Archive for the ‘Traumatic Brain Injury – TBI’ Category

FES Equipment Coming to Baltimore’s Mount Washington Pediatric Hospital

Thursday, September 8th, 2011

Author - Sarah Keogh

Back in February, Jon Stefanuca wrote about a study in the Journal of Neurorehabilitation and Neural Repair about Functional Electrical Stimulation (FES) and the benefits it can provide to those individuals who have suffered spinal cord injuries. He explained how FES is able to provide electrical impulses to stimulate paralyzed muscles. The study’s authors found improvements based on using FES that led them to recommend using stimulation therapy in conjunction with occupational therapy for patients with incomplete spinal cord injuries. This technology is now also being used to help people with a wide range of injuries and illnesses including, stroke, multiple sclerosis, traumatic brain injury, and cerebral palsy, in addition to spinal cord injuries. According to the Christopher and Dana Reeves Foundation website, FES works by applying “small electrical pulses to paralyzed muscles to restore or improve their function”. The benefits can be extensive:

FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. FES can help some to improve bladder and bowel function. There’s evidence that FES helps reduce the frequency of pressure sores. From: Christopher and Dana Reeves Foundation website

Improved Technology To Be Locally Available

Since FES was originally developed, the technology improved from being something that was typically integrated into large expensive equipment, such as exercise bikes and wheelchair based equipment, into smaller more portable devices. The good news for individuals with neuro-motor injuries in Baltimore City and the surrounding areas is that this type of FES treatment is about to become more available locally. At the end of August, Mount Washington Pediatric Hospital announced that they have received a “Quality of Life” grant from the Christopher and Dana Reeve Foundation. The article explains:

The money will help Mt. Washington Pediatric Hospital purchase Bioness® equipment for its Adaptive Equipment Rehabilitation Clinic (the clinic). The clinic works with patients with neuro-motor disorders to maximize their movement as much as possible given their physical limitations.

From Bioness.com

The Bioness website explains that they produce a variety of “medical devices designed to benefit people with Stroke, Multiple Sclerosis, Traumatic Brain Injury, Cerebral Palsy, and Spinal Cord Injury. These products use electrical stimulation to help people regain mobility and independence, to improve quality of life and productivity.” While I do not know what particular equipment will be available at the Mount Washington Pediatric Hospital, Bioness makes equipment to assist patients with hand paralysis, foot drop and thigh weakness among other conditions.

MWPH Uses Interdisciplinary Approach Combining FES and Therapy

The article about the grant explains some of the many wonderful things available for patients at the Mount Washington Pediatric Hospital (MWPH):

  • …[an] interdisciplinary approach to the assessment and management of adolescents and children with neuromuscular impairments, paralysis and/or movement disorders
  • … [a] team of 21 experienced specialists in physiatry, occupational therapy, and physical therapy.

The new equipment at MWPH will be used along with the other occupational and physical therapy options available to patients. A study described in US Neurology looked at stroke victims and found the combination of FES and traditional therapies that include repeated motion provide the best results:

Stroke patients with limited voluntary movement could now benefit from technologies such as functional electrical stimulation (fes) combined with necessary repetition of functional tasks (use-dependent plasticity) to enhance the neural repair process and improve outcomes, thus enabling them to begin to overcome their previous limitations and to improve their physical capabilities.

From Bioness.com

The goal at MWPH for children and adolescents is based on a similar idea:

Patients whose muscles can be retrained will require several months of therapy to gain normal range of motion and strength. For those patients with more severe conditions where muscles cannot be retrained, the Bioness® equipment will be used to augment their range of motion. Using these two therapy modalities, patients will acquire greater functionality, range of motion, muscle strength, and the ability to move independently.

This multi-disciplinary approach should allow these children and teens to have the best chances of improved motor use and the most independence in their future lives.

Related Articles:

Coming Soon? Restored Breathing for Spinal Cord Injury Patients

Spinal Cord Injury Updates: More Reasons for Optimism?

