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)
Despite study after study demonstrating long term effects from mild traumatic brain injury (concussions), it is astounding that defense courtroom doctors still maintain that there are no permanent residuals from mild traumatic brain injury. A new study, Imaging Correlates of Memory and Concussion History in Retired National Football League Athletes, published in JAMA Neurology once again debunks this myth that everyone gets better.
The objective of the study, according to the abstract was “to assess the relationship of hippocampal volume, memory performance, and the influence of concussion history in retired NFL athletes with and without mild cognitive impairment.” The design of the study was a retrospective cohort study assessing differences between groups, mean hippocampal volumes, and memory performance by computing age quintiles based on group-specific linear regression models corrected for multiple comparisons for both athletes and control participants. The study utilized 28 former NFL athletes who were compared with 27 control participants. The mean age was 58.1 for the former athletes and 59.0 for the control participants.
The study found that retired athletes with concussion history, but without cognitive impairment, had normal, but significantly lower, California Verbal Learning Test scores compared with control participants. However, those with a concussion history and mild cognitive impairment performed worse when compared with both control participants and athletes without memory impairment. Among the athletes, 17 had a G3 concussion and 11 did not. Older retired athletes with at least one G3 concussion had significantly smaller bilateral hippocampal volumes compared with control participants.
The authors concluded that “prior concussion that results in loss of consciousness is a risk factor for increased hippocampal atrophy and a development of mild cognitive impairment. In individuals with mild cognitive impairment, hippocampal volume loss appeared greater among those with a history of concussion.”
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.