Brain Injury

We frequently write blogs about concussion, but Dr. Robert Cantu, neurologist and medical director of the Nation Center for Catastrophic Sports and Injury Research in Boston, has a new set of recommendations for parents and sports coaches.

Because a child’s brain isn’t fully developed, any trauma has the potential to be more damaging than trauma to an adult brain.  In addition, Dr. Cantu says children tend to lack the neck strength to reduce the acceleration forces the brain will receive.  As a result, he said, children who play youth sports may be at more risk than adults realize.

According to an article from U-T San Diego, Dr. Cantu’s recommends are:

• No heading in soccer until age 14.

• Require chin straps in baseball; ban the headfirst slide.

• No bodychecking in youth hockey before 14.

• No full-contact football until age 14.

• Eliminate head-to-head hitting in Pop Warner (youth football).

• Reduce the contact allowed in football practice.

• Have children perform exercises to strengthen neck muscles.

• Require helmets in field hockey and girls lacrosse.

These guidelines may change the way youth sports are played, but that’s better than having to watch the outcomes of concussions.

For more information about concussions and other traumatic brain injury, visit our dedicated web page at lawmed.com/braininjury/. If you have questions, HensonFuerst has answers.

It seems like it should be common knowledge, but new research has just shown that when children experience concussion–or mild traumatic brain injury–those with more severe symptoms will need a longer amount of time to recover. Mild concussions may heal within 3 to 4 days, but bigger hits may require a month or longer to heal.

Scientist from the Boston Children’s Hospital and the University of Pittsburgh Medical Center examined medical records from 182 children with concussion. They looked for a group of symptoms and rated them on a scale of 0-6.  Symptoms included headaches, vomiting, balance problems, changes in sleep patterns, sensitivity to light or noise, fatigue, numbness, visual problems, and difficulty with memory or concentration.

According to study author William Meehan, M.D.:  ”Parents, physicians and caregivers of athletes who suffer from a high-degree of symptoms after a sports-related concussion should start preparing for the possibility of a prolonged recovery.”

Most physicians recommend that children who receive a concussion while playing sports shouldn’t return to play until all symptoms resolve. It’s a difficult call to make–coaches may want to put star players back in the game…and the injured child may downplay symptoms so they can return to play more quickly. It’s up to parents, teachers, doctors, and other adults to observe the child and make sure they are confident that the injury has healed entirely before sending the kids back out onto the playing field.

February 7, 2013

Data collected by the Department of Veterans Affairs (VA) shows that approximately 500,000 soldiers returning from overseas have been diagnosed with Post-Traumatic Stress Disorder (PTSD) or a Traumatic Brain Injury (TBI). Experts say the estimate may be low though, as many cases go unreported due to a veteran’s unwillingness to seek help.

What if there was a definitive way to gather biological evidence of these conditions? That is what a team of researchers from New York University’s medical school is working to create. According to the New York Times, the team is attempting to identify certain “biomarkers” amongst those who have PTSD or TBIs. The biomarkers are physiological signals a person is, or is likely to be, afflicted with a certain condition.

As part of the study, soldiers from Fort Bragg, North Carolina, are being evaluated in five groups:

• those suffering from PTSD,
• those suffering from TBI’s,
• those suffering both conditions,
• those suffering from depression, but neither PTSD or TBIs,
• and those suffering from no conditions

Biological samples will then be collected to identify any similarities or changes that could be linked to having PTSD or a TBI.

The North Carolina Injury Attorneys with HensonFuerst are aware of the devastating effects brain injuries can have on a victim’s life and urge anyone who has possibly suffered a brain injury to seek medical treatment. Then, contact an attorney to discuss your legal options.

In May 2012, we told you about the apparent suicide death of football star Junior Seau. He killed himself with a shot to the chest, presumably to preserve his brain so that experts could determine whether he was suffering from chronic traumatic encephalopathy (CTE), a progressive form of brain damage caused by multiple concussions. (To read the full blog about his death, click here:  Another NFL Concussion Tragedy)

On January 10, 2013, the National Institutes of Health (NIH) released a study that confirmed that Seau’s brain did, indeed, have abnormalities consistent with CTE. According to an article on msn.foxsports.com:

”I was not surprised after learning a little about CTE that he had it,” Seau’s 23-year-old son Tyler said. ”He did play so many years at that level. I was more just kind of angry I didn’t do something more and have the awareness to help him more, and now it is too late.

