A new study published in the Annals of Neurology has found that TBI patients’ brains were estimated to be older than their chronological age, “suggesting that TBI accelerates the rate of brain atrophy.”
It is well accepted that with the use of neuro imaging, it is possible to predict age in healthy individuals. The study therefore looked to see what effect, if any, a traumatic brain injury would have on accelerated atrophy of the brain.
The researchers studied 99 patients with persistent neurological problems after traumatic brain injury and compared them with a group of a 113 healthy controls assessed on the same scanner to validate the accuracy of the age prediction model. All of the patients were scanned at least one month post injury with a range of 1 to 563 months. Of the 99 patients, 17% were classified as mild, and 83% being moderate to severe. The cause of injury was included to those injured in motor vehicle accidents, falls, assaults, sport related injuries as well as other causes.
Neurological testing of the first cranial nerve, which carries the sensory information for the sense of smell, is rarely performed. A new study from the Walter Reed National Military Center provides proof that olfactory testing should be performed.
According to the abstract, the objective of this recent study was to determine whether a structured and quantitative assessment of differential olfactory performance – recognized between a blast-injured traumatic brain injury (TBI) group and a demographically comparable blast-injured control group can serve as a reliable antecedent marker for preclinical detection of inter cranial neuro trauma.
The researchers, at Walter Reed, performed a prospectively and consecutively enrolled evaluation of 231 polytrauma inpatients who were exposed to explosions during combat operations in either Afghanistan or Iraq. The study correlated olfactometric scores with both contemporaneous neuro imaging findings as well as the clinical diagnosis of TBI.
The study found that while “quantitative identification olfactometry had limited sensitivity, it had high specificity as a marker for detecting acute structural neuropathology from trauma.” The researchers found that central olfactory dysfunction identified patients with TBI who had intracranial radiologic abnormalities. While the test had a sensitivity of only 35%, it had a specificity of 100%.”
Neuro attorneys representing patients with suspected traumatic brain injury, should insist that the neurologic examination include a test of the first cranial nerve. If you have questions about these exams, you should speak with your legal counsel.
It is presently the standard of care to keep children who have sustained concussion/traumatic brain injuries off the field and not to return to play until they are cleared by a competent professional. Assemblywoman, Pamela R. Lampitt (D Burlington and Camden) has introduced a bill in the New Jersey Assembly, which would require any student who suffers a concussion to be evaluated by a doctor or other health care provider and to get written clearance before the child can go back to school. Under the bill, each school district that deals with students with disabilities would be responsible for enforcing any limits on a student’s activities that were determined by the health care provider.
The statement accompanying the bill states:
This bill provides that a student enrolled in a school district who sustains a concussion must receive an evaluation by a physician trained in the evaluation and management of concussions and written clearance from the physician to return to school. In the event that the physician provides notice that the student requires accommodations for learning, the school district must immediately implement the accommodations and notify all teachers and staff who have contact with the student of the accommodations. The school district’s child study team will promptly evaluate the student in order to identify the manner in which the accommodations will be provided to the student during recovery and the need for the continuation or adjustment of the accommodations, and to determine the duration of the accommodations.
The bill also provides that a student enrolled in a school district who sustains a concussion is prohibited from engaging in any physical activity at school including, but not limited to, recess, physical education, sports, or cheerleading. The student may not participate in any physical activity until he is evaluated by a physician and receives written clearance to participate.
The sponsor’s intent is to have the child study team use the physician’s diagnosis and recommendations to guide accommodations upon the student’s return to school for the period of time prescribed by the physician.
A copy of the bill can be found here. You can read the story published in New Jersey Spotlight here.
People, who have sustained a permanent injury which results in a permanent work disability, will earn less and will have a shortened work life expectancy, even where the individual has returned to full time employment. Thus, in every case, where a plaintiff has sustained a permanent injury resulting in a permanent work disability, a claim for loss of future earning capacity exists.
