head injury

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!

“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.

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

This is a story about athletes and concussions.

When you read that sentence, what picture popped into your mind:  250-pound football players… or 10-year-old girls with ponytails?  According to research published in The American Journal of Sports Medicine, the severity of symptoms after a concussion is–in part–dependent on the age and gender of the patient. Girls and young women suffer worse symptoms than men, and young people suffer more than older people.

The study tested young athletes for balance and verbal and visual memory. Researchers tracked the athletes for two years. In that time, about 300 of the athletes received a concussion and were tested again. Results showed that high school athletes performed worse for their age than college-aged athletes, and that female athletes with concussion had more symptoms and worse visual memory than male athletes with concussion. In addition, symptoms lasted longer in younger athletes than in older athletes.

According to an article in The New York Times:

The findings suggest that because of anatomical differences that make them more vulnerable, female athletes, and younger athletes in particular, may need to be managed more cautiously after a concussion, said Tracey Covassin, an associate professor of kinesiology at Michigan State University and the lead author of the report.

“Parents need to understand that if their daughter has a concussion, that they may potentially take longer to recover from that concussion than their son who is a football player,” she said.

Experts think that younger brains suffer greater damage from concussion because they haven’t fully developed…and because we tend to treat them as miniature adults when it comes to sports and expectations. According to Mark Hyman, author of “Until It Hurts: America’s Obsession With Youth Sports and How It Harms Our Kids” (Beacon Press, 2009):

“The brain and head of a small child are disproportionately large for the rest of the body,” he said. “The result is that their heads are not as steady on their shoulders. When they take a big hit in a football game or are slammed with an elbow in a soccer game, their brains move inside their skulls. That’s when concussions occur.”

RESOURCES

To read an abstract of the article in The American Journal of Sports Medicine, click here:  The role of age and sex in symptoms after concussion

To read the full article in The New York Times, click here:  Concussions May Be More Severe in Girls and Young Athletes

from The Observer

For Eastern Oregon University student and softball pitcher Holly Martin, February 25, 2010 was both the luckiest and unluckiest day of her life. On that day, she suffered a life-threatening, life-changing head injury. Given the reported lack of care she received after the injury, Holly was lucky to survive.

According to an article in an Oregon newspaper called The Observer, Holly Martin was pitching during practice from a distance of about 10 to 20 feet (significantly closer than the regulation distance of 40 feet). The batter, who was using a composite bat, struck the ball directly back to the pitcher, striking her in the head behind her right ear. A length of chain-link fence had been set up as protection, but it didn’t keep Martin safe.

So far, there were four mistakes made: The pitching distance was too short, the batter should not have been using a composite bat, the protective cage was inadequate, and the pitcher should have been required to wear a helmet.

But as far as we can discern from the article, those problems were compounded by the coach’s actions after the injury occurred.

Once hit, Martin fell to the ground, unconscious and bleeding from her ear. While other players urged coach Melissa Wheeler to call 9-1-1, she ignored them and called a trainer instead. According to the article:

Martin was transported on a golf cart to the training room. The suit alleges she was kept in the training room about two hours before Wheeler took her to the Grande Ronde Hospital in her personal car.

At the hospital, Martin was diagnosed with a longitudinal fracture of her right temporal bone. She was flown to Emmanuel Hospital in Portland for treatment.

That is hardly an appropriate reaction to a head injury. The injured Martin should have been transported by ambulance after a 9-1-1 call. This was a serious injury. According to the article, Martin suffers from permanent severe headaches, memory loss, inability to perform tasks requiring sustained attention, trouble with math and deductive reasoning, and more.

“She had all the signs of a head concussion but they kept her there for over two hours,” [Holly Martin's mother, Dawn Martin] said. “My whole point is, why wasn’t 9-1-1 called? It took them two hours to call me, and then another half hour to get them to take her to the hospital.”

The Martin family has filed a lawsuit to recover economic damages and other costs. Apparently, the University is fighting the lawsuit on a few grounds, including that the statute of limitations had passed.

That would be a shame. Holly Martin has been harmed enough.

To read the full story in The Observer, click here:  Softball player sues EOU over head injury

from Chicago Tribune

Junior Seau was a star. He was the kind of football hero that put butts on couches and raised Sunday TV ratings.

Junior Seau died on May 2 of an apparent suicide. In echoes of the suicide of another former NFL great Dave Duerson, Seau killed himself with a shot to the chest, presumably because he wanted to preserve his brain so that experts could determine whether he was suffering from chronic traumatic encephalopathy (CTE). CTE is a form of progressive brain damage caused by multiple concussions. It can cause mood changes, memory difficulties, neurologic impairments, and dementia.

The tragedy of CTE—make that one of the many tragedies—is that the damage can be suffered when a person is young, strong, and seemingly quick to recover from any injury… but there is no way to diagnose CTE. The only way to tell the extent and progression of the injury is to examine the brain after death. Hence, one of the new preferred suicide methods for people who believe they have suffered enough brain injury to cause CTE is a gunshot to the chest, preserving the brain for autopsy.