”I don’t think any of us were aware of the side effects that could be going on with head trauma until he passed away. We didn’t know his behavior was from head trauma.”

That behavior, according to Tyler Seau and Junior’s ex-wife Gina, included wild mood swings, irrationality, forgetfulness, insomnia and depression.

Today, the Associated Press reports that Seau’s family has sued the NFL, making him the latest of about 3,800 players to have filed to get compensation for brain injuries incurred during their careers. It’s a serious matter, and not one that can easily be tossed aside by asking “what did they expect from playing a violent game?” The issue is one of knowledge: It is alleged that the NFL knew the risks to players’ brains but failed to inform them. If the NFL knew about the risk but failed to warn players–especially considering that CTE usually become evident years after a player retires–the NFL was negligent.

According to the Associated Press article, Seau’s family wrote:

“We know this lawsuit will not bring back Junior. But it will send a message that the NFL needs to care for its former players, acknowledge its decades of deception on the issue of head injuries and player safety, and make the game safer for future generations.”

It’s a good message. Concussions are definitely not a “minor” injury. It’s sad that it is taking the death of Junior Seau and the suffering of thousands of other football players to make that point clear for the rest of us.

What’s even sadder is the timing of Seau’s suicide. This week, researchers announced that it may be possible to diagnose CTE without examining the brain after death. According to an article on CNN.com, a type of brain scan called positron emission tomography (PET) can detect a type of microscopic protein called “tau,” which is thought to be a marker for CTE. This means that it may soon be possible to diagnose CTE in living people, allowing them to get the help they need. (To read more about the scan, click here: Scan may detect signs of NFL players’ brain disease)  Let’s hope this means that no more football players need to shoot themselves in the chest to gain acknowledgment of their pain.

To learn more about concussion and other forms of traumatic brain injury, visit our website at www.lawmed.com/BrainInjury/ … and watch our YouTube video about symptoms of concussion here:

If you have questions, HensonFuerst has answers.

Over the past three years, I have written several blogs about preventing falls in the home. (The most recent blog was posted on September 20, 2012, to honor National Falls Prevention Awareness Day. To read that blog, click here: National Falls Prevention Awareness Day).

After years of researching information for Health & Safety blogs, I thought I knew everything. I was wrong…and I’d like share what I learned when a happy event turned to tragedy for my family.

On December 1, 2012, my parents finally moved from California to North Carolina to be nearer to us. (And by near, I mean two blocks away, which was great because my mother is a fantastic person.)

On December 3, while my mom and I were carrying bags of new towels and floor mats into her new house, up three small steps from the garage, she lost her balance and fell backwards—straight onto her head on the concrete floor.

The nightmare of the past two weeks has been…educational. And during long days spent in the ICU, I’ve had a chance to reflect on the event itself, and to gather lessons for preventing and dealing with a fall, things I don’t recall reading anywhere else.