New Treatment Holds Promise for Patients With Spinal Cord Injuries

New Microchip Promises to Make Life Much Easier for Paraplegic Patients

Week in Review: (June 13 – June 17, 2001) Eye Opener Health, Law and Medicine Blog

Saturday, June 18th, 2011

Eye  Opener’s Week in Review

 

Jason Penn

From the Editor:  Today marks the end of week two as “guest” editor for the Eye Opener. I can tell you that the title “editor” is a misnomer. When it comes to the Eye Opener and its panel of bloggers, very little (if any) editing takes place. Consistently, our blawgers provide you with timely and topical posts. This week was no different. Let’s take a retrospective look at what the “Eye Opener” offered this week (and, of course, a sneak peek at the week ahead.)

– Jason Penn, Guest Editor

 

(Many thanks to Jason and all those back at the firm, who helped get the word out on some great topics this past week while I’ve been wrapping-up week #2 of the trial from hell…….Brian Nash)

July 1 – New Residents, New Rules……Again!

By: Theresa Neumann

While the loss of sleep is rarely a topic on Gray’s Anatomy (or any made-for-television medical drama), it is a genuine quandary for non-actor, medical residents. This past Monday, Theresa Neumann explored the ACGME’s limitations on the hours worked by medical residents in the United States. As Theresa explained, the overall maximum hours per week will not change; it remains at 80 hours.  One big change is the limit on the maximum continuous duty period for first year residents; this will be decreased from 24 to 16 hours.  It will remain 24 hours for residents after their first year, but recommendations include “strategic napping.” Curious about the other changes?  Read more

Newest Word on Crib Safety: Ban the Bumpers?

By: Sarah Keogh

Sleep isn’t only important for medical residents; it is also important for the smallest members of our families. As Sara Keogh explained on Tuesday, Maryland is considering regulations to ban the sale of crib bumpers. For many years, more and more emphasis has been placed on infants sleeping in safe cribs without any additional “stuff” in them. This has included the elimination of lots of former nursery staples. Baby blankets, stuffed animals, pillows and other loose items have been banned from the crib by safety experts for years. As requirements for cribs have required slats that are closer together, the utility of using a bumper to help a child from getting stuck between crib slats has been eliminated. More recently, the Consumer Product Safety Commission has developed even newer crib safety standards, including eliminating the use of drop-sides, and warned against the use of sleep positioners. Yet, despite the advice to put babies to sleep only on their backs in cribs empty of everything except a well fitting mattress and fitted sheet, many parents and caregivers persist in using other items in cribs. Now, with an increasing number of deaths associated with crib bumpers, Maryland is considering a stronger stance. Read more

Legal Boot Camp Class Four. Sean and Kristy’s Story: How a Jury Award is Conformed to the Cap

By: John Stefanuca

On Wednesday blogger Jon Stefanuca broke out his calculator:  bootcamp style.  In the state of Maryland, there is a cap on the damages that can be awarded.  But what happens when a jury returns a verdict in excess of the statutory amount?  Mathematics and law intersect.

To see the results, and a detailed explanation of how it all works, you can read more ….

 

Confusion with Advanced Directives: Palliative Care, End-of-Life and Hospice Care

By: Theresa Neumann

With the death of the always controversial Jack Kevorkian, we revisited a post by Theresa Neumann.  Breathing a little life into the post (pun intended), Theresa provides an excellent primer for readers that are facing end of life situations.  The differences are nuanced and can be difficult to understand at a most difficult time. Are you sure you know the difference between palliative, end-of-life and hospice care?  Read more

