The use of diffusion tensor imaging, an advanced neuroimaging technique, has once again been found by a Massachusetts court, to be a reliable diagnostic tool in the diagnosis of a traumatic brain injury. In the case of Craffey v. Embree Construction Group, a Norfolk trial judge rejected defendant’s motion in limine to strike plaintiff’s expert, Randall Benson, M.D. and to preclude his testimony regarding his use and interpretation of diffusion tensor imaging. In denying the defendant’s motion, the trial court found:
DTI is a well-established and reliable tool to identify conditions in the brain. In line with the science, Dr. Benson may not testify that DTI proves brain injury, but may testify that DTI results are consistent with brain injury and, along with other medical evidence, is part of the puzzle leading to a diagnosis of brain injury. Without limitation, this expert will assist the jury, has sufficient qualifications, is based upon reliable principles and applying those principles in a reliable manner to the particular facts of this case.
This decision is in line with multiple decisions that have been rendered by trial and appellate courts throughout the United States, finding that diffusion tensor imaging is a valuable tool. While one cannot make a diagnosis of traumatic brain injury solely upon abnormalities seen on DTI, as this court found, DTI nevertheless is a valuable tool along with her medical records, history and physical examination in leading to and making a diagnosis of traumatic brain injury.
A new study published in Radiology evaluated the age effect on working memory performance and functional activation after mild traumatic brain injury. According to the abstract, researchers at Taipei Medical University-Shuang-Ho Hospital in Taiwan compared a group of thirteen individuals between the ages of 21-30 (with a mean age of 26.2 years) to a group of thirteen older patients who had an age range between 51-68 years (with a mean age of 57.8 years). Both groups had sustained mild traumatic brain injuries (MTBI). The researchers compared these twenty-six patients with twenty-six age- and sex-match control subjects. Functional MR images were obtained within one month after injury and six weeks after the initial study. Researchers performed group comparison and regression analysis among post concussion symptoms, neuropsychological testing and working memory activity in both groups.
The results showed different manifestations of post concussion symptoms at functional MR imaging between younger and older patients, which confirmed the important role of age in activation, modulation and allocation of working memory processing resources after mild traumatic brain injuries. The researchers concluded that these findings also supported the observation that younger patients have a better neural plasticity and clinical recovery than older patients.
David Yen-Ting Chen, the lead author of the study, stated in a press release, “old age has been recognized as an independent predictor of worse outcome from concussion, but most previous studies were performed on younger adults.” Dr. Chen went on to state, “taken together these findings provide evidence for differential neural plasticity across different ages, with potential prognostic and therapeutic implications. The results suggested MTBI might cause a more profound and lasting effect in older patients.”
The researchers also looked at the differences between men and women. They found that female patients with MTBI had lower digit span scores than did female control subjects, and functional MR imaging depicted sex differences in working memory functional activation; hypoactivation with non recovery of activation change at follow-up studies may suggest a worse working memory outcome in female patients with MTBI.
Again, this is just another example that refutes defense allegations that mild TBI always goes on to uneventful healing and recovery with 3-6 months. If you or your family was injured and sustained traumatic brain injuries, it is encouraged that you seek experienced legal counsel.
In almost every case in which I represent a client who has sustained a mild traumatic brain injury (TBI), the defense courtroom doctors write that my clients have not, in fact, suffered permanent injuries as everyone who suffers a mild traumatic brain injury goes on to eventually and uneventfully recover. If that were true, then we would expect that people who sustain multiple concussion/mild traumatic brain injuries should have no long term effect, because, from this logic, each injury is self-limited and results in full recovery over a period of time.
However, a recent study, which was conducted by researchers with the Department of Veteran Affairs and Boston University, found that 96% of examined NFL players and 79% of all examined football players have suffered the degenerative disease known as chronic traumatic encephalopathy (CTE). CTE is known to be a progressive degenerative disease of the brain, which can be found in person’s suffering from repetitive brain trauma. This trauma includes both symptomatic concussions and asymptomatic subconcussive hits to the head.
Additionally, the study found that 40% of those who tested positive CTE were offensive and defensive lineman. “That finding supports past research suggesting that it’s the repeat, more minor head trauma that occurs regularly in football that may pose the greatest risk to players, as opposed to just the sometimes violent collisions that cause concussions.”
This recent study, which can be found here, should certainly put to rest the argument that everyone who suffers a concussion recovers.
