Posted by rozeklawoffice on April 12, 2011 under Mild Brain Injury, Traumatic Brain Injury | 
In the last blog entry we discussed how the insurance industry and some within the field of neuropsychology have conspired to create a fictitious defense to the existence of long-term problems associated with mild traumatic brain injury. Essentially they have created a Karl Rovian defense to mTBI. They took what was once common knowledge, ie that mTBI can result in long-term symptoms, and they refuted the entire proposition, mainly by publishing flawed studies or by relying on simple works such as those authored by Michael McCrae.
McCrae’s premise is that the entire field of neuropsychology relied upon only two studies to establish the long-held belief that about 15% of mTBI’s result in long-term symptoms. McCrae then goes on to use flawed logic to refute these two studies, jumping to the conclusion that because these two studies were not valid, therefore the 15% number is actually less than 1%.
Any mild traumatic brain injury survivor with symptoms lasting longer than 6 months can tell you their symptoms are real and can be disabling. The common symptoms include the following:
- headaches
- dizziness
- nausea
- fatigue
- noise sensitivity
- irratibility
- sadness
- nervousness
- temper problems
- concentration deficits
- memory deficits
- difficulty reading
- sleep distrubance
Despite the prevalence of these symptoms in mild traumatic brain injury survivors, the insurance industry has persuaded a large segment of the field of neuropsychology to attempt to “prove” these ongoing symptoms are due to pre-existing depression, pre-existing anxiety or other pre-existing psychological issues. One of the most revealing claims made by this segment of the field of neuropsychology is that because these injuries cannot typically be shown with current imaging techniques, this means the injury is not real and is not organic. That argument is analogous to concluding that broken bones never existed prior to the advent of the X-ray.
Nevertheless, the neuropsychologists that are routinely hired by insurance company lawyers have gone to great lengths to establish some type of normative data to support their proposition that mild traumatic brain injuries cannot result in long-term symptoms. They have failed in their endeavors because each and every study can be easily refuted when closely scrutinized.
The adoption of the insurance industry’s agenda of denying that mild traumatic brain injury survivors could have injury-related symptoms by this segment of the field of neuropsychology is sure to create a huge cost to taxpayers through public benefit programs. Instead of holding the wrongdoers and their insurance companies responsible, we the tax payers will be paying for the ongoing care and treatment as well as the long-term disability benefits for these brain injury survivors that have permanent mTBI symptoms. While the lack of personal responsibility and accountabilility has the broadest impact to society, it is minor when compared to impact of this approach on the mild traumatic brain injury survivor.
Now more than ever it is critical that mild traumatic brain injury survivors retain an experienced, qualified brain injury attorney to advocate on their behalf. All too often, I am contacted by brain injury survivors after they retain an attorney and their attorney has completely bought into the insurance industry premise that mTBI’s cannot result in long-term consequences.
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Contact an experienced Wisconsin Brain Injury Attorney.
Posted by rozeklawoffice on March 22, 2011 under Mild Brain Injury, Traumatic Brain Injury |
Traumatic Brain Injury is a serious public health problem in the United States, with over 1.7 million people sustaining brain injuries annually. Of the 1.7 million TBI’s, the vast majority are mild traumatic brain injuries. Unfortunately, many mild brain injuries go undiagnosed in the emergency rooms and urgent care centers, in fact, one study established that more mild tbi’s go undiagnosed than those that are actually diagnosed. (Emergency rooms miss MTBI 56% of time. Powell JM, Ferraro JV, Dikmen SS, Temkin NR, Bell KR, Accuracy of mild traumatic brain injury diagnosis. Arch Phys Med Rehabil. 2008 Aug;89(8):1550-5).Unfortunately, many emergency room physicians still feel loss of consciousness is necessary to sustain a brain injury of any significance, despite a plethora of literature establishing loss of consciousness is not necessary to sustain a TBI.
Many of the symptoms of mild TBI are typically non-specific and can be associated with many other conditions, i.e. complaints of memory problems, concentration problems, headaches, fatigue, sleep disturbance, irritability, etc. The majority of Mild Traumatic Brain Injuries are usually not detectable on conventional imaging techniques such as CT or MRI.
In the personal injury litigation context, at-fault insurance companies and their defense lawyers use all of the above to their advantage in attempting to escape responsibility. The insurance industry has also been successful in convincing a segment of the neuropsychological community to deny the possibility of long-term consequences as a result of mild traumatic brain injuries, despite a long-standing consensus that 5-15% of mild TBI patients would suffer from long-term consequences of their mTBI. This 5-15% segment of mild TBI survivors that had long-term symptoms were traditionally referred to as the miserable minority.
Authors such as Michael McCrae, in his rudimentary booklet, Mild traumatic brain injury and postconcussion syndrome. The new evidence base for diagnosis and treatment. New York: Oxford University Press (2008), attempted to prove that the 5-15% miserable minority was actually less than 1%, the implication being that one could not suffer from any type of permanent impairment as a result of a mild traumatic brain injury. McCrae’s book was not peer-reviewed, his conclusion was based upon flawed logic and McCrae addressed only 2 out of dozens of peer-reviewed studies establishing long-term consequences of mild TBI. Neuropsychologists that routinely work for the insurance industry have embraced McCrae’s book, referring to it as their “bible.”