• Don’t load yourself up with packages. My mom and I each were carrying two bags—one in each hand, which means that neither one of us could hold onto the handrail. One of the bags my mom was carrying was over-sized, and the weight of it dragged her backwards. I think back to my personal strategy of trying to get all the grocery bags out of the car in the fewest number of trips, and I realize that I was putting myself at risk. Now I know:  Better more trips back and forth to the car than a single trip to the hospital.
• If you witness the accident, call 9-1-1 yourself. I saw the accident happen, and then I saw my mother lying unconscious at the base of the stairs. I yelled into the house for another person to call 9-1-1 as I crouched by my mother’s side. Because no one else knew what happened, I started trying to explain what happened, valuable time that could have been used talking to the 9-1-1 operator. Even though it may mean leaving the victim’s side for a moment, get the phone and call 9-1-1 yourself.
• If a fall results in any head injury–even what might look like just a bump–call 9-1-1…no matter what anyone says. After my mother regained consciousness, she didn’t understand why she needed to go to the hospital. Of course, she didn’t know where she was, what my name was, or why she was lying down in the garage, either. It just proves that a damaged brain isn’t a rational brain. Call 9-1-1, even if the victim says she is fine, and even if others in the house think it is not necessary. After decades of taking orders from my mom, my stepdad heard her say she didn’t want to go to the hospital and told me to cancel the ambulance. (He changed his mind when my mom looked straight at him and asked where her husband was.)
• Be prepared to give lots of information on the phone.Maybe I’ve seen too many bad TV shows, but I just assumed that calling 9-1-1 was as simple as saying “Send help immediately.” The operator will want to know:
  • your name;
  • the address;
  • the victim’s name, age, date of birth, and relation to you;
  • details of how the injury occurred;
  • the current physical status of the victim: Is she breathing…is there blood…any obvious broken bones?
  • The current mental status of the victim: Is she conscious…does she know where she is…is she talking…does she report any pain?
  • The operator will also stay on the phone with you until the EMS workers arrive. You will be given specific instructions (such as: Don’t allow the victim to move; lock dogs away in another room, etc.), and you will have to give periodic updates: Is the victim still breathing…still unconscious? It took a mere 10 minutes for help to arrive at our remote home, but it felt like forever on the phone.
• Stay calm. After the call to 9-1-1, the fire squad showed up first, followed quickly by EMS workers. Each time, I was asked a lot of questions about my mother, her medical history, and the accident. Be prepared to say the same stuff over and over again (e.g., What is her birthdate? Is she allergic to any medications?). Don’t get upset—this is part of the process.
• Learn everything you can about your loved one’s medical history and medications…and carry a list of your own medications with you in your wallet. Hospital staff need to know which medications the victim is taking, what dosage, and what times of day. Thankfully, my mother is generally healthy and was only on two medications. I had to track them down before going to the hospital, and the job would have been more difficult if she kept some bottles in her handbag, some in the bathroom, some in the kitchen, etc.
• Assign one ride-along. One person can travel to the hospital with the EMS crew. In our case, that was my stepfather. I went back to the house to find my mother’s medications, my stepdad’s medications (in case we were at the hospital for hours), and to arrange for friends to watch after our pets.
• Bring a pad of paper and a pen to the hospital. Take notes when the doctors and nurses give you a report…have everyone you talk with write down their names and departments for future reference…write down any questions you think of so your brain doesn’t blank out when the doctor is right there in front of you. If your loved one will be in ICU, ask for the direct line to the nursing station so that you don’t have to go through the general hospital switchboard each time you call. In times of stress, memory fails, so write down everything.
• Invest in a walker for after the hospital. Trained in the fine art of shopping and mall-walking, my mother used to be fast. The brain injury has left her off-balance and unsure on her feet. She is grateful to have walker to help her get around more independently now.

We discovered that my mother’s skull had fractured in two places, she had a brain bleed at the site of the fractures, another brain bleed at the front of her brain where the brain whiplashed against the front of the skull (a contrecoup injury), and a large gash in her scalp. My mom spent three days in ICU, and another day in the neurological ward before coming home. Since then, we’ve returned to the ER twice because her symptoms got worse and worrisome. After the latest hospital run, we were told that she has “Post Concussion Syndrome,” a disorder commonly found in professional football players who sustain lots of hard hits to the head.

We’re not sure when my mother will be back to “normal.” We’re lucky in that her memory seems fine and her personality is the same as before the accident. She is unsteady on her feet, has big headaches, is unable to concentrate for very long, and is very easily fatigued.

It could have been much worse, and it was pretty close to being fatal. And do you know what my last words to my mom would have been? “Are you sure you can handle that big bag, Mom?” Seriously. I saw that it was too big for her, and I asked. She reassured me that she could handle it. In 20/20 hindsight, I shouldn’t have asked. I should have simply taken the bag from her and allowed her to walk up the steps without the encumbrance. That’s my final lesson: If you have to err at all, err on the side of being over-protective. I don’t think anyone has died from an abundance of caution.

Wishing you all a safe and healthy holiday season!

What do you call an activity requires strength, stamina, flexibility, agility, planning, and coordination with team members?  What if the participants were required to train with weight-training and aerobic exercises?  And what if that activity was performed in gymnasiums, in stadiums, and on outdoor fields?  And what if teams competed regionally and nationally? Sounds like a sport, right? Well, not according to sports authorities. For decades, even as Cheer has evolved from pompom waving to rough-and-tumble tumbling, sports experts have continually rejected the notion that Cheer is a sport. They call it an activity in support of “real” sports, like football and basketball, but not a sport in and of itself.

