Brain Injury Lawyer

I found an interesting article on the International Brain Injury Association’s website the other day written by Robert L. Shepherd MS, Certified Medical Illustrator and Vice President & Director of Eastern Region Operations for MediVisuals Incorporated.

The article discusses how medical and health care professionals are often called upon to provide expert opinions during litigation. Those experts providing medical/legal opinions may either be called due to their role as a treater of a patient involved in litigation or retained to provide so called “expert witness” testimony because these specialists are recognized as experts in a specific area (even though they may not have treated a patient involved in litigation). In either case, the role of the testifying professional is very important in helping decision makers or triers of fact identify and appreciate the truth in order to achieve just resolution of the contested issue(s).

The article goes on to discuss the challenges testifying professionals will need to consider in order to present an opinion in a legal venue. You can read the full article online here. 

The Brain Injury Association of New Jersey will offer two regional seminars this month focusing on the long-term effects of brain injuries on a patient's mental health. The seminars will address the needs of individuals with brain injuries served by health and human service workers throughout New Jersey.

The seminars were created in an effort to increase awareness of brain injuries among health and human service professionals. Since the first series of regional seminars were held in 2003, over 300 health and human service professionals from a wide variety of agencies throughout the state of New Jersey attend the seminars every year.

You can access additional information on the seminars, as well as dates and times for the seminars, online here. 

The Brain Injury Association of New Jersey will hold it's next round of Brain Injury Basics for Families programs over the next several months throughout the state of New Jersey. Brain Injury Basics for Families is a free educational seminar series designed to educate the public on brain injuries, and raise awareness of the more than 9,000 children and adults who are hospitalized each year due to a traumatic brain injury in the state of New Jersey alone. 

Brain Injury Basics discusses the impact of brain injury on families, provides an overview of brain injuries, provides information on the effects of brain injury on families, including the stages of grief family members experience, and offers information about strategies families can utilize when dealing with a brain injury in their own family, and tips for caregivers.

You can access additional information on the Brain Injury Basics series, as well as a list of upcoming seminars, online here. 

The New Jersey Council on Developmental Disabilities have created a new, and free, program entitled Partners in Policymaking (PIP) which is an innovative leadership training program for adults with disabilities and for parents of young children with disabilities. The program provides information and training for participants to help develop and build on their advocacy skills needed to obtain appropriate services for themselves and family members.

 You can learn more on the Partners in Policymaking program online here.

I just received a copy of the February 2009 issue of Brain Injury, The Official Research Journal of the International Brain Injury Association.  There, I found an interesting article by Rael T. Lange, Grant L. Iverson and Michael D. Franzen entitled “Neuropsychological Functioning Following Complicated Versus Uncomplicated Mild Traumatic Brain Injury”.  (Brain Injury February 2009; 23 (2):83-91.)
 

The purpose of the study was to examine the neuropsychological functioning in patients following complicated versus uncomplicated mild traumatic brain injury in the first seven days post injury.  The researchers assumed that patients with day-of-injury intracranial abnormalities would have worse neuropsychological functioning than patients without these abnormalities.  Studies previously conducted had concluded that patients with intracranial abnormalities detected on CT or MRI had worse performance on some neuropsychological measures in the initial days, weeks and months following mild TBI compared to those without such abnormalities.
 

The researchers selected from an archival database of 465 patients seen as part of the Allegheny General Hospital Trauma Service Clinical Pathway in Pittsburgh, PA for a known or suspected brain injury.  For the purposes of the study, only patients who could be classified as sustaining an uncomplicated mild TBI or complicated mild TBI were of interest.  Of those 465 patients, 167 patients were classified as either uncomplicated or complicated mild TBI based on CT scan results and a GCS score falling between 13-15.  Of that population, 20 patients with uncomplicated mild TBI were selected who matched 20 complicated mild TBI patients.  These patients were matched on age, education, gender, ethnicity, days tested post injury and mechanism of injury.
 

These 40 patients had undergone neuropsychological testing.  The cognitive measures used were trail making test part a and part b, controlled oral word association test (COWAT), the Hopkins Verbal Learning Test and selected sub-tests from the WMS-R: Digit Span Forward, Digit Span Backward, Logical Memory I, Logical Memory II, Visual Reproduction I, and Visual Reproduction II. 
 

Overall, the result for providing some support for the hypothesis that patients with complicated mild TBI would have worse neuropsychological functioning.  Patients with complicated mild TBI did perform worse on several measures and had a greater proportion of low scores on some measures when compared to the uncomplicated group.  However, a global reduction of functioning across all measures in the complicated mild TBI group was not found.  The effect of complicated mild TBI on neuropsychological functioning was lessened when only subjects with GCS scores equaled a 15 were compared. 
 

The researchers concluded that the data suggested that there are some differences in neuropsychological functioning in the acute phase of recovery.  However, they noted that the differences in neuropsychological functioning were found on only a few measures and the effect size of these differences were lower than expected.

As you may already know, The Sarah Jane Brain Foundation has quickly become one of the leading organizations dealing with Pediatric Acquired Brain Injury (PABI) throughout the nation.  The foundation is named after 3-year-old Sarah Jane Donohue who was shaken by her baby nurse when she was only 5 days old breaking 3 ribs, both collarbones and causing a severe brain injury.  Sarah Jane's father, Patrick Donohue, has quickly galvanized the leading professionals in the field of PABI to action.
 