I am pleased to alert you that my article, Neuropsychology and Traumatic Brain Injury, was recently published in the October edition of Trial Magazine, the American Association for Justice’s award-winning magazine for attorneys, law professors, judges and others in the legal community.
The article addresses important topics, such as what is a neuropsychological evaluation and why is it needed, its admissibility in court, third party observers and obtaining neuropsychological raw test data.
Click here to read the full article.
Because of the wars in Afghanistan and Iraq, 15- to 17-percent of our soldiers have experienced a concussion. As a result, the Departments of Defense and Veterans Affairs have spent large sums of money investigating these injuries and funding research.
This research has been particularly useful in objectively demonstrating that our clients with mild traumatic brain injuries have been injured. However, a question that has arisen from this research is whether there is a difference between “blast” injuries and “blunt” injuries. A blast injury is considered to be any kind of physical trauma that occurs from a direct or indirect exposure to an explosion. On the other hand, a blunt injury is considered to be any kind of physical trauma that occurs by impact, injury or violence—for example, injuries sustained in a car crash.
As a result, this question also raises the issue of whether the scientific research arising from the war can be relied upon in cases that derive from motor vehicle crashes, falls, and other traumatic events.
A new study investigating the impact of pediatric traumatic brain injury on attention found that lapses of attention represented a core attention deficit in children with traumatic brain injury, even with mild traumatic brain injury (even in the absence of intracranial pathology) or moderate/severe TBI. A study, entitled “Pediatric Traumatic Brain Injury and Attention Deficit,” published in Pediatrics, the official journal of the American Academy of Pediatrics, looked at 113 children aged 6 to 13 years who were diagnosed with a traumatic brain injury. These children were compared to a control group of 53 children with a trauma control injury not involving the head. The investigation group looked at children who had mild TBI with or without risk factors for complicated mild TBI, as well as moderate/severe TBI survivors. Behavioral function was assessed by using parent and teacher questionnaires and the Attention Network Test, which assessed alerting, orienting, and executive attention.
The results of the study showed that the TBI group had higher parent and teacher ratings of attention and internalizing problems, higher parent ratings of externalizing problems and lower intelligence than the control group. Children with mild TBI who had extra risk factors such as headache, vomiting, or seizures after injury also had lower IQ scores and more lapses of attention.
Click here to view the abstract of the article. For additional information, read this article from yahoo.com.
As per the Brain Injury Association of America:
On July 16, 2015, the United States Senate passed S.192, the Older Americans Reauthorization Act of 2015. The Senate Health, Education, Labor, and Pensions Committee and the Senate Special Committee on Aging led the effort to reauthorize the Older Americans Act. This bipartisan legislation will support social and nutritional services for nearly 12 million U.S. seniors. Funding of this legislation will be used for home-delivered meals to senior centers allowing the senior population to be active in their communities, keep their independence, and continue to lead healthy lives. This week marks the 50th anniversary of the signing of the Older Americans Act into law. Throughout the legislative process, Brain Injury Association of America (BIAA) provided Senators with letters of support for this bill.
As per the U.S. Senate Committee on Health, Education, Labor and Pensions:
Recently, the Senate passed the Every Child Achieves Act to replace No Child Left Behind, which was seven years past the reauthorization date. This bipartisan agreement was shepherded through the Senate by the Senate Health, Education, Labor, and Pensions Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.)
What the Every Child Achieves Act Does
- Strengthens state and local control – The bill recognizes that states, working with school districts, teachers, and others, have the responsibility for creating accountability systems to ensure all students are learning and prepared for success. These accountability systems will be state-designed but must meet minimum federal parameters, including ensuring all students and subgroups of students are included in the accountability system, disaggregating student achievement data, and establishing challenging academic standards for all students. The federal government is prohibited from determining or approving state standards.
- Maintains important information for parents, teachers, and communities – The bill maintains the federally required two annual tests in reading and math in grades 3 through 8 and once in high school, as well as science tests given three times between grades 3 and 12. These important measures of student achievement ensure that parents know how their children are performing and help teachers support students who are struggling to meet state standards. A pilot program will allow states additional flexibility to experiment with innovative assessment systems. The bill also maintains annual data reporting, which provides valuable information about whether all students are achieving, including low-income students, students of color, students with disabilities, and English learners.