Now, finally, medical experts have weighed in, and they believe it is time for cheerleading to gain acceptance as an official sport. Yay! Gimme a “C”…gimme an “H”…gimme an “E”…well, you get the idea. We think it is a spectacular idea, and about time.

In 2011, we wrote a 3-part series about why Cheer should be recognized as a sport, namely because doing so would afford participants with more safety protections. According to an article on MedPageToday.com:

…the rate of catastrophic injuries — such as head or spine injuries resulting in death or permanent disability — is considerably higher for cheerleading than for other sports. Cheerleading has accounted for about two-thirds of all catastrophic injuries in female high school athletes over the past 25 years.

In addition, concussion rates have increased at a much faster pace in cheerleading compared with other sports.

In response, the American Academy of Pediatrics (AAP) has said that school sports associations should designate cheerleading as a sport, and to make it subject to safety rules and better supervision. That should include on-site athletic trainers, restrictions on difficult stunts in high school squads, limits on practice time, and better qualified coaches. In addition, just like other athletes, cheerleaders should be required to do conditioning exercises and undergo physical exams before joining the squad.

According to an article by The Associated Press:

“Not everyone is fully aware of how cheerleading has evolved over the last couple of decades. It used to be just standing on the sidelines and doing cheers and maybe a few jumps,” said Dr. Cynthia LaBella, a sports medicine specialist at Chicago’s Lurie Children’s Hospital and an author of the new policy….

Last year, there were almost 37,000 emergency room visits for cheerleading injuries among girls aged 6 to 22, according to data from the Consumer Product Safety Commission. That’s more than four times higher than in 1980, when cheerleading was tamer.

Although some cheerleaders themselves think that rules will make the sport less exciting, sports medicine specialists are all for the proposed changes, which includes limiting the height of human pyramids in high school cheerleading to just two people, and that routines that include pyramids, tumbling, or tosses should not be performed on hard surfaces.

“Most serious injuries, including catastrophic ones, occur while performing complex stunts such as pyramids,” guidelines co-author Dr. Jeffrey Mjaanes, a member of the AAP Council on Sports Medicine & Fitness, said in an academy news release. “Simple steps to improve safety during these stunts could significantly decrease the injury rate and protect young cheerleaders.”

ADDITIONAL READING

To read our 3-part blog series on making Cheer a sport, click here:

Cheerleaders Are Athletes, Part 1

Cheerleaders Are Athletes, Part 2: Just Chunk It

Cheerleaders Are Athletes, Part 3

“The home use of trampolines is strongly discouraged.”

That is the conclusion of a policy statement issued today by the American Academy of Pediatrics in the journal Pediatrics. According to an article on NBCnews.com, Dr. Michele LaBotz believes that pediatricians need to actively discourage recreational trampoline use.

 “This is not a toy. It’s a piece of equipment. We recommend that you not provide it for your family or your neighbors to use. But if you do use one, you need to be aware of the risks.”

Parents mistakenly see trampolines as benign playthings, LaBotz said.

“I think parents see the soft springy mat and they think it’s safe, like water,” LaBotz said. “What they don’t realize is that once you get it to bouncing, especially if there are multiple users, it can be dangerous. Bigger kids and adults like to rocket propel up the little kids, getting them to bounce higher than they would otherwise and if the kid comes down wrong, it is the same as falling 9 or 10 feet onto a hard surface.”

To read the full article in Pediatrics, click here:  Trampoline Safety in Childhood and Adolescence

To learn more about personal injury, visit our website at www.lawmed.com. If you have questions, HensonFuerst has answers.

On July 6, 2012, Usher’s 11-year-old stepson, Kile Glover, suffered a serious head injury after a jet-ski accident. The child was floating on an inner tube with a teenaged friend when they were struck by a jet ski piloted by 38-year-old Jeffrey Hubbard. While an investigation is continuing, drugs and alcohol were not involved. According to numerous news reports, young Kile was pronounced brain dead on July 8.

That tragedy follows close on the heels of another: On July 1, astronaut Alan Poindexter died after a collision of water scooters.