McCrae fails to grasp the concept of “cause.” McCrae first attempts to erode or erradicate the 5-15% miserable minority, then he goes on to conclude that any long-term problems following mild TBI must be due to psychological problems, since no uncomplicated mild TBI can ever cause permanent problems. McCrae’s theory fails for many reasons. Legal cause means the mild TBI is a substantial factor resulting in the ongoing impairment. There may be more than one cause for the ongoing impairments. However, if the mild TBI is one of those causes, then the ongoing impairments are caused by the mild TBI under the law. The easiest way to attack such an unscientific premise is with one simple question:
Dear Insurance Company Neuropsychologist – Had it not been for the mild TBI would the person be suffering from same exact degree of ongoing impairment as they are now experiencing?
If the neuropsychologist claims that the individual would have suffered from the same exact degree of impairment at the same exact moment in time, regardless of the mild TBI, they will look ridiculous. If this question is asked in a deposition, be sure to videotape it, as you will want to play the reaction of the squirming insurance company neuropsychologist for the jury at the subsequent trial.
Posted by rozeklawoffice on October 18, 2010 under Mild Brain Injury, Traumatic Brain Injury |
Post-traumatic amnesia is the period of time following head injury where the individual is unable to consistently and continuously remember things. Confusion and disorientation may or may not accompany the period of post-traumatic amnesia. For example, there have been many stories of NFL players sustaining concussions in the beginnings of games, but continuing to play. The next day, they may have no memory of playing in the game, however, they were not exhibiting any signs of confusion or disorientation during the game.
It is important to keep in mind that the period of post-traumatic amnesia does not end until the person is able to consistently and continuously remember events. Many times, mild traumatic brain injury victims complain of “swiss cheese memory,” wherein they are able to remember bits and pieces of the events following the head injury but there are many holes in their memory.
Knowledgeable brain injury professionals have long known that the length of post-traumatic amnesia following a head injury is one of the best predictors of the severity of the head injury. The duration of post-traumatic amnesia (PTA) is also one of the best predictors of long term outcome following head injury:
- Very Mild TBI – PTA of < 5 minutes
- Mild TBI – PTA of 5-60 minutes
- Moderate TBI – PTA of 1-24 hours
- Severe TBI – PTA of 1-7 days
- Very Severe TBI – PTA 1-4 weeks
- Extremely Severe TBI – PTA > 4 weeks
Researchers from the Netherlands have now successfully confirmed the period of post-traumatic amnesia with the use of perfusion CT, which monitors blood flow in the brain. The study showed decreased blow flow in the frontal lobe and caudate nucleus of the brain injury victims during the period of time they were experiencing post-traumatic amnesia. The study will be published in the Journal of Neurotrauma:
“Acute cerebral perfusion CT abnormalities associated with posttraumatic amnesia in mild head injury.” Zwany Metting, Lars Roediger, Bauke de Jong, Roy Stewart, Berry Kremer, Joukje Van der Naalt. Journal of Neurotrauma. doi:10.1089/neu.2010.1395.
Posted by rozeklawoffice on April 12, 2010 under Child Injuries, Mild Brain Injury, Traumatic Brain Injury |
In January 2009, leading medical experts at the Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University School of Medicine (BUSM) reported that a 9 year NFL veteran was suffering from a degenerative brain disease (also known as CTE) caused by head trauma, when he died at the age of 45. In addition, the CSTE discovered early evidence the same disease in a recently deceased 18 year old boy who suffered multiple concussions in high school football.
Due to the growing link between brain trauma on the football field and CTE, a number of living former NFL players decided that, upon death, they would donate their brains to Boston University School of Medicine. This pact of players was titled the 88 Plan, named after former NFL star John Mackey’s jersey number. Mackey was suffering from severe dementia. It is not possible to determine the underlying disease which causes dementia from a living brain. The pact’s players hope that the resulting research will serve as a wake-up call that radical change is needed in football to protect the millions of adults and children playing the game.
Later in 2009, the National Football League was accused in front of the House Judiciary Committee of neglect in its handling of active and retired players with brain injuries. It was reported that there was mounting evidence of a link between playing football and cognitive impairment, such as dementia later in life. The long term effects of the game of football on player’s health was discussed. One representative said there should be federal scrutiny of football, particularly because the impact of injuries on the millions of players at the college, high school and youth levels.
More than one million youngsters play high school football every fall, with hundreds seriously injured by concussions due to the young player not understanding the risks or playing despite their pain to mirror their N.F.L. heroes.
Since the House Judiciary Committee hearing, the NFL has instituted stricter return-to-play guidelines for players showing concussion symptoms; required each team to enlist an independent neurologist as an adviser; entered into a partnership with Boston University brain researchers who have been critical of the league’s stance on concussions; and conducted tests on helmets. The recently updated guideline prevent athletes from returning to a game after sustaining a head injury. The NFL’s change of policy, in addition to high profile brain injuries sustained by Olympic athletes, has recently highlighted the risk of permanent damage from a head injury.
The Mackey-White Traumatic Brain Injury Committee was formed by the NFL Players Association and includes professional athletes, past and current NFL players, doctors and researchers. The purpose of the group is to open a dialogue on brain injuries in professional football, discuss the latest research and begin developing recommendations to keep players safer. The first committee meeting was held in January 2010.
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