The election of the International Brain Injury Association (IBIA) Executive Committee was held by the incoming IBIA Board of Governors. The results are as follows:
- Chairman: David Arciniegas, MD
- Vice Chair: Nathan Zasler, MD
- Secretary: Lisandro Olmos, MD, PhD
- Treasurer: Bruce Stern, Esq.
- BOG Liaison: Jennie Ponsford, PhD
I am honored to have been re-elected to serve as treasurer for IBIA.
The good news is that most if not all states have passed a version of Washington State’s Zackery Lystedt law which is helping to educate high school athletic coaches, trainers, parents, and athletes about concussions and return to play. The bad news, is that still, despite the passage of this legislation and a great deal of public information, new research finds that only 69% of student athletes that were surveyed in the study still played with concussion symptoms. According to a recent news release, two studies published this month in the American Journal of Sports Medicine, that athletes were still returning to play much too soon. Please continue reading to see a full copy of the press release about this study.
I was honored to be reelected to another term as a member of the International Brain Injury Association (IBIA) Board of Governors. IBIA is dedicated to the development and support of multi-disciplinary medical and clinical professionals, advocates, policy makers, consumers, and others who work to improve outcomes and opportunities for persons with brain injury.
This March, IBIA will be sponsoring the Tenth World Congress on Brain Injury, which is being held in San Francisco, California from March 19-22, 2014.
For all attorneys who represent persons with traumatic brain injury, the North America Brain Injury Society (NAIBIS) will be holding its 27th annual conference on legal issues and brain injury at the same time and place. For attorneys who register for the NAIBIS conference, admission to the world congress is free. Links to both may be found below.
As part of the hockey concussion education project, researchers used MRI diffusion tensor imaging to examine the brain’s white matter microstructure in ice hockey players with a history of clinically symptomatic concussion compared with players without a history of concussion.
The researchers utilized six players with a history of concussion and eighteen players without a history of concussion who underwent 3-T DTI. The researchers concluded “the results of the current study indicate that a history of concussion may result in alteration of the brain’s white matter microstructure in ice hockey players. Increased FA based on decreased radial diffusivity may reflect neuro inflammatory or neuro plastic processes or the brain responding to brain trauma.
Hockey Concussion Education Project, Part 3. ”White matter microstructure in ice hockey players with a history of concussion: a diffusion tensor imaging study”. Marc Muehlmann, M.D.,1,3 Peter Savadjiev, Ph.D.,1 Sylvain Bouix, Ph.D., Marek Kubicki, M.D., Ph.D., Eli Fredm an, B.A., Brian Dahlben, M.Sc., Karl G. Helmer, Ph.D., Andrew M. Johnson, Ph.D., Jeffrey D. Holmes, Ph.D., Lorie A. Forwell, M.P.T., Elaine N. Skop elja, M.A.L.S., Martha E. Shento n, Ph.D.,Paul S. Echlin, M.D.,12 and Inga K. Koerte, M.D., J Neurosurg / February 4, 2014
The continued use of diffusion tensor imaging to examine the brains of individuals who have sustained a mild traumatic brain injury (concussion) provided further fuel to defeat defense efforts to bar DTI’s use in MTBI cases.
The hockey concussion education project under the leadership of Dr. Paul Echlin and in collaboration with a team from Harvard Medical School/Bingham and the women’s hospital/Massachusetts General Hospital/Athinoula A. Martinos Center for biomedical imaging/Western University of Canada had published new findings from an advanced MRI analysis of male and female collegiate ice hockey athletes. According to their press release:
The international team used advanced MRI imaging and innovative analysis techniques to study the probable acute effects of concussion on the brain; and the resulting studies demonstrate multi-modal microscopic acute organic changes in the brains of athletes that have suffered clinically diagnosed concussions.
Says Paul Echlin, MD, CCFP, Dip Sports Med, CAQSM, and lead author on the study, “What are our societal goals - will we foster the development of our young people’s cognitive, social and physical potential in a safe and protected environment - or will we continue to teach and reward a culture of violence and accepted brain injuries as “part of the game”? HCEP has published peer-reviewed scientific findings twice, in 2010 and in 2012, highlighting the high incidence of concussion and the damage inflicted on our young hockey players. Are we able to evolve and make significant or even radical changes in the sports themselves based on the scientific evidence of too many serious short and long-term brain injuries?”