Acquired Brain Injuries: Subdural Hematomas

By: Theresa Neumann

When Humpty Dumpty fell, they were able to put him back together again.  Because our lives are nothing like a children’s nursery rhyme, when we fall, we get hurt.  A head injury is particularly serious. Have you ever bumped your head and developed a “goose-egg?” It’s truly amazing how fast that big bruise under the skin grows. That bruise, or hematoma, is from a broken blood vessel, usually a vein. The pressure from the swelling helps with clotting, along with the blood’s own clotting factors. This types of hematoma typically takes a week or more to go away. If it’s on the forehead, it’s often followed by one or two “black eyes.”  That’s because the blood tends to spread along  tissue planes, and gravity notoriously pulls everything downward causing it to pool in the eye sockets, where the blood cells degrade and their components are reabsorbed by the body. Unlike a fairy tale, however, this goose-egg can be serious.  Read more

Sneak Peak of the Week Ahead:

As I told you at the beginning, the Eye Opener’s writers continue in their efforts to provide you with timely and topical blogs for your reading pleasure. As evidenced by the above, this past week was no exception. The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Changes in Sunscreen:  will regulation prevent cancer?
  • HIV Patients:  Increased risk for developing cancer
  • Legal Boot Camp is back in session and Part III of our Cerebral Palsy tutorial.

Wishing You and Yours a Great Week Ahead!

Images courtesy of:

www.theepochtiems.com

www.sleepzine.com

www.nailsmag.com

www.aginglongevity

 

 


How Much is Your Marriage Worth?

Friday, June 10th, 2011

When you’re injured as a result of someone else’s negligence, it’s easy to see why you have a legal claim. You are entitled to recover for the injuries that you suffered, including economic damages (lost wages, medical bills, etc.) and non-economic damages (pain and suffering). However, if you’re married, there is another category of damages that you may be able to recover – damage to your marriage. It’s called Loss of Consortium and is an important element of damages in the right circumstances. It is a legal recognition that the marital relationship itself – separate and apart from the injury to the individual – is a protected interest that is deserving of compensation if it has been harmed by the negligence of another person.

Loss of consortium has an interesting history. Under Common Law (which roughly translates to “the olden days” in this circumstance) a woman had no right to sue for loss of consortium. It was only the man who had the right. That was because the woman was essentially seen as the man’s property. If she was injured and unable to provide her usual domestic or bedroom duties as a result of someone else’s negligence, the man could recover for the loss of such services. He had basically lost some of the value of his property so he was entitled to compensation. Eventually, the courts (most courts, at least) recognized the unfairness of such a one-sided system and ruled that women could also make such a claim if their husband suffered an injury. However, there are still some states (Virginia, for example) that do not recognize loss of consortium at all, no matter who tries to bring it.

Back to the present day. A loss of consortium claim arises when one spouse suffers a serious injury that impairs the marital relationship. An easy example is if a husband suffers a traumatic brain injury as a result of a doctor’s negligence. In that circumstance, the man would be able to file a claim for his own damages, of course, but he and his wife could also allege loss of consortium because the brain injury impacts the marriage. The couple will now find it more difficult to do the things they use to do together as man and wife – going out together, caring for their children, taking vacations, intimacy, and the day-to-day marital difficulties that arise because the husband now has a brain injury. In Maryland, a jury can award monetary damages for the couples’ loss of companionship, affection, assistance and yes, sexual relations. It is notoriously difficult to put a dollar figure on such injuries, but the law recognizes the right of a husband and wife to recover financially if their marriage has been damaged. How much money to award for such injury is for the jury to decide. Like other damages, it is always the plaintiffs’ burden to prove that the marriage has been injured, which is usually done through the testimony of the husband and wife.

Speaking of intimacy, some pundits say that loss of consortium is just a code-word for damage to the couples’ sex life. This is not entirely true as the marital relationship entails far more than just sex, but these pundits have a point. A loss of consortium claim usually does include an allegation that the couples’ sex life has been impacted. If you are bringing a lawsuit, you have to understand that when you allege loss of consortium, you are opening up the door on the most intimate parts of your life. Defense attorneys will often ask highly personal questions – how often did you have sex before the injury, how often do you have sex now, how exactly does the injury make sex more difficult, have either of you ever strayed from the marriage, etc. Some couples are understandably reluctant to discuss such things. Thankfully, most defense attorneys are just as uncomfortable asking these questions as the plaintiffs are answering them, so the questions tend to be over with relatively quickly. Be aware, though, that if you do file a loss of consortium claim, your sex life may become an issue in open court.