In Figurski vs. Trinity Health-Michigan, the Michigan Court of Appeals upheld a verdict in an obstetrical medical malpractice action. On appeal, defendants asserted that the trial court abused its discretion when it determined that Anthony Gamboa, Ph.D., MBA, could offer an opinion as to plaintiff’s future loss of earning capacity. Defendants attacked both Dr. Gamboa’s qualifications to testify as an expert and attacked his methodology as unreliable. The Michigan Court of Appeals disagreed.
The Court of Appeals found that the trial court clearly understood her role as gatekeeper. Dr. Gamboa was qualified as a vocational rehabilitation expert. He held a number of degrees, including a Master’s in vocational counseling and a Ph.D. in an area that included vocational counseling and education. Gamboa also received a MBA and testified that he liked to focus on statistics. Gamboa has been with Vocational Economics, Inc. in one capacity or another since 1977. His work there necessarily included offering expert opinions on the cost of future care and compensation loss. He was a prolific writer in the area of earning capacity loss and work life expectancy. The Court of Appeals also found that there was nothing unusual with regard to Dr. Gamboa’s methodology and that the trial court was correct in concluding that the different methods of calculating plaintiff’s damages was best left to the ultimate trier of fact.
This past week, I attended the American Association for Justice’s mid-winter convention in Palm Desert, California. Besides my duties and responsibilities as Parliamentarian of AAJ, I was pleased to be invited to give a presentation at the Specialized Track: Concussion Crisis-Litigating Sports Injuries and TBI CLE program where I spoke on the topic of “Proving the Invisible: Arguing a Sports-Related Concussion Case without Neuroimaging.”
On returning to New Jersey this past Saturday, I co-chaired the New Jersey Association for Justice (NJAJ) Traumatic Brain Injury program. Besides co-chairing the event, I gave a presentation entitled “Identifying and Handling the Traumatic Brain Injury Case.”
I read a wonderful story by Amy Zellmer, a professional photographer and TBI survivor who published a firsthand account of her struggles with a mild traumatic brain injury. According to her story, Amy fell on a patch of ice and sustained a “mild” traumatic brain injury. Despite people telling her “it’s just a concussion,” a year later Amy is still struggling with the effects of her traumatic brain injury. I strongly recommend you read Amy’s story to understand what TBI survivors struggle with on a daily basis.
You can find the link to the story here.
If you have suffered form a traumatic brain in jury, contact Stark & Stark today for a free consultation.
A new study conducted by researchers from Boston University found that children who sustained a concussion/mild traumatic brain injury prior to the age of 12 had a greater risk of later-life cognitive impairment. Robert A. Stern, Ph.D. and colleagues at Boston University conducted a study to “determine the relationship between exposure to repeated head impacts through tackle football prior to age 12, during a key period of brain development and later-life executive function, memory, and estimated verbal IQ.” The study, published in Neurology, the official journal of the American Academy of Neurology studied 42 former NFL players ages 40-69, who were divided into two groups based on their age and first exposure to tackle football. The players were administered a neuropsychological test battery consisting of the Wisconsin Card Sort test, Neuropsychological Assessment Battery List Learning Test, and the Wide Range Achievement Test, 4th Edition (WRAT-4) reading subtest.
The researchers found that those NFL players who had sustained a brain injury prior to the age of 12 performed significantly worse on all measures after controlling for the total number of years of football played and age at time of evaluation, indicating executive dysfunction, memory impairment, and lower estimated verbal IQ.
According to the abstract conclusion, “there is an association between participation in tackle football prior to age 12 and greater later-life cognitive impairment measured using objective neuropsychological tests. These findings suggest that incurring repeated head impacts during a critical neuro developmental period may increase the risk of later-life cognitive impairment.”
From a neuro legal perspective, this study lends objective proof that children who sustained a traumatic brain injury have a greater risk of long term problems that their cohorts who sustained a concussion after the age of 12. Click here for the full article. If you or a loved one has been injured, contact Stark & Stark today for your free no obligation consultation.
