Injury. See http://subtlebraininjury.com/noloc.html
“It is not necessary to have a loss of consciousness to suffer permanent brain injury.”
Source: Definition of Mild Traumatic Brain Injury Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. J Head Trauma Rehabil 1993:8(3):86-87
In that definition, loss of consciousness was only one of four acute symptoms, that could form the basis of a diagnosis of concussion or MTBI. Those four events are:
Loss of Consciousness (of less than 20 minutes);
A change in mental state;
Amnesia, for events both before OR after the event; or
Focal neurological deficits.
With this 1992 definition, the medical community began to look at brain injury differently, and in subsequent years, the American Academy of Neurology and the CDC, adopted similar definitions. Now, no recognized organization still maintains the Loss of Consciousness is a prerequisite for a diagnosis of brain injury, but there are still holdouts. One of the challenges of being a brain injury attorney, is finding ways to get defense neurologists to admit that what it says in the old textbooks about loss of consciousness, is no longer good medicine or good science.
This discussion here has used the classical term of mild traumatic brain injury. However, this has been used strictly in the context of the definitional scheme that is laid out throughout our three tiered classification of brain injury. I have been since creating the web page http://subtlebraininjury.com in 1999, using the word subtle brain injury© to describe MTBI.
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 problem with these classifications schemes that define the severity of the brain injury in terms that relate to a period of loss of consciousness, is that they severely understate the risk factors associated with mild brain injury. Mild brain injury, which is also synonymous with concussion, can leave a person completely and totally disabled. Even though a brain injury may not involve a significant disruption of the part of the brain that triggers consciousness, it can involve severe damage to either specific parts of the cerebral cortex, or disruptive damage to the white matter of the brain.
Focal versus Diffuse Brain Damage. Brain injury is usually broken out into two geographic classes, focal and diffuse. A focal brain injury involves damage to a specific area of the brain, and in mild brain injuries, this can be a very small area. Diffuse damage means the damage is spread out throughout the brain, but the pathology in any one area is large enough for specific pathology in that one area to be identifiable.
Mild Focal Injury. Again the term mild here is something of a misnomer. The type of focal injury which would be classified as mild, would typically be a focal injury that does not involve a significant portion of one of the major lobes of the brain, but can still be identified as existing, because it has compromised a specific function of that particular part of the brain. Most of the significant mild focal injuries, involve injuries to the frontal lobes, particularly the underside of the frontal lobes. The reason these relatively small areas of damage can become disabling, is that the underside of the brain hold particularly important functions in terms of adult like behaviors and productivity.
Diffuse Injury. Diffuse injury to the white matter is referred to as diffuse axonal injury. An axon the long skinny wire like part of a neuron, that transmits the electrical impulse from the cell nucleus of the neuron, to the next part of the brain or nervous system, that must receive that signal, for the appropriate function to occur. Neuron’s are microscopic, and axons, even smaller. Typically an axon can only be seen by an electronic microscope. While there are massive numbers of these microscopic axons transmitting signals throughout the white matter of the brain, injury to even thousands of these axons in the same area, may not be concentrated enough pathology for it to show up on even a high resolution MRI. For more information on Diffuse Axonal Injury, click here.
Most of the controversy in brain injury cases involves battles about whether or not a mild brain injury even occurred and if so, whether it was severe enough to leave any last deficits. The reason such controversy exists is that most mild brain injuries do not involve clear cut loss of consciousness. For most of the 20th century, a identifiable loss of consciousness was required in order for there to be the diagnostic possibility of a brain injury. While this issue began to change as considerable research on axonal injury evolved between 1971 and 1990, the significant definition change occurred in 1992, with the publishing by the American Congress of Rehabilitation Medicines definition of Mild Traumatic Brain Injury. See http://subtlebraininjury.com/noloc.html
“It is not necessary to have a loss of consciousness to suffer permanent brain injury.”
Source: Definition of Mild Traumatic Brain Injury Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. J Head Trauma Rehabil 1993:8(3):86-87
In that definition, loss of consciousness was only one of four acute symptoms, that could form the basis of a diagnosis of concussion or MTBI. Those four events are:
Loss of Consciousness (of less than 20 minutes);
A change in mental state;
Amnesia, for events both before OR after the event; or
Focal neurological deficits.