In the District of Columbia, a loss of consortium claim is for similar damages, but with a slight difference. While in Maryland the claim belongs to both the husband and the wife and is brought by them jointly, in the District of Columbia the claim belongs solely to the non-injured spouse. Any money awarded by the jury for loss of consortium goes to the non-injured spouse rather than to the couple jointly.

Lastly, Maryland’s cap on non-economic damages applies to claims for loss of consortium. There is no separate cap for this claim. In other words, there is a single cap that applies to all allegations of injuries, whether it’s an injury to the individual or an injury to the marriage.  The Maryland Legislature does not allow a couple to receive more money for injury to the marriage above and beyond the cap, even if a jury decides that that money should be given. Just another example of how Maryland’s cap punishes plaintiffs.

Have you ever suffered an injury that impacted your marriage? Did you file a loss of consortium claim? What was the result?

Related Nash and Associates Links

Maryland’s alleged healthcare “crisis”

Insurance and Traumatic Brain Injury

Acquired Brain Injuries

 

 

Concussions: The Message of Orioles’ Brian Roberts’ Injury Should Not Go Unheeded!

Sunday, May 22nd, 2011

Brian Roberts - NBC Sports photo (modified)

As I was reading the sports page this morning, after working my way past yesterday’s Preakness news, I was motivated to write this post by the report of Jeff Zrebieck in the Baltimore Sun’s Notebook section. Earlier this week, Brian Roberts of the Orioles was removed from the lineup due to headaches. At the time, I thought back over the games that preceded this news report but couldn’t remember any incident when Roberts could have sustained an injury that led to his headaches. For a guy like Brian Roberts, whose recent career has been marred by injuries, it was hard to believe that as tough and gritty as he is, that something like a sinus problem, allergies or the like had felled this guy. Then within a day or so, following examination and testing, we learned that Brian had sustained a concussion.

Once again, I thought through the games leading up to his line-up departure and still couldn’t remember any play or at-bat that would, in my mind, cause a concussion. There was no high and tight, back-him-off-the-plate pitch, no knee to the head by a middle infielder when he was sliding into second on an attempted steal, not even a take-out at second base while he was turning a double play. As we learned later, he sustained his current injury while sliding into first base headfirst trying to beat out a single. He never struck his head on anyone or anything. So how in the world did Brian Roberts wind-up on the disabled list with a concussion?

Last year’s injury set the stage for a recurrence

While no one knows for sure, the speculation during the 2010 season, which was also marred for Roberts by a back injury, was that Roberts had caused the concussion when, out of sheer frustration from a bad plate appearance, he struck himself in the helmet with his bat on the return to the dugout. We’re not talking a violent collision between a defensive back and an unprotected wide receiver, a car crash or a vicious criminal assault. Nevertheless, Roberts’ head injury lingered on well past the end of the season, which ended for him six games early due to dizziness and headache following this incident.

When he reported to spring training, the Orioles faithful were hoping that the past season’s injuries (back, strained abdominal muscle, concussion), which caused him to miss a total of 103 games in 2010, were a thing of the past. Then on Wednesday, February 23, 2011, the report came out that Brian had left spring training that morning due to a stiff neck. What was this all about? Then came the news last week – a slide felled this mighty warrior.

Concussions: a mild traumatic brain injury

Just what is a concussion? Brainline.org, a great resource for those seeking more information about traumatic brain injuries, gives this description:

In a nutshell, a concussion is a blow or jolt to the head that can change the way your brain normally works. Also called amild traumatic brain injury, a concussion can result from a car crash, a sports injury, or from a seemingly innocuous fall.Concussion recovery times can vary greatly.