According to an article on the Huffington Post:

After defensive back Andre Waters’ suicide in 2006, Dr. Benet Omalu of the Brain Injury Research Institute at West Virginia University told the New York Times that the 44-year-old “Waters’ brain tissue had degenerated into that of an 85-year-old man with similar characteristics to those of early-stage Alzheimer’s victims.”

When the Bengals’ troubled Chris Henry died, Dr. Omalu and his colleagues determined that the wide receiver suffered from the same chronic traumatic encephalopathy. He was 26 years old.

Seau was a former All-Pro linebacker who played for 19 seasons in the NFL, for the San Diego Chargers, New England Patriots, and Miami Dolphins. According to an article on Forbes.com, on the day Seau’s death was reported, NFL commissioner Roger Goodell handed out suspensions for the New Orleans Saints players involved in the team’s bounty program.

Have you heard about the bounty program? As we wrote in a previous blog, the New Orleans Saints had a bounty program, in which players were paid thousands of dollars for hard hits that knocked opponents out of games. Supposedly, players were paid $1000 for a “knockout hit,” and another $1000 if a player needed to be carried off the field. Those are just some of the tactics that have driven more than 1000 former NFL players to sue the league for their head trauma and potentially permanent disability.

How many more players and former players will have to commit suicide before the NFL puts more safety measures in place? Then again, maybe the hundreds of pending lawsuits against the NFL will be the deciding factors. Very often, safety and progress only come after an issue has been screened through the filter of the legal system:  Bad actors go to trial, good laws evolve.

Better a courtroom than an autopsy room any day.

RESOURCES

To read the HensonFuerst blog about the bounty program, click here: “Organized Savagery” in the NFL

To read the full article in Forbes.com, click here:  NFL’s Junior Seau Dies in Suspected Suicide

To read the full article on the Huffington Post, click here:   Junior Seau–Changing the NFL Forever

Ray Easterling, former player for the Atlanta Falcons, died Thursday at age 62 of an apparent self-inflicted gunshot wound. According to an article in The New York Times, Easterling was part of a group of former NFL players who sued the league, claiming that it had failed to treat players for concussions, and for attempting to conceal links between football concussions and long-term brain injuries.

An article on USAToday.com reported that the 61st concussion lawsuit was filed in federal court in Philadelphia by 28 former NFL players. In total, more than 1,260 players have filed concussion-related suits against the NFL. The suits blame that the players suffered long-term damage from concussions due to the league’s “carelessness, negligence, intentional misconduct, and concealment of information.”

As we wrote in previous blogs last year, multiple concussions can result in a brain disorder known as chronic traumatic encephalopathy, or CTE. This progressive, incurable condition leads to memory loss, depression, and dementia. Unfortunately, the only way to definitively diagnose CTE is after death, by autopsy. Boston University’s Center for the Study of Traumatic Encephalopathy has been researching the link between football and CTE. Of the brains of 15 former NFL players, 14 showed signs of CTE.

Concussion Safety

According to The New York Times, Easterling’s widow, Mary Ann Easterling, will continue to pursue the lawsuit on behalf of her husband, and she is urging the league to establish a fund for players with traumatic brain injuries related to their playing days.

“Half the time the player puts themselves back in the game, and they don’t know what kind of impact it has,” she said. “Somehow this has got to be stopped.”

Friends and Easterling’s attorney, Larry Coben, said that Easterling had not been himself for about the past six months. According to Coben:

“I could tell he was not on his game. He kept repeating himself and getting confused. It’s pretty tough, pretty tough.”

To read the full story in The New York Times, click here: Ray Easterling, of Atlanta’s Gris Blitz, Dies at 62

To read the full story on USAToday.com, click here:  Easterling’s death will impact concussion lawsuit

To learn more about the NFL lawsuits, click here:  NFLConcussionLitigation.com

To watch our video about concussion, click here:  Concussion Safety

After a head injury, patients face numerous physical and emotional challenges. During and even after hospitalization, there are many medical decisions that need to be made as part of treatment. But the very act of making decisions is a problem, according to research published in the April 11, 2012, issue of the medical journal Neurology.

According to an article in ScienceDaily, the severity of the injury directly corresponds to the amount of decision-making impairment. One month after the initial injury, patients with mild traumatic brain injury (TBI) showed little residual impairment, while those with more severe TBI had significant impairment. This impairment can affect patients’ health in ways that go beyond simple decision making.

“Immediately following injury and during the rehabilitation and recovery period, patients and their families must make ongoing and often complex medical decisions, including treatment of brain trauma and orthopedic injuries, choice of rehabilitation programming and treatment of neuropsychiatric problems,” said Daniel C. Marson, J.D., Ph.D., professor of Neurology, director of the UAB Division of Neuropsychology and senior author of the study.