Phase 1 of the Sarah Jane Brain Project began in October 2007 when Patrick launched the Open Source Initiative which was the first time in medical history someone's (Sarah Jane's) medical records and therapy videos were made publicly available using open source principles (they were posted at www.TheBrainProject.org).  He immediately began Phase 2 which was recruiting other families to participate in the Open Source Initiative and attracting the best in the field of PABI to join his National Advisory Board.  Phase 3 involved having the National Advisory Board develop the first-ever National PABI Plan (a comprehensive continuum of care model system).  The first draft of the PABI Plan was finalized in NYC during the PABI Conference of the National Advisory Board last month and is posted on the website.  The Board is seeking public comments through the end of next week from stakeholders in the field of PABI from around the world (I encourage you to read it and post your comments/suggestions).  Phase 4 will be Congress passing the PABI Act which will fund and fulfill the PABI Plan (Patrick's goal is to have this completed by Sarah Jane's 4th birthday in June).
 
Part of Phase 3 has been establishing a Legal Committee of the National Advisory Board by recruiting some of the best legal, regulatory and financial professionals to examine and address the many complex legal issues facing the millions of children and families dealing with PABI (criminal law, family law, personal injury/tort law, healthcare insurance/Medicaid issues, medical and bioethics law, estate planning, special education law as well as intellectual property law).  Patrick asked me to join the National Advisory Board in December and I readily accepted.  I particpated in the PABI Conference last month where more than 50 of the country's leading PABI experts gathered to draft the PABI Plan - there has never been a concentration of such expertise assembled before.
 
A significant part of the PABI Plan will be establishing a National Pediatric Brain Injury Law Clinic which will assist the children and families with their legal issues where government support services currently are lacking.  Part of the the law clinic's role will be establishing a national network of talented and committed legal professionals who understand the PABI community.

I recently read a new book entitled “MMPI-II Assessing Personality and Psychopathology (4th Edition) by Dr. John R. Graham.  Dr. Graham played a major role in the development of the MMPI-II and is currently a professor of psychology at Kent State University. 

In this text, Dr. Graham reviews the Fake Bad Scale developed by Paul Lees-Haley.  Readers of this blog are familiar with other studies attacking the validity of this scale.

In this text, Dr. Graham writes, “Published research with the FBS does not support its validity for its intended purpose.”  “A meta-analysis of MMPI-II malingering studies (Rogers et al., 2003) revealed that the FBS has been quite ineffective in identifying malingerers and, in fact, had the worst validity for this purpose of all of the MMPI-II scales included in the meta-analysis.  It is this author’s recommendation that the FBS not be used to identify malingering of psychopathology on the MMPI-II.”

This book is another weapon in the arsenal to discredit the use of the FBS in neuro litigation.

I recently found a website which I think will be very helpful to the readers of my blog. The site is an online presentation established by the Department of Psychology at Macquarie University in Australia which is designed to assist people who have suffered from a mild Traumatic Brain Injury through the administration of the Abbreviated-Westmead Post-Traumatic Amnesia Scale. The scale was developed in order to assist in the early identification of cognitive impairment following mild traumatic brain injury (mTBI).

The site states that early identification of patients with cognitive problems after a traumatic brain injury is imperative in the management of the injury. The most common symptom associated with mild traumatic brain injury is memory loss or amnesia.

You can read more on Macquaire University's presentation here.

At present, the gold standard for objectively proving that an individual sustained a mild traumatic brain injury is through neuropsychological testing.  As we know, standard diagnostic testing such as CT scans, MRIs and EEGs, due to their lack of sensitivity, rarely if ever detect brain abnormalities in patients with mild traumatic brain injury.

However, advances in neuroimaging may soon eliminate the need for neuropsychological testing to diagnose brain damage.  Advances in FMRI and diffusion tensor imaging (DTI) will soon become the gold standard.

I recently read an article published in Brain entitled “Structural Dissociation of Attentional Control and Memory in Adults with and without Mild Traumatic Brain Injury”.  The article by S. N. Niogi et al, noted that executive function such as attention and memory are among the most significant human brain processes impacting overall cognitive function.  The study contained 43 patients prospectively recruited with mild TBI, (28 males, 15 females) who were imaged at least one month post injury and 23 healthy volunteers, (17 males, 6 females).  There was no significant difference in mean age, gender, handedness, or level of education between the mild TBI group and the control group.  Those with a prior history of TBI, a history of neurological or psychiatric illness were excluded.  All subjects underwent diffusion tensor imaging along with conventional MRI.  The study provided clear evidence that DTI may serve as a microstructural imaging biomarker for cognitive dysfunctions and variations within normal cognitive functions.  Hopefully, further research will confirm this finding.  DTI has already been accepted in our courts as a reliable neuroimaging mechanism to detect brain injury from trauma.  Further studies such as this will only strengthen its admissibility.

In previous blog entries, I have discussed the recent exposé regarding industry’s payment of money to scientists to publish "research" that is supportive in industry’s defense of defective products.  I just finished an outstanding book entitled "Doubt Is Their Product: How Industry’s Assault on Science Threatens Your Health" by David Michaels.  Dr. Michaels is an epidemiologist and Director of the project on scientific knowledge and public policy at the George Washington University School of Public Health and Health Services.  He previously served as Assistant Secretary of Energy for Environment, Safety and Health under the Clinton administration.

Dr. Michaels illuminating book documents "the way in which product defense consultants have shaped and skewed the scientific literature, manufactured and magnified scientific uncertainty, and influenced policy decisions to the advantage of polluters and the manufacturers of dangerous products."

This book follows product after product, toxin after toxin and how the manufactures of these chemicals, drugs and products have deceived, hidden and misrepresented the known dangers of their products.  For all concerned about the public health and how industry has subverted the legal and regulatory systems, this book is a must.  You can purchase the book online here.