- Ends federal test-based accountability – The bill ends the federal test-based accountability system of No Child Left Behind, restoring to states the responsibility for determining how to use federally required tests for accountability purposes. States must include these tests in their accountability systems, but will be able to determine the weight of those tests in their systems. States will also be required to include graduation rates, another measure of academic success for elementary and middle schools, English proficiency for English learners. States may also include other measures of student and school performance in their accountability systems in order to provide teachers, parents, and other stakeholders with a more accurate determination of school performance.
- Maintains important protections for federal taxpayer dollars –The bill maintains important fiscal protections of federal dollars, including maintenance of effort requirements, which help ensure that federal dollars supplement state and local education dollars, with additional flexibility for school districts in meeting those requirements.
- Helps states fix the lowest-performing schools – The bill includes federal grants to states and school districts to help improve low-performing schools that are identified by the state accountability systems. School districts will be responsible for designing evidence-based interventions for low-performing schools, with technical assistance from the states, and the federal government is prohibited from mandating, prescribing, or defining the specific steps school districts and states must take to improve these schools.
- Helps states support teachers –The bill provides resources to states and school districts to implement activities to support teachers, principals, and other educators, including allowable uses of funds for high quality induction programs for new teachers, ongoing rigorous professional development opportunities for educators, and programs to recruit new educators to the profession. The bill allows, but does not require, states to develop and implement teacher evaluation systems.
- Reaffirms the states’ role in determining education standards – The bill affirms that states decide what academic standards they will adopt, without interference from Washington, D.C. The federal government may not mandate or incentivize states to adopt or maintain any particular set of standards, including Common Core. States will be free to decide what academic standards they will maintain in their states.
Lawrenceville, N.J. attorney Bruce H. Stern has been sworn in as the treasurer of the American Association for Justice (AAJ) at the organization’s annual convention in Montreal. AAJ is the world’s largest trial bar, working to make sure people have a fair chance to receive justice through the legal system when they are injured by the negligence or misconduct of others.
Stern, a shareholder at Stark & Stark, specializes in traumatic brain injury litigation. He is the author of numerous articles on the subject and co-authored a book entitled “Litigating Brain Injuries” published by Thomson Reuters. Stern also serves on the Board of Governors of the American Association for Justice and is a past president of the New Jersey Association for Justice, which awarded him its highest honor: The Gold Medal for Distinguished Service.
“I am excited to serve on the AAJ leadership team and continue to work toward our goal of protecting the civil justice system,” said Stern.
Stern is also a fellow of the International Academy of Trial Lawyers and has been selected a fellow in the International Society of Barristers.
“Stern’s expertise and commitment to the association will be essential as we work to engage our membership and fight for AAJ’s mission in Congress, the courts, and in the arena of public opinion,” said AAJ President Larry Tawwater.
For over fifteen years, researchers at the University of Glasgow and the University of Edinburgh have been following a large population of adults admitted to hospital with traumatic brain injuries. Those readers familiar with this blog are familiar with my reporting of the various papers that have been published by these researchers.
I recently came across an interesting research paper published in the Journal of Neurology, NeuroSurgery and Psychiatry, which looked at the mortality and morbidity fifteen years after hospital admission for patients who sustained a mild traumatic brain injury.
Dr. Tom McMillan and his colleagues designed a prospective case control record linkage study investigating the mortality rate in a population of Scottish adults admitted to hospital with mild traumatic brain injuries fifteen years post injury.
The study included 2,428 adults with mild traumatic brain injury and an equal number of community controls who were case-matched for age, gender and social depravation. The researchers also included a further control group admitted with non-brain injury that was also matched for duration of hospital admission. Any control member with a history of head injury prior to the study was excluded.
The researchers found that mortality in the mTBI group was higher than in the control group and other injury control group. They found that age at injury was important as younger adults (15-54) with mild brain injury had a 4.2 greater risk of death than the control group. In adults age over 54 the risk of death was 1.4 times higher. Repeated brain injury was also a risk factor for death in the mild traumatic brain injury group.
The researchers concluded, “Adults hospitalized with [mild traumatic brain injuries] had a greater risk of death in the following fifteen years in matched controls. The extent to which lifestyle and potential chronic changes in neuro pathology explain these findings is unclear. Lifestyle factors do contribute to risk of death after MHI and this finding has implications for lifestyle management interventions.” (Source)