Please continue reading for more information from the press release.
In doing research for a brief on the admissibility of DTI and NeuroQuant, I came upon an article from June 2013, entitled Mild Traumatic Brain Injury: Longitudinal Regional Brain Volume Changes from the Department of Radiology, NYU School of Medicine. Yongxia Zhou, PhD, Andrea Kierans, MD Damon Kenul, BS. , Yulin Ge, MD,., Joseph Rath, BS, Joseph Reaume, BS Robert I. Grossman MD, and Yvonne W. Lui, MD. Radiology Vol. 267, No.3 (June 2013).
The purpose of their study was to investigate longitudinal changes in global and regional brain volume in patients one year after mild traumatic brain injury and to correlate such changes with clinical and neuro cognitive metrics. Keep in mind, defense courtroom doctors routinely testify that individuals with mild traumatic brain injury all recover within six months.
The researchers utilized 28 patients with mild traumatic brain injury (with 19 followed up at one year with post traumatic symptoms after injury) and matched them with 22 control subjects (with 12 followed up at one year). Automated segmentation of brain regions to compute regional gray matter and white matter volumes was performed by using 3-dimensional T-weighted 3.0T magnetic resonance imaging and the results were correlated with clinical metrics.
The NYU researchers found that one year after mild traumatic brain injury, there was measureable global brain atrophy larger than that found in the control subjects. The authors concluded “these observations demonstrate structural changes to the brain one year after injury after a single concussive episode. Regional brain atrophy is not exclusive to mild severe traumatic brain injury, but may be seen after mild injury. In particular, the anterior part of the cingulum and cingulated gyros isthmus as well as the precuneal gray matter may be distinctively vulnerable one year after mild TBI.
A new study published in the American Journal of Psychiatry out of Denmark found an increase in risk for all psychiatric outcomes after brain injury. The Danish researchers investigated the relationship between head injury and subsequent psychiatric disorders. According to the abstract, the authors used linkable Danish nationwide population-based registers to investigate the incidents of schizophrenia spectrum disorders, unipolar depression, bipolar disorder, and organic mental disorders in 113,906 not six individuals born between 1977-2000 who received in inpatient or emergency department diagnosis of head injury . Data were analyzed by survival analysis and adjusted for gender, age, calendar year, presence of psychiatric family history, epilepsy, infections, auto immune diseases, and fractures not involving the skull or spine.
The results and conclusions were:
Results Head injury was associated with a higher risk of schizophrenia (incidence rate ratio [IRR]=1.65, 95% CI=1.55–1.75), depression (IRR=1.59 95% CI=1.53–1.65), bipolar disorder (IRR=1.28, 95% CI=1.10–1.48), and organic mental disorders (IRR=4.39, 95% CI=3.86–4.99). This effect was larger than that of fractures not involving the skull or spine for schizophrenia, depression, and organic mental disorders, which suggests that the results were not merely due to accident proneness. Head injury between ages 11 and 15 years was the strongest predictor for subsequent development of schizophrenia, depression, and bipolar disorder. The added risk of mental illness following head injury did not differ between individuals with and without a psychiatric family history.
Conclusions This is the largest study to date investigating head injury and subsequent mental illness. The authors demonstrated an increase in risk for all psychiatric outcomes after head injury. The effect did not seem to be solely due to accident proneness, and the added risk was not more pronounced in persons with a psychiatric family history.
Orlovska S et al. Head injury as risk factor for psychiatric disorders: A nationwide register-based follow-up study of 113,906 persons with head injury. Am J Psychiatry 2013 Dec 10; [e-pub ahead of print]. (http://dx.doi.org/10.1176/appi.ajp.2013.13020190)
Two separate courts in Minnesota have upheld the introduction of testimony regarding abnormalities found on diffusion tensor imaging (DTI). In the case of Nelson v. BNSF Railway Company, Court file number: 27‑CV‑12‑9171, October 1, 2013, defendants filed a motion in limine to bar the testimony of Dr. Joseph Wu, a neuro imaging expert. Dr. Woo interpreted a DTI of plaintiff and concluded that the DTI findings were consistent with a mild traumatic brain injury. The trial court rejected defendant’s motion, permitting Dr. Wu to testify and permitting plaintiff to introduce the results of the DTI.
