Brain Injury Lawyer

Advances In Neuroimaging

rdeluca@stark-stark.com (Bruce H. Stern) — Tue, 18 Nov 2008 08:04:12 -0500

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.

New Study on Word Memory Testing

rdeluca@stark-stark.com (Bruce H. Stern) — Thu, 13 Nov 2008 08:06:55 -0500

I have written several times in the past on the validity of Word Memory Testing in diagnosing and treating traumatic brain injuries. A new study calls into question statements continuously made by Paul Green that the SVT measures on the Word Memory Test requires minimal to no cognitive effort. Reporting in this month’s issue of the Journal International Neuropsychological Society (2008), 14, 1074-1080, Batt et al., from the Department of Psychology McQuarie University, Sydney, New South Wales, Australia, measures the effect of distraction on the Word Memory Test (WMT) and Test of Memory Malingering (TOMM) performance in patients with a severe brain injury.

According to the paper, the “research compares the performance of a sample of non-litigating participants with severe brain injury on both the WMT and TOMM under conditions of (1) full effort, (2) distraction, or (3) simulated malingering.” The study included sixty participants with a severe brain injury. The study revealed that while both tests demonstrated excellent sensitivity, the false positive rates for the WMT were significantly greater than those for the TOMM. It was concluded that the so-called “effort” components of the WMT required more cognitive capacity than was previously believed.

In the discussion portion of the paper, the authors noted that the findings of those participants who failed the WMT had significantly lower estimated pre-morbid intelligence than those who passed, which further supported the notion that the WMT results are influenced by cognitive ability. The authors also noted: "In addition to this, false positives on the WMT were unacceptably high, which decreased the specificity of the test to unacceptable level."

The authors noted that this unacceptably high rate of false positives may not satisfy Daubert standards.

Pascrell Praises VA Decision to Expand Compensation for People with Traumatic Brain Injury

rdeluca@stark-stark.com (Bruce H. Stern) — Tue, 11 Nov 2008 08:01:22 -0500

United States Representative Bill Pascrell, Jr. of New Jersey, the co-founder and co-chairman of the Congressional Brain Injury Task Force, applauded the Department of Veterans’ Affairs for increasing disability payments for veterans diagnosed with mild traumatic brain injury (mTBI). The VA estimates that compensation for mTBI victims will increase from about $117 per month to as much as $600 per month. The VA states that these changes will help roughly 3,500 to 5,000 veterans each year.

A recent study estimates that up to 320,000 troops who served in Iraq and Afghanistan have suffered from a traumatic brain injury. “I’m pleased that the VA has finally opened its eyes, and more importantly its wallet, to the thousands of veterans and their families who have silently suffered from traumatic brain injury,” stated Representative Pascrell. “This decision was a long time coming, but marks significant progress. Unfortunately, there is still long way to go before I am fully satisfied with the services available to America’s brain injured veterans.”

Representative Pascrell is awaiting a response to his September 19, 2008 request for the Department of Defense Secretary Robert Gates to expand TRICARE to cover cognitive rehabilitation therapy for TBI victims. The letter was supported by a bipartisan coalition of 67 House of Representatives members.

Doubt Is Their Product: How Industry's Assault on Science Threatens Your Health

rdeluca@stark-stark.com (Bruce H. Stern) — Fri, 07 Nov 2008 08:00:13 -0500

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.

Brain Injury Association of New Jersey - Board of Trustees

rdeluca@stark-stark.com (Bruce H. Stern) — Tue, 04 Nov 2008 08:03:32 -0500

I was honored on October 23, 2008 to be reelected to serve a second three-year term on the Board of Trustees of the Brain Injury Association of New Jersey.

On Thursday, BIANJ held their annual meeting. Besides the election of new officers, BIANJ presented three awards. The first award was the Founders award for volunteer service which was given to Michael Barnes, for his hard work in volunteering to assist campers with acquired traumatic brain injury at BIANJ’s summer camp.

