This past weekend I was honored to be inducted as a Fellow in the International Academy of Trial Lawyers at this year’s mid-year meeting in Manchester Village, Vermont. I was privileged to be introduced by my friend and colleague Kathleen Flynn Peterson, a past president of the American Association for Justice.
The Academy is a group of truly elite trial lawyers representing both sides of the bar: prosecutors and defense lawyers in criminal cases, and plaintiffs’ and defense counsel in civil litigation, including business and personal injury cases. While the majority of Fellows come from the United States, the Academy includes lawyers from more than thirty countries. Fellowship is by invitation only, and the trial lawyers are invited to become Fellows only after an extremely careful vetting process. As to U.S. Fellows, the academy’s by-laws limit fellowship to 500 active trial lawyers.
At the American Headache Society’s 56th Annual Scientific Meeting, Sylvia Lucas, M.D., Ph.D., a clinical professor of neurology and neurological surgery at the University of Washington Medical Center reported on her research looking at the correlation between headache and depression following mild traumatic brain injury.
The study looked at 212 patients with mild traumatic brain injury at the University of Washington who sustained a mild traumatic brain injury. Participants had a mean age of 44 years and were mostly male (76%), white (75%), and had at least a high school education (83%). Their injuries primarily involved vehicle accidents (58%), followed by falls (24%), assaults (5%), and sports mishaps (3%). Researchers carried out baseline assessments during face-to-face interviews within 7 days of the injury. Follow-up interviews using a structured questionnaire were completed over the telephone at 3, 6, and 12 months post-injury.
The study found that a year after suffering mild traumatic brain injury, patients with headache were five times more likely to be depressed than patients with mild traumatic brain injury without headache and those who were depressed were more likely suffer headaches.
Click here to see the article published in Medscape Medical News, July 3, 2014.
A recent publication in Neurology, the official journal of the American Academy of Neurology, found that traumatic brain injury and the risk of dementia in older military veterans. “Traumatic brain injury and risk of dementia in older veterans,” Deborah E. Barnes, PhD, MPH, Allison Kaup, PhD, Katharine A. Kirby, MA, Amy L. Byers, PhD, MPH, Ramon Diaz-Arrastia, MD, PhD and Kristine Yaffe, MD.
The researchers from the University of California, San Francisco, San Francisco Veterans Affairs Medical Center and the Uniform Services University of the Health Sciences and Center for Neuroscience and Regenerative Medicine in Bethesda, Maryland, examined the association between traumatic brain injury and risk of dementia in veterans.
The researchers performed a “retrospective cohort study” of 188,000 U.S. veterans age 55 years or older who had at least one in-patient or out-patient visit during the baseline (2000-2003) and follow-up (2003-2012) and did not have a dementia diagnosis at baseline.
According to the abstract, which can be found here, traumatic brain injury in older veterans was associated with a 60 percent increase in the risk of developing dementia over nine years after accounting for continuous and potential confounders. “Our results suggest that TBI in older veterans may predispose toward development of symptomatic dementia and raise concern about the potential long-term consequences of traumatic brain injury in younger veterans and civilians."
The Centers for Disease Control and Prevention has released a new “Heads Up" app. According to their website, “The Heads Up"app will help you learn how to spot and what to do if you think your child or teen has a concussion of other serious brain injury. This app will also teach you about helmet safety and features information on selecting the right helmet for your child’s or teen’s activity, including information on what to look for and what to avoid.”
We know that there is no medical cure to traumatic brain injury. The best thing is prevention. I recommend this app to everyone.
Find out more about this app by clicking here.
A new study out of the Ohio State University and published in the American Journal of Sports Medicine found “concussion rates in the US High‑School athletes more than doubled between 2005 and 2012." During this time period, the researchers, led by Joseph Rosenthal, M.D. a clinical assistant professor of physical medicine and rehabilitation at the Ohio State University looked at 4024 concussions suffered by athletes in nine sports. Click here to read the full story.
While some may find these statistics alarming, it is much more likely that this increase demonstrates to some extent a recognition of the seriousness of concussion and the need for appropriate care. In its press release, Dr. Rosenthal was quoted as saying “our theory is that more people are looking for concussions, and athletes, parents, and coaches are being educated on the symptoms and importance of removal from participation, as well as treatment. There is a greater emphasis on monitoring for injury.”