With this 1992 definition, the medical community began to look at brain injury differently, and in subsequent years, the American Academy of Neurology and the CDC, adopted similar definitions. Now, no recognized organization still maintains the Loss of Consciousness is a prerequisite for a diagnosis of brain injury, but there are still holdouts. One of the challenges of being a brain injury attorney, is finding ways to get defense neurologists to admit that what it says in the old textbooks about loss of consciousness, is no longer good medicine or good science.
This discussion here has used the classical term of mild traumatic brain injury. However, this has been used strictly in the context of the definitional scheme that is laid out throughout our three tiered classification of brain injury. I have been since creating the web page http://subtlebraininjury.com in 1999, using the word subtle brain injury© to describe MTBI.
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
Guidelines for Coma Management
One of the most difficult challenges in being a brain injury attorney and an advocate, is struggling with what to tell people when they call up and their loved one is in a coma. The Brain Injury Law Group is here to a significant degree, because that was one of the challenges we faced when we first started doing web advocacy. We created http://waiting.com in 1997, with a sense of urgency to help those who were waiting for word as to whether their loved one would ever awake. The story of our frustration with the Brain Injury Association’s refusal to accept our offer of help to create such a page, and our decision to do it ourselves, is well explained on that page.
The Brain Trauma foundation is an organization which shares a similar advocacy to help those in a coma, and I received this email from them today, covering the guidelines to assist medical professionals dealing with coma patients. To get to those links, click here: http://www.guideline.gov/whatsnew/newthisweek.aspx#date
What these new guidelines don’t call for, which I believe they should, is the use of funtional imaging, such as PET scans or fMRI to tell the degree to which there is sufficient brain function going on in the comatose person, to predict any reasonable chance of recovery. Coma guidance from doctors is far too much “we will just have to wait and see” and most times, from a very pessimistic outlook. I believe that PET scans and fMRI should be routinely used to give guidance to the family, when they are trying to make that awful decision as to whether there is enough chance of a satisfactory recovery, to keep trying to save the life of the comatose person. We always counsel prayer and inner searching. But when there are tools out there that could be used to provide more meaningful information on what is going on inside of that skull, we believe they should be used. I have instructed the person who is my health care power of attorney to demand that I have a functional imaging test if I am ever in that situation, and there is no valid reason why doctors don’t do the same.
They Brain Trauma Association has guidelines on the following:
Anesthetics, analgesics, and sedatives.
Antiseizure prophylaxis.
Blood pressure and oxygenation.
Brain oxygen monitoring and thresholds.
Cerebral perfusion thresholds.
Deep vein thrombosis prophylaxis.
Hyperosmolar therapy.
Hyperventilation.
Indications for intracranial pressure monitoring.
Infection prophylaxis
Intracranial pressure thresholds.
Nutrition.
Prophylactic hypothermia.
Steroids.
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 Brain Trauma foundation is an organization which shares a similar advocacy to help those in a coma, and I received this email from them today, covering the guidelines to assist medical professionals dealing with coma patients. To get to those links, click here: http://www.guideline.gov/whatsnew/newthisweek.aspx#date
What these new guidelines don’t call for, which I believe they should, is the use of funtional imaging, such as PET scans or fMRI to tell the degree to which there is sufficient brain function going on in the comatose person, to predict any reasonable chance of recovery. Coma guidance from doctors is far too much “we will just have to wait and see” and most times, from a very pessimistic outlook. I believe that PET scans and fMRI should be routinely used to give guidance to the family, when they are trying to make that awful decision as to whether there is enough chance of a satisfactory recovery, to keep trying to save the life of the comatose person. We always counsel prayer and inner searching. But when there are tools out there that could be used to provide more meaningful information on what is going on inside of that skull, we believe they should be used. I have instructed the person who is my health care power of attorney to demand that I have a functional imaging test if I am ever in that situation, and there is no valid reason why doctors don’t do the same.
They Brain Trauma Association has guidelines on the following:
Anesthetics, analgesics, and sedatives.
Antiseizure prophylaxis.
Blood pressure and oxygenation.
Brain oxygen monitoring and thresholds.
Cerebral perfusion thresholds.
Deep vein thrombosis prophylaxis.
Hyperosmolar therapy.
Hyperventilation.
Indications for intracranial pressure monitoring.
Infection prophylaxis
Intracranial pressure thresholds.
Nutrition.
Prophylactic hypothermia.
Steroids.
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