This study suggests that doctors and caregivers need to be more aware of what patients are, and are not, capable of. Patients may not be able to give consent to medical procedures for months after the initial injury. It could be that caregivers need to take a more active role in medical decision making for a longer period of time than previously thought.

Unfortunately, there is no test to help us judge when a patient is capable of making decisions. Caregivers will need to rely on physicians and other experts to help them make proper decisions for their injured loved ones. This study points out another reason why TBI attorneys are valuable members of a treatment team for people with brain injury–attorneys have experience dealing with the long-term needs of patients, needs that include help for caregivers who may need to take control over their loved one’s lives for months or years after the patient leaves the hospital.

To read the full article in ScienceDaily, click here: Head Injuries Often Impair

To learn more about how an attorney can help in TBI cases, visit our dedicated TBI webpage:  www.lawmed.com/braininjury/

There are two new and wonderful resources about concussion. You know we write a lot about mild traumatic brain injury (MTBI), and it takes a lot to impress us, but these resources are truly special:  One is a physician-developed smart phone app designed to help coaches, parents, and athletes recognize and assess concussion; the other is a CDC info pamphlet about recognizing and treating concussion in children, including strategies for addressing concussion symptoms at school.

There’s an App for Concussion, Too!

When they say “There’s an App for That,” they’re not kidding…and that’s a good thing.

Concussion Recognition & Response gives real-time advice about recognizing and treating concussion. Menu items include “NEW INCIDENT,” which walks you through a series of assessment screens, including evaluative questions, such as “Was there likely a blow to the head or body, jerking the head?”, and did you observe vomiting, balance problems, or other specific (and listed) signs of concussion?

The app also provides a list of criteria to help you decide whether to treat a head injury as an emergency and call 911, questions to ask the child who experienced the head injury, and Frequently Asked Questions. Finally, the app tells you whether a concussion is likely, what led to that assessment, and what you should do about it. (Of course, there is a disclaimer at the first page of the app which states:  This application is not intended to replace seeking help from a trained medical professional. If the youth has lost consciousness, even briefly, call 911 immediately.  That makes sense—no app should ever replace common sense or rational concern when it comes to a child’s health.)

Should you need to seek medical attention for the child, the app provides a summary of all the information you input to share with a doctor…even by email.

“Concussion Recognition & Response” (CRR) is available on iTunes and Android Market. It works on smart phones, iPods, and tablets (such as the iPad). It was developed by two experts with ties to the University of North Carolina at Chapel Hill (UNC-CH), Jason Mihalik, Ph.D., an assistant professor of Exercise and Sports Science in UNC’s College of Arts and Sciences, and Gerard Gioia, Ph.D. (UNC ’84) of the George Washington University School of Medicine. This new app is so impressive that it has already been nominated for an Appy Award–and it is one of three finalists in the medical category. The app is priced at $3.99 for a limited time, and a portion of the proceeds of the sale go to support concussion research at the Children’s National Medical Center, and the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center.

According to developer Dr. Mihalik:

“We see as many as 60 percent of concussions go unreported or undiagnosed,” Mihalik said. “This app will really help to provide a systematic diagnostic approach to that injury, and we’re hopeful that it will capture more diagnoses of concussions so that kids can be managed properly.”

And despite the focus on sports, don’t think that the benefits of this app are only for young athletes. According to a press release by UNC:

“This is not just an application for kids that play sports,” said Karen Earp, as her 9 year-old daughter climbed on playground equipment behind her. “This is an application for anybody and everybody to use whether you play sports, whether you play on a playground, ride your bike or are just outside having fun.”

For more information about the CRR App, click here:  Concussion App publisher.  (You can find links to the Android Market and iTunes purchase pages here, too.) It is easy to get confused by the offerings on iTunes–there are at least four other concussion-related apps, but this is the best app of this type we have seen..by far. The full name is Concussion Recognition & Response: Coach & Parent Version. And the icon looks like this:

icon for CRR app

Information from the CDC to Read at Home

One of the biggest changes resulting from recent research is how young victims of concussion are treated at home and at school. Questions many parents have are:

• When can my child start playing sports again?
• What can I do to ease his or her symptoms?
• What can I expect in terms of emotional or behavioral changes, or ability to concentrate and do schoolwork?
• How can we deal with those changes?
• How long should symptoms last…and what should I do if they don’t seem to get better?
• How can I get the school involved in my child’s concussion treatment?
• What experts can we contact if the problem seems not to get better?

These questions are all answered in a fabulous new PDF document from the U.S. Centers for Disease Control and Prevention (CDC) titled Heads up to Schools: Know Your Concussion ABCs. Even though it is called “a fact sheet for school professionals,” parents will find it a valuable tool, as well.

You can download a free copy of this pamphlet here: http://www.cdc.gov/concussion/pdf/TBI_Returning_to_School-a.pdf