The Silvio O. Conte award for public awareness and education was given to the entire children and adolescents committee of BIANJ for their work not over the past year but for their hard work over the many past years. Members of the children and adolescents committee who were awarded were:

Stephanie Bar Am
Malia Corde
Connie Domingo, M.D.
Lori Kyle
Lenore Laracuente, Esq.
Joseph Marcantuono, Ph.D.
Thomas McBride, Ph.D.
Lois Mishkin, MA.CCC/LDTC
Crystal Ramirez, MSW, LSW
Sue Stephens, LCSW
Donna Bogart, Ph.D.
Barbara Couvadelli, M.D., Ph.D.
Wallace Kyle
Paula Henry
Linda Levine
Janet Margusity
Keri Meberg
Susan Paradise, M.Ed.
Brad Ross, Ph.D.
Judith Woop, M.Ed., RN

Finally, the James and Sarah Brady award for Public Service was given to Debbie McWilliams and the Timothy C. McWilliams, Jr. Foundation (The Timbo Fund). Three years ago, Debbie and her family lost their son after a long battle as a result of a severe traumatic brain injury. Following her son’s death, Debbie began the Timothy C. McWilliams, Jr. Foundation which presents small grants to needy individuals with acquired traumatic brain injury. In the past year, the Timbo Fund has provided grants in excess of $100,000. Those who are interested in contributing can find the Timbo Fund at www.timbofund.org.

Not to be forgotten were the numerous service awards given to staff for fifteen, ten and five years of service. As we all know, an organization is only as good as its staff and BIANJ is blessed with outstanding staff members. This year receiving awards were Barbara Podgorski (fifteen years), René Carfi and Joanna Boyd (ten years) and Stacy Lyons (five years).

Kudos once again go out to Barbara Geiger-Parker, President and CEO of BIANJ as well as to John Tiene, Chairperson of the Board.

Maybe, Just Maybe

rdeluca@stark-stark.com (Bruce H. Stern) — Thu, 30 Oct 2008 08:06:39 -0500

It was late in the third quarter and Penn State was fighting not only to keep its undefeated season alive, but its hopes for a national championship as well. As Penn State quarterback, Daryll Clark scrambled for a seven-yard gain, he collided with two 300-pound defensive linemen. Seven snaps later, Penn State officials diagnosed Clark with having sustained a concussion from the collision and pulled him from the rest of the game. Those watching the game could see that Clark was visibly upset by the decision not to let him return to play.

Not only did Penn State win the game and keep its national championship hopes alive, Penn State demonstrated that the health of its athlete was more important than winning a football game. Dr. Wayne Sebastianelli, Penn State’s Director of Athletic Medicine, was quoted as saying “We know the stakes are high, but we’re pretty much dedicated to the preservation of an athlete’s well-being. No one questioned it at all. We knew we had to find another way to win. That was it.”

The actions by Penn State’s team doctors and coaches should be a lesson to everyone that players who sustain concussions during sporting events should not be returned to play. Maybe, just maybe, others will follow this example.

Daubert Issues in Traumatic Brain Injury Cases

rdeluca@stark-stark.com (Bruce H. Stern) — Mon, 27 Oct 2008 08:02:57 -0500

Last Thursday, October 23, 2008, I traveled to New York City to participate in a continuing legal education program on traumatic brain injury sponsored by Lorman Education Services. My topic at the program was Daubert Issues in TBI Cases. My presentation focused on the evidentiary requirements for expert testimony and steps that can be taken to keep junk science out of the courtroom. Besides my presentation, the attendees heard from other outstanding attorneys who specialize in neurolaw as well as from Wilfred van Gorp, Director of Neuropsychology at Columbia Presbyterian Hospital.