It was recently reported that King-Devick Tests, Inc. has developed a quick and effective screening tool for the evaluation of concussion. The tests, to be called the King-Devick Test, according to the manufacturer, is a “quick‑accurate and objective concussion screening tool that can be administered on the sidelines by parents, coaches, athletic trainers, school nurses, and medical professionals.”
In the press release, Mayo Clinic neurologist and director of Mayo Clinic’s concussion program David Dodick, M.D. stated “most importantly, the test is affordable and can easily be used by any youth sports league, and administered by non‑medical personnel. And youth athletes are the higher risk for concussion and a longer recovery time than adults.”
It will be interesting to see whether the King-Devick test is adopted by rescue squad and emergency room doctors and nurses for the evaluation of concussion.
Generally, it is defendants that move to attack the admissibility of diffusion tensor imaging (DTI) asserting that this objective neurodiagnostic test fails to meet either the Daubert or Frye standard. Most recently, a plaintiff went on the offensive, filing its own motion for an order precluding defendant’s expert from denying at trial the general acceptance and reliability of diffusion tensor imaging and from denying the existence of non-hemorrhagic brain white-matter lesions. Defendant’s expert witness disclosure asserted that defendant’s expert was expected to testify that DTI “has not been recognized as a reliable technique to be utilized on an individual patient due to lack of any standardized and general accepted methods for acquiring, analyzing and interpreting DTI data.” Defendant’s also cross-moved for an order seeking to preclude the admission at trial the results of the DTI and precluding any of plaintiff’s expert witnesses from testifying regarding those results.
The court, relying on the scientific articles submitted by plaintiff, coupled with the fact that numerous courts in various jurisdictions, as well as in New York, have admitted DTI results in evidence, established that there is general acceptance of DTI in the medical community as a means of diagnosing traumatic brain injury. The court denied plaintiff’s motion with regard to defense expert’s opinions regarding the existence of non-hemorrhagic brain white-matter lesions finding that issue was based explored on cross-examination.
The case citation is Klipper vs. Liberty Helicopters, Inc., Supreme Court of the State of New York, County of New York: Part 10, Index No. 110711-2003.
Following a concussion, patients are instructed to rest for twenty-four to forty-eight hours beginning any type of return to normal activities. Many doctors recommend an even longer period of rest so as to reduce the risk of re-injury during recovery from the concussion. Some clinicians even advocate “cocoon therapy” which “restricts patients to several days in a darkened room before slowly returning to activity.”
A new study out of the Department of Pediatrics at the Medical College of Wisconsin calls into question the efficacy of cocoon therapy.
Danny G. Thomas, M.D. and his colleagues conducted a study of patients aged between eleven and twenty-two years who presented to a pediatric emergency department within twenty-four hours of having sustained a concussion. Participants underwent neuro cognitive, balance and symptom assessment in the emergency room and were randomized to strict rest for five days versus the usual care of one-two days rest followed by stepwise return to activity. Patients were asked to complete a diary to record physical and mental activity level, calculate energy exertion, and record daily post concussive symptoms.
Ninety-nine patients were enrolled and eighty-eight completed all study procedures. Post discharge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days two to five post concussion. However, “there was no clinically significant difference in neuro cognitive or balance outcomes. However, the intervention group reported more daily post-concussive symptoms and slower symptom resolution.” The conclusion of the researchers was “recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents’ symptom reporting was influenced by recommending strict rest.”
This study can be downloaded from pediatrics.aappublications.org. The study is entitled “Benefits of Strict Rest after Acute Concussion: A randomized controlled trial, Thomas
Space, DG, APPS JN, Hoffman RG and McCrea M, and Hammeke T. Pediatrics, Vol. 135, No. 2, February 2015.
If you or a loved one have suffered from a brain injury and have legal questions, contact Stark & Stark today.