Recent articles, also published in the American Journal of Sports Medicine give some support to that view. Two papers out of Harbor View Injury Prevention and Research Center in Seattle, Washington looked at the implementation of concussion legislation and extent of concussion education for athletes, parents, and coaches. There, the researchers conducted a survey in 2012 and 2013 on a random sample of public high school football, girls’ soccer, and boys’ soccer coaches in Washington State, stratified by urban and rural locality. The survey was constructed to cover the extent of concussion education for coaches, athletes, and parents as well as coaches’ concussion knowledge and experience.
According to the abstract, “three years after the passage of a concussion law in Washington State, high school football and soccer coaches are receiving substantial concussion education and have good concussion knowledge. Concussion education for athletes and parents is more limited. Football players receive more extensive concussion education than do soccer players." To read more, click here.
In a second study, these researchers concluded, “more objective and accurate methods are needed to identify concussions. Changes in athlete attitudes on reporting concussive symptoms will likely not be accomplished through legislation alone.” To read more, click here.
Almost everyone involved in representing or treating persons with traumatic brain injury is aware of the history and story of Phineas Gage. Mr. Gage, in 1848, was working as a railroad foreman for the Rutland & Burlington Railroad. Although accounts differ as to how his accident occurred, needless to say, while tamping gunpowder with an iron rod an explosion occurred causing the 13 ¼ pound tamping iron to be propelled. The iron entered Gage’s head point-first, striking below the left cheekbone. It passed behind his left eye and tore into his brain’s left frontal lobe. The incident has become a textbook lesson as it is claimed that Phineas Gage never lost consciousness despite having suffered a significant traumatic brain injury. Accounts of his life depict that Phineas Gage’s behavior was significantly changed for the worse following this incident.
I bring this story to everyone’s attention as a new article by Sam Kean entitled “Phineas Gage, Neuroscience's Most Famous Patient” was recently published online in Slate. A link to this interesting medical story can be found by clicking here.
Researchers at the University of Pittsburgh, utilizing diffusion tensor imaging, studied whether one’s gender could affect the recovery time from concussion. Dr. Saeed Fakhran, an assistant profession of neuro radiology at the University of Pittsburgh School of Medicine, and his colleagues, studied the DTI imaging results and medical records of 47 men and 26 women who had been diagnosed with mild traumatic brain injury. They also used a control group consisting of 11 women and 10 men.
Diffusion tensor imaging found that male patients with concussion had a much lower FA levels within the white matter tracks connects the uncinate fascicule (the tracks that connect the frontal and temporal lobes of the brain). They also found that the FA levels in that area of the brain were the best predictor of recovery time.
The study found that the average recovery time for men was 66.9 days while the average recovery time for women was 26.3 days.
Please click here to read the full Medical Press story.
One must keep in mind that although this small sample apparently did return to baseline, not everyone is so fortunate.
A new study out of John Hopkins found that “better-educated people appear to be significantly more likely to recover from moderate to severe traumatic brain injury, suggesting that a ‘cognitive reserve’ may play a role in helping people to get back to their previous lives.” The new article, which was published in the Journal of Neurology, can viewed by clicking here.
The article, entitled “Functional Recovery after Moderate/Severe Traumatic Brain Injury” looked at 769 patients, one year post injury. Of that group, 185 patients (24.1%) had less than twelve years of education while 390 patients (50.7%) and 184 patients (25.2%) had twelve to fifteen years and greater than sixteen years of education respectively. The researchers concluded:
Educational attainment was a robust independent predictor of one‑year disability-free recovery even when adjusting for other prognostic factors.
Please click here to view the full press release from Johns Hopkins.
This past week, the North America Brain Injury Society (NABIS) held its 27th annual medical-legal conference on traumatic brain injury. As one of the co-chairs of the program, we brought together one of the nation’s top medical and legal experts.
On Saturday, I gave a presentation on direct examination of experts in the traumatic brain injury case. This lecture discussed the possible experts who can and should be retained in properly representing an individual with an acquired traumatic brain injury. The presentation further discussed new ways to affectively present expert testimony utilizing the newest technologies and visuals available.
The American Association for Justice Education’s Trucking Collision Seminar at the end of April provides the latest courtroom litigation strategies for representing victims of trucking collisions. A faculty of experienced trial lawyers and consultants will offer tools and tactics when representing victims and their families.
Mr. Stern has been invited to give a presentation on traumatic brain injury following trucking collisions.
Mr. Stern is a past chair of AAJ's motor vehicle collision, highway and premises liability section.