Most people who sustain a concussion or mild TBI are back to normal by three months or sooner. But others . . . have long-term problems remembering things and concentrating. Accidents can be so minor that neither doctor nor patient makes the connection.

The Days of Yore – “Gut It Out” – are thankfully coming to an end

Anyone who follows sports is well aware that finally the old school mentality of “gut it out and get back in there” following blows to the head are coming (not too soon) to an end. Committees have been formed, articles written and the national spotlight of the media have finally focused on this issue. Those recommendations, debates and guidelines are beyond the scope of this post. Nevertheless, those involved in sports, particularly at the scholastic levels, should constantly be aware of this ever-expanding information, which is available through multiple resources and media channels.

What are the signs and symptoms of a concussion?

While there is apparently no universally accepted definition of concussion despite hundreds of studies and years of research, according to one source, there is some unanimity in what are the worrisome signs and symptoms, which can include:

  • Headaches
  • Weakness
  • Numbness
  • Decreased coordination or balance
  • Confusion
  • Slurred speech
  • Nausea
  • Vomiting

If you or someone in your family has sustained any type of head injury, no matter how minor and they show these signs or symptoms, get to the doctor or an emergency room immediately.

CT Scans, MRI’s and other diagnostic test after head injuries

TBI’s or traumatic brain injuries are reported to be “a major cause of death and disability worldwide, especially in children and young adults.” In cases of obvious severe head trauma, it’s a “no-brainer” that diagnostic testing should be done. But what about cases of mild to moderate head trauma? Who defines what is “minor” and “moderate” when it comes to TBI’s? What testing is necessary; when is it unnecessary?

While these judgments are made by the medical professionals, you need to be your own advocate at times in making this decision-making process. Brian Roberts was tested and submitted to radiographic tests for a host of reasons – probably not the least of which is the fact that he is a very valuable member of a professional sports team. What about the ordinary guy in the street?

Well, the short answer is – the recommendations vary when it comes to mild and moderate head injuries. In fact, the very definition of what constitutes a moderate TBI can also vary depending on whom you read. Nevertheless, certain signs, symptoms and history are not disputed indications for a radiographic study to rule in or rule out a potential brain injury. For example, one need only read the indications for the use of radiographic studies published by MedicineWorld.org or a host of other organizations on this topic.

In a recent case, I personally came across someone whom I believe to be a leader in the field of traumatic brain injuries (TBI), Dr. Andy Jagoda, an emergency medicine specialist in New York. He has done extensive research, writing and lecturing on this topic. I’ll save you the effort, here are the search results for his body of work.

A Lesson – Hopefully – Learned

I started this piece with the story of Brian Roberts. I didn’t simply do this because I am a long-suffering fan of the Orioles (which I am) and an admirer of Brian Roberts (which I also am) but because of the message his story tells us. A self-inflicted bat to the helmet because of a strikeout? A slide into first base with no blow to the head? A concussion none the less – apparently!

Brian Roberts may have a team of medical specialists watching and monitoring his every grimace, complaint and move; you probably won’t have that luxury. If you have a head injury – minor or otherwise – and have any of the known signs, symptoms or risk factors for a traumatic brain injury, be vigilant and pro-active for your own health and well-being.

If you are in an emergency room and the discussion of whether or not you should undergo radiographic testing takes place, get involved – ask questions. If you are discharged from the emergency room, whether you had a CT or an MRI or not, pay very careful attention to the head injury discharge instructions you are given. It is a well known phenomenon that there can be a delay in symptoms and signs of a TBI days if not weeks later. If you are suffering any ill-effects during this post-discharge period, get to a healthcare provider immediately.

The stories of how lives are altered forever more as a result of TBI are legion. Don’t become yet another statistic.

Your time to share

Have you ever had a TBI? Know someone who has? What happened in that situation? Was a test done? Do you think CT scans are overused, particularly in children? Are they underused? How did your “experience” turn out? Any advice for others? Share, Good People, share!

Good luck, Brian – and speed recovery!