Montclair High School Student's Death Leads to Stricter Policies

rdeluca@stark-stark.com (Bruce H. Stern) — Thu, 23 Oct 2008 08:03:41 -0500

The dangers of athletes returning to competition too soon after suffering from a sports-related concussion has been recognized for some time now. In fact, just a few years ago, the Brain Injury Association of New Jersey invited trainers and coaches from New Jersey high school athletic departments to attend a sports concussion seminar at Giant’s Stadium in the Meadowlands.

This morning I read in the New York Times that Montclair High School planned to meet this week to develop a written policy for dealing with students who sustained concussions. This announcement came days after a Montclair High School student athlete, Ryne Dougherty, died of a brain hemorrhage. That injury came less than a month after Ryne sustained a prior concussion during a school practice on September 18, 2008.

The article quotes Montclair High School’s Interim Principal Judith Weiss who indicated that she overhead at least one teammate “lamenting that he had not told school officials that Dougherty was complaining of post-concussion symptoms after he had been cleared.”

The failure of Ryne or his teammates to complain is not surprising. Over and over again, experts in the field warn that athletes will not bring their complaints to the attention of coaches as a result of the culture that surround these sports.

While it is wonderful that Montclair will now begin to develop the necessary policies regarding athletes who sustain concussions, it is shameful that this program was not in place before this tragic event occurred. It is imperative that schools begin to educate coaches, athletic trainers and their athletes concerning the dangers that concussions pose.

More than half of Toronto's homeless population have experienced severe trauma

rdeluca@stark-stark.com (Bruce H. Stern) — Tue, 21 Oct 2008 08:15:06 -0500

A new study states that prior to becoming homeless, more than one out of every three of Toronto, Canada’s homeless had suffered from a traumatic brain injury, which furthers past theories that mental health is linked to homelessness.

A paper published in the Canadian Medical Association Journal recently found that more than half of the homeless population of Toronto had experienced a severe brain injury, and 70% of those did so before ending up on the streets. The study surveyed roughly 900 people living in Toronto homeless shelters from 2004 – 2005. Traumatic brain injuries usually result in cognitive impairment, attention deficits and emotional instability.

You can read more on this story here.

Army Announces New Suicide Prevention Tool for Soldiers

rdeluca@stark-stark.com (Bruce H. Stern) — Thu, 16 Oct 2008 08:08:23 -0500

Last week I reported on a fascinating lecture I attended at the NABIS medical legal conference in New Orleans. Readers will recall that at that presentation, Dr. Mary Hibbard of Mount Sinai Medical Center discussed the increased suicide following traumatic brain injury of our soldiers returning from Iraq and Afghanistan.

Yesterday, the Washington Post reported that the army has unveiled a unique prevention tool-an interactive video to be mandatory viewing army-wide - in order to address the alarming record rate of suicide in its ranks. The video features soldiers role playing that of an anguished infantry training man and make virtual choices that lead the character to get help or in the worst case shoot himself in the head. The video is entitled “Beyond the Front” and “leads the viewer through a detailed drama in which [the infantryman] is hit by relationship troubles, financial problems and scraps with the law - what army research shows are major events that precipitate suicide.”

While this is certainly an excellent first step to address the problem, it is more important that the military address one of the major underlying problems, that of making sure that our soldiers returning from war obtain the appropriate screen for traumatic brain injury and/or post-traumatic stress disorder (PTSD) and most important obtain the needed medical care to address these injuries.

Montclair High School Student Critically Injured in Football Game

rdeluca@stark-stark.com (Bruce H. Stern) — Wed, 15 Oct 2008 09:18:54 -0500

I have previously written on the increasingly high number of sports-related brain injuries suffered by high school students and the devastating and lasting effects these injuries have on a child's brain. An article on MSNBC.com reports of a local high school student who was injured in a football game, and is now fighting for his life.

Ryne Dougherty, a 16-year-old Montclair High School student, was rushed to Hackensack University Medical Center after being critically injured in a football game against Don Bosco Prep School in Ramsey, New Jersey. Dougherty suffered a brain hemorrhage after he tackled another player. There was no contact to the head or neck before Dougherty suddenly collapsed on the field.

