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.
At the annual meeting of the Radiological Society of North America (RSNA), Christopher C. Whitlow, M.D., Ph.D., M.H.A., an associate professor of radiology at Wake Forest School of Medicine and radiologist at Wake Forest Baptist Medical Center presented the findings from his research that some high school football players exhibit measurable brain changes after a single season of play, even in the absence of concussion
Dr. Whitlow and his fellow researchers studied twenty-four high school football players between the ages of sixteen and eighteen, none of whom had a history of having sustained a concussion. During all games and practices, the twenty-four players were monitored with Head Impact Telemetry System (HITs) helmet-mounted accelerometers.
Utilizing this data, the players were divided into two groups “heavy hitters” and “light hitter.” All twenty-four players underwent pre- and post- season evaluation with Diffusion Tensor Imaging (DTI). Although none of the players suffered a concussion during the season “the results showed that both groups demonstrated global increases of FA over time, likely reflecting effects of brain development. However, the heavy-hitter group showed statistically significant areas of decreased FA post-season in specific areas of the brain, including the splenium of the corpus callosum and deep white matter tracts.”
“’Our study found that players experiencing greater levels of head impacts have more FA loss compared to players with lower impact exposure,” Dr. Whitlow said. ‘Similar brain MRI changes have been previously associated with mild traumatic brain injury. However, it is unclear whether or not these effects will be associated with any negative long-term consequences.’
Dr. Whitlow cautions that these findings are preliminary, and more study needs to be done.” If you or a loved one has been affected by a brain injury, contact Stark & Stark today.
Click here for the link to the RSNA press release.
There has been much research with regard to the long term effects of mild traumatic brain injury (MTBI) and post traumatic stress disorder (PTSD) as independent conditions. However, there has been very little research studying the combined effect of MTBI and PTSD.
This month’s Journal of Neurotrauma contains an article by Walter High, M.D. and his colleagues at the University of Kentucky, Department of Physical Medicine and Rehabilitation, Neurosurgery and Psychology. Dr. High and his colleagues conducted a multi site study looking at the collective as well as the individual effects of MTBI and PTSD on an individual’s psychological, and cognitive functioning abilities.
The participants in the studies underwent a series of neuropsychological testing to measure their cognitive functioning. The participants were classified as MTBI only, PTSD only, or both. The results of the studies suggested that veterans suffering from both PTSD and MTBI have a poor cognitive and psychological outcome than those diagnosed with only one of the two conditions. A link to the University of Kentucky press release can be found here.
This summer the Radiological Society of North America published an article summarizing the findings from Research conducted at Stanford University on the effects of concussive and sub-concussive head injuries. There the Stanford researchers, headed by Michael Zeineh, MD, Ph.D. concluded that even for young football players who didn’t experience a concussion, football and other contact sports can cause brain abnormalities that mimic mild traumatic brain injuries and which can lead to the frightening degenerative decease call CTE. More information can be found here.
Recently, the athletic administration at Ohio University has published on its website an infographic that highlights the impact CTE has had on sports. Ohio University breaks down the number of cases of CTE per sport (76 Football players at the professional level, 47 amateur or professional boxers, two soccer players, and more). While the narrative surrounding concussions and CTE has been attached to the NFL, it is spreading to other sports, including soccer, which was once considered a safer alternative to football. The infographic also offers ways to make sports safer and the stories of many athletes diagnosed with CTE, including Pat Grange, the first soccer player diagnosed with CTE. Click here to read the full article. If you or a loved one has been affected by a brain injury, contact Stark & Stark today for a free consultation.
I just received the recent issue of Brain Injury Professional, the official publication of the Brain Injury Society which I had the honor and pleasure to serve as guest editor.
This issue was entitled “Special Issue on Brain Injury Litigation.” The issue included articles on “The Use of Diffusion Tensor Imaging” and “Life Care Planning and Acquired Brain Injury and the Affordable Care Act.” The former article was authored by Dorothy Clay Sims, Esq. and Manley Kilgore, M.D. The latter article was authored by Harvey E. Jacobs, Ph.D.
The journal included an article on the Economics on Mild Traumatic Brain Injury Disability authored by Joseph T. Crouse, Ph.D. and Anthony M. Gamboa, Ph.D., MBA. Brandon Woodward, Esq., Gregory A. Kendall, Kyle S. Dayton, B.S. and Douglas Rennie, Esq. contributed an article entitled “Pitfalls of oversimplied headache diagnosis in TBI litigation.” Ken Kolpan, Esq., who for over 26 years has co-chaired the NABIS Legal Conference wrote an article entitled “What to You Expect When You Become An Expert.” Finally, Frank Toral, Esq. contributed an article entitled “No Really, It Takes a Team.”
If you are not a member of NABIS, I strongly encourage you to join. An application can be downloaded from the website www.nabis.org.
A recent decision by the Supreme Court – State of New York, Nassau County, Part 40 rejected a motion by defendants to preclude the plaintiffs from presenting evidence regarding diffusion tensor imaging in support of their claim that the infant plaintiff suffered a traumatic brain injury as a result of a traumatic incident. Sullivan v. Walters, Index number 6110-2005, Supreme Court-State of New York, Nassau County, Part 40.
There, defendants moved pursuant to Frye v. United States, 293 F. 1013 (1923) to bar the admissibility of plaintiffs’ expert Michael Lipton, M.D., Ph.D., asserting that the use of DTI violated the Frye standard.
In support of their motion, defendants submitted the affidavit of Dr. A. John Tsouris who is a board certified staff neuro radiologist and director of neurological MR imaging at New York Presbyterian Hospital-Weill Cornell Medical Center, and an associate professor of radiology. Dr. Tsouri has co-authored two articles on DTI and is presently researching the possibility of utilizing DTI to establish mild traumatic brain injury in professional football players and patients suffering from MS, ALS, and brain neuoplasm as part of a collaborative study by the Hospital for Special Surgery and Weill-Cornell Medical Center’s Department of Neurology. Dr. Tsouris affirmed that “research to date has shown that there is a significant overlap between FA values of individuals with traumatic brain injury and FA values in persons with no history of traumatic brain injury.” Dr. Tsouris was also of the opinion that while DTI could be used if at all in a group study that individual results were meaningless unless compared to a control group.
Plaintiffs’ expert, Dr. Lipton, explained “MRIs are insensitive to white matter in the brain and so people who have sustained a closed head injury often have normal MRI results despite damage to white matter in their brains. DTI is far more sensitive than MRI in that it measures the direction of extremely small-scale movement a/k/a diffusion of water molecules within tissue. It was Dr. Lipton’s opinion that plaintiff’s quantitative analysis of FA images from the MRI/DTI study demonstrated multiple foci of significant low anisotropy consistent with traumatic axonal injury. Dr. Lipton also explained that DTI does not and cannot, on its own, diagnose mild traumatic brain injury, but that it must be correlated with history and other clinical data to either substantiate or refute the diagnosis.
Plaintiff presented numerous medical literature and other publications which supported the use of DTI in establishing a traumatic brain injury as well as numerous Orders in which DTI has been admitted into evidence.
Defendants also asserted that Dr. Lipton’s failure to provide the computer programs and foundational data basis should also result in Dr. Lipton being barred. The Court noted that these programs where the proprietary property of Montefiore Medical Center and Albert Einstein College of Medicine, which were not a party to the action nor had relief against them been sought. More importantly, the Court noted that the information was confidential under HIPAA and the Court denied that portion of the motion as well.