 

 

 

Week in Review (April 16 – 20, 2011) The Eye Opener Health, Law and Medicine Blog

Saturday, May 21st, 2011

From the Editor (Brian Nash)

Another week of great posts (IMHO) by our blawgers. Apparently, I’m not the only one who thinks so since we have now surpassed 21,000 page views in the last 30 days. The number keeps rising. Our sincere gratitude to all our readers!

Our topics were once again quite varied. They spanned the law, health, science and medicine. We even had a piece on a local event – Marathon Kids. This piece is part of our new program to promote charities and civic organizations in our own backyard – Baltimore and Washington.

We try week in and week out to find topics of interest for you, our readers. If you ever have any suggestions for topics of interest to you, please leave a comment or send us an email or fill-out the contact form with your thoughts and suggestions. We’d love to hear from you.

Let’s get to it then. What did we cover this past week that you might be interested in reading? Take a look -

Why early settlement is a win-win for all

By: Michael Sanders

There is an old adage in the law that cases settle on the courthouse steps. There is a reason for that. When the parties are actually walking into court to try their case, they seem to suddenly recognize that there are significant risks to going to trial, and that there is serious money at stake. When you go to trial, only one side can win. The other side goes home a loser. Faced with such a stark outcome, both sides tend to become more reasonable in their assessment of their case and more willing to talk settlement. After all, despite all the years of experience that trial attorneys amass, no one can ever predict what a jury is going to do in any specific case. As one mediator I know likes to tell the litigants, going to court is like going to Vegas:  you roll the dice and you take your chances. Read more….

Milk from Mom: Effective in preventing common infant complication (NEC)

By: Jason Penn

The debate among parents regarding the use of human milk vs. formula wages on, but according to a recent study, you can chalk one up for the human body.  That study, headed by the Johns Hopkins University in Baltimore, concluded that premature babies fed human donor milk were less likely to develop the intestinal condition necrotizing enterocolitis (NEC).  Both sides has its advocates, willing to do battle at any time. When it comes to NEC, Mom’s milk has the decided advantage. Read more….

H.I.V. treatment advances, but what are the implications of terminating research early?

By: Sarah Keogh

Last week, I read some exciting news about H.I.V. treatment and transmission. A New York Times article reported that a large clinical trial found that “[p]eople infected with the virus that causes AIDS are far less likely to infect their sexual partners if they are put on treatment immediately instead of waiting until their immune systems begin to deteriorate…” The study found that “[p]atients with H.I.V. were 96 percent less likely to pass on the infection if they were taking antiretroviral drugs…” These findings are overwhelmingly positive and the implication for public health is huge. Read more….

A Windy, Rainy but Fabulous Day in Baltimore: Marathon Kids Final Mile Celebration

By: Rachel Leyko

Despite the wind and rain, this past Saturday I volunteered at the Marathon Kids Final Mile Celebration Event at Western Polytechnic High School in Northwest Baltimore.  I learned of the event through the Junior League of Baltimore and to be honest, prior to Saturday, I did not know much about the organization, its purpose or effect on the children it sought to serve.  However, after Saturday’s event, not only was I impressed with the purpose of Marathon Kids, but I saw firsthand the positive effect this program has had on the children who have participated. Read more….

Acquired Brain Injuries: Causes and Impact

By: Theresa Neumann

On the heels of Jason Penn’s blogregarding calling “911″ for signs of a possible stroke, I decided to introduce a variety of acquired brain injuries for further discussion in future blogs since damage to the brain results in some of the most catastrophic injuries possibly sustained by the human body with significant “collateral damage” for all of the friends and family involved in the individual’s life. Read more….


Sneak Peak of the Week Ahead

Some topics we’ll be covering next week…and then some…

  • You or someone you know has been diagnosed with cancer, now you have to deal with the horror. Jon Stefanuca will be writing a piece based on our experiences with a number of clients “living with cancer.”
  • Mike Sanders and I have both recently resolved cases involving families who have lost a child. Mike’s involved the death of a fetus very near