The Brain Injury Association of New Jersey has also realized the increasingly devastating effects of sports-related concussions and brain injuries suffered by high school students. They have created a website with information on the resources available to those who have suffered a brain injury and their families. The website includes educational articles on the signs and symptoms of sports related concussions, tips on how to prevent brain injuries and information on upcoming events in order to educate and help prevent these tragedies from occurring.

The Sarah Jane Brain Foundation

rdeluca@stark-stark.com (Bruce H. Stern) — Tue, 14 Oct 2008 08:07:42 -0500

The Sarah Jane Brain Foundation, a non-profit organization whose mission is to assist in the research of new developments for children suffering from pediatric traumatic brain injury (PTBI) and the rehabilitation of children, recently announced that two of the nation's leaders in the field of PTBI, Dr. Roberta DePompei and Dr. Ron Savage, have joined The National Advisory Board of The Sarah Jane Brain Foundation.

A goal of The Sarah Jane Brain Foundation is to establish a PTBI Act based off the successful TBI Act, developed for adults suffering from traumatic brain injury and having established a Traumatic Brain Injury Model System throughout the nation. Pediatric Traumatic Brain Injury is the leading cause of death and disability for children under 15 years of age in the United States resulting in over 5,000 deaths and over 17,000 permanent disabilities each year.

Are Our Troops at Risk For Suicide?

rdeluca@stark-stark.com (Bruce H. Stern) — Fri, 10 Oct 2008 08:07:46 -0500

During Dr. Mary Hibbard’s presentation on the neurobehavioral aspects of traumatic brain injury, she discussed the subject of suicide following traumatic brain injury. For quite some time, rehabilitation professionals have been aware of the correlation between traumatic brain injury and increased incidence of suicide. Studies by Silver (2001), Teasdale and Engberg (2001), Oquendo (2004) and Mainio (2007) have all documented the increased risk of suicide following traumatic brain injury.

What gave me pause was Dr. Hibbard’s discussion about the increased suicide of our troops who sustained traumatic brain injury while serving in Iraq and Afghanistan. While the media has well documented the high incidence of traumatic brain injury and post-traumatic stress disorder, the issue of suicide has unfortunately been pushed below the radar. It is essential that our troops on returning from war are provided with the appropriate treatment.

21st Medical-Legal Conference for Attorneys on Traumatic Brain Injury

rdeluca@stark-stark.com (Bruce H. Stern) — Wed, 08 Oct 2008 08:02:24 -0500

As I stated in my earlier blog, NABIS sponsored the 21st medical legal conference for attorneys on traumatic brain injury. I had the honor of serving as co-chair of the legal conference and both moderated and spoke at yesterday’s session. Joining me on the program were William Singer, M.D., pediatric neurologist from Harvard Medical School as well as Mary Hibbard, Ph.D., a board-certified neuropsychologist who specializes on traumatic brain injury and neurobehavioral issues. Dr. Hibbard presently is a professor at Mount Sinai Medical School in New York and shortly will be moving over to the Rusk Institute at New York University where she will become director of neuropsychology. It was certainly an honor being on a program with both Dr. Singer and Dr. Hibbard.

North America Brain Injury Society's Annual Board Meeting

rdeluca@stark-stark.com (Bruce H. Stern) — Mon, 06 Oct 2008 08:09:22 -0500

I have just returned from New Orleans where I attended the North American Brain Injury Society’s (NABIS) annual board meeting where I serve as treasurer of the organization and to attend NABIS’ annual medical-legal conference.

At our board meeting on Wednesday, the board of trustees elected Ron Savage, Ed.D. of Haddonfield, New Jersey as the organization’s president. The board also elected Harvey Jacobs, Ph.D., a behavioral psychologist from Richmond, Virginia as well as Mike Davis, a traumatic brain injury advocate and case manager to join the board of trustees. We all look forward to another successful year and look forward to next year’s conference.