Similarly, in the matter of Nordstrom v. Fleet Farm of Menomonie, file number 82‑CV‑11‑5842 (District Court Tenth Judicial District, January 17, 2014), defendants filed a motion in limine to exclude all results of a diffusion tensor imaging (DTI) study and to preclude plaintiff’s experts from testify regarding the DTI. Like the case above, the district court denied defendants’ motion to preclude.
In Nordstrom, defendants argued that DTI was an experimental technique that was not generally accepted in the relevant medical community and that it lacked foundational reliability. The Court, noting that DTI was FDA approved and peer reviewed, found that DTI had been in clinical use for many years and was generally accepted in the scientific community as reliable and accurate.
In opposition, plaintiff argued that the DTI was being offered to show that damage has occurred to plaintiff’s brain. Plaintiff acknowledges that the DTI was not being used to show causation, but was being used in conjunction with other diagnostic tools to aid in a diagnosis. Defendants’ motion to exclude DTI evidence was denied.
Last week, a federal district judge in Louisiana, barred the testimony of Dr. Richard Harding, a member of Bio Dynamics Research Corporation (BRC) out of San Antonio, Texas. In the matter of Oaks v. Westfield Ins. Co., Civil Action No. 13 1637 (January 16, 2014), U.S. District Judge Carl J. Barbier, after considering the motions and briefs, held that Dr. Richard Harding, an expert in “biomechanical engineering, impact kinematics and injury causation analysis” found that the proposed expert testimony was inadmissible because it was (a) unreliable, (b) beyond the expert witnesses' expertise, and (c) unhelpful to the trier of fact.
The Court reasoned:
Dr. Harding's proposed testimony is unreliable because the analyses and testing that he relied upon to arrive at his opinions are based upon insufficient facts and data. Dr. Harding did not inspect the actual vehicles involved in the collision at issue. Rather, he relied on previous testing on different vehicles than those involved in the accident. Further, the testing assumed certain facts as to the angle of the impact, etc. Finally, Dr. Harding never personally examined the Plaintiff, yet he renders opinions on the causation of her injuries.
In addition to the testimony and report's foundations in insufficient data, the Court finds that Dr. Harding's opinions speak to matters beyond his expertise. Though Defendants present Dr. Harding as a "biomechanical expert," his biomechanical qualifications are only partially relevant because his report does not present solely a biomechanical analysis. Instead, Dr. Harding speaks to both biomechanics and medical causation by opining that the force of the impact could not have caused Plaintiff's injuries. Dr. Harding is not qualified to testify about Plaintiff's medical condition because he is not board certified or qualified in any medical specialty, he has not practiced clinical medicine in over a decade, and he has never been licensed to practice medicine in the United States. Although he was at one time licensed to practice medicine in the United Kingdom, he has since lost his license due to inactivity. See Thomas v. G & K Servs. Co., et al., No. 01-1637, 2002 WL 34720493 *3 (E.D. La., Aug. 16, 2002) (Lemmon, J.). Moreover, Dr. Harding's "accident reconstruction" certification is irrelevant because his report does not reconstruct the exact accident at issue. Rather, he either re-created a loosely similar accident or relied on prior testing that presented an allegedly similar scenario.
The North America Brain Injury Society and the Alaska Brain Injury Network have announced the 2014 Alaska Brain Injury Conference which will be held in Anchorage, Alaska, April 30 – May 2, 2014.
There, national and international traumatic brain injury experts will join Alaskans’ professionals to present bet practices to tackle one of the highest rates of brain injury in the nation and the challenges of service delivery in rural and remote areas.
Topics at the conference will include:
- Aging with TBI
- Behavioral Health
- Community Services and Reentry
- PTSD, Concussion and mTBI
- Educational Services
- Family Supports
- Military and Veteran Issues
- Substance Abuse
- Vocational Rehabilitation
- ... and much more!
For additional information on the preliminary program, please click here.