While injuries from personal watercraft are rare–slightly more than 800 per year in the United States–most of the injuries could have been prevented. Experts are stepping up their efforts to warn people that water vehicles can be dangerous. According to an article in USA Today:

Organizations such as the Personal Watercraft Industry Association (PWIA) are pushing for increased education and safety requirements for those riding the more than 1.29 million jet-propelled watercrafts registered across the nation.

“It’s simply because we feel that it is important that these vessels be operated safely,” association Executive Director David Dickerson said. “They are unique. They require a certain level of judgment and expertise.”

Among the increased safety requirements urged by the PWIA are increasing minimum operator age to at least 16, mandatory safety education for everyone, and mandatory wearing of life jackets. Currently in North Carolina, anyone age 14 or older can operate a personal watercraft, and education courses are required only for people under age 17.

Top Safety Guidelines

The PWIA has created a helpful brochure the outlines safety rules for riding jet skis, water scooters, and other personal watercraft. As they say in the opening paragraph:

A personal watercraft (PWC) is a boat, and you’re the captain. You are legally in com- mand of a powerboat, and you’re bound by the boating rules of the road as well as the laws and traditions of responsible boating. 

Here are the top rules and guidelines:

• Never ride after consuming drugs or alcohol.
• Wear a personal floatation device (life vest).
• Wear protective clothing. Owners manuals suggest wearing a wet suit bottom (which can prevent injury should the jet nozzle get too close to body orifices), footwear, gloves, and goggles.
• Attach an engine shut-off cord to your wrist so that if you fall off, the engine stops.
• Don’t allow anyone to operate the vehicle if they are unfamiliar with boating regulations or if they are underage.
• Treat the watercraft like the high-performance vehicle it is, and not like a toy. Don’t make sharp turns, and don’t try to jump wakes or waves.
• If someone is behind the vehicle, turn the engine off–throttling up can cause severe injury from the jets.
• Scan constantly for people, objects, and other watercraft.
• Don’t “play” by driving too close to people in the water.

To read all the safety guidelines from the PWIA, click here:  PWIA brochure

June 28, 2012

According to WRAL News, the father of a Smithfield, North Carolina, teen hospitalized at WakeMed is fighting to keep guardianship over his son.

The young man was a 17-year-old high school senior when he was involved in a car accident in March 2011 that left him seriously injured. Doctors determined that he had suffered a traumatic brain injury in the crash and that he would likely be in a vegetative state the rest of his life. Over the next 14 months, the majority of the teen’s nearly $4 million in medical expenses was initially covered by his father’s Medicaid, but the day he turned 18-years-old, he was dropped from the policy.

Since then, his father has been working to have the coverage of his son reinstated, but WakeMed is pushing the court system to appoint an individual from the state government or the hospital to be the teen’s legal guardian. The young man’s father is resisting because those individuals would be able to make medical decisions about the care of the teen.

A hearing on the case has been scheduled for the end of July.

The North Carolina Personal Injury Lawyers with HensonFuerst Injury Lawyers understand how difficult and frustrating insurance disputes can be and the firm would like to wish this family the best of luck in getting this issue resolved as quickly as possible to get this young man the care he needs.

As doctors like to say, “Time is brain,” meaning that every minute a brain injury goes untreated, more brain cells die. Swift, effective treatment can save a live and, if circumstances are right, prevent catastrophic brain injury.

[Dr. George] Garcia said that he has seen some intense injuries in his career as a trauma surgeon, but he acknowledged that this case was “pretty unique because the spear was so long.” He said there was no time to get distracted by the sensational scene, and his team shifted into high gear of their “regimented” response routine.

After verifying that the patient had no additional injuries beside the obvious one, the first challenge was how to get Lopez into the doughnut-shaped CT scan machine with a three-foot spear protruding from his forehead. The paramedics had done an incredible job of getting the patient to the hospital without disturbing the shaft, said Garcia, but given the lucky — and precarious — trajectory of the spear through Lopez’s brain, any movement could have proven fatal.

“There is a good chance that he will have a perfect recovery,” Bullock said. “Young people have this amazing capacity for the uninjured part of the brain to take over functions controlled by the damaged part.”

To learn more about brain injury, visit our website:  HensonFuerst Attorneys Brain Injury pages