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In 2001, Teasdale and Engberg published an article in the Journal of Neurology, Neurosurgery and Psychiatry, entitled Suicide after Traumatic Brain Injury: A Population Study. The researchers reviewed data from Danish hospital admissions covering the years 1979-93 and found that patients who had sustained a TBI had an increased risk of suicide. The authors in that study concluded, “The increased risk of suicide among patients who had an MTBI may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally physical, physiological, and social consequences of the injuries as directly contributing to…suicide.”

In a recent research article, Lauren B. Fisher, et al. evaluated data from a brain injury-focused database, the BI Model Systems National Database, to further evaluate whether or not suicide rates are higher in TBI patients. Using patient health questionnaires detailing self-reported suicide attempts over a period of twenty years, the authors concluded that those who suffer a TBI are indeed at “greater risk for depression and suicidal behavior.” The outcome of the study indicates the need for “routine screening and mental health treatment in this population.”

The theory of neuroplasticity holds that the brain will change and adapt to different conditions including to childhood injuries. This theory is often challenged and sometimes referred to as a “myth.” However, a new study by Seena Fazel and colleagues from the Department of Psychiatry at University of Oxford in the United Kingdom delivered data that supports the claims of neuroplasticity theorists. Fazel’s conclusions reveal that the later a mild TBI is sustained, the worse the health and social outcome is for the patient. The study also found a causal effect between childhood Traumatic Brain Injuries (TBIs) and the risk of brain impairment and social dysfunction at later stages in life.

Continue Reading New Study Debunks Claim that Neuroplasticity is a Myth—the Later the Onset of Mild TBI, the Worse the Outcome

It is well known that headache is one of the most common debilitating chronic pain conditions in patients who sustain a mild traumatic brain injury (mTBI). No conventional pharmacological treatment has been shown to be effective in treating headaches related to traumatic brain injury (TBI). I recently read an interesting abstract published in Pain Physician; 19(2)(E 34754)- entitled rTMS in Alleviating Mild TBI Related Headaches – A Case Series.

In this study, the authors designed a perspective evaluation in patients with established diagnoses of mild traumatic brain injury related headaches who were treated with neuronavigational guided rTMS. The study was conducted at the Veterans Administration San Diego Health Care System, where over 400 patients with mTBI are evaluated annually.

The study included six men (average age of 50) with mTBI-HA. Constant headaches were rated at 4 on a 0-10 numerical rating pain scale (NRPS) and all patients were on stable headache medication regiments. Each of the patients received 4 sessions of rTMS over a 2 month period.

Following the treatment, the patients were again evaluated. The average post rTMS headache intensity was reduced by 53.05%. The average headache exacerbation frequency per week was reduced by approximately 79% with 2 patients reporting complete cessation of severe headache episodes.

The authors concluded that rTMS offered a “non-evasive” treatment option for MTBI-HA.

(Pain Physician. 2016 Feb;19(2):E347-54. rTMS in Alleviating Mild TBI Related Headaches – A Case Series)

I am pleased to alert you that my article, Neuropsychology and Traumatic Brain Injury, was recently published in the October edition of Trial Magazine, the American Association for Justice’s award-winning magazine for attorneys, law professors, judges and others in the legal community.

The article addresses important topics, such as what is a neuropsychological evaluation and why is it needed, its admissibility in court, third party observers and obtaining neuropsychological raw test data.

Click here to read the full article.

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.

Continue Reading Accelerated Atrophy of the Brain Following Traumatic Brain Injury

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.

This past week, I attended the American Association for Justice’s mid-winter convention in Palm Desert, California.  Besides my duties and responsibilities as Parliamentarian of AAJ, I was pleased to be invited to give a presentation at the Specialized Track: Concussion Crisis-Litigating Sports Injuries and TBI CLE program where I spoke on the topic of “Proving the Invisible:  Arguing a Sports-Related Concussion Case without Neuroimaging.”

On returning to New Jersey this past Saturday, I co-chaired the New Jersey Association for Justice (NJAJ) Traumatic Brain Injury program.  Besides co-chairing the event, I gave a presentation entitled “Identifying and Handling the Traumatic Brain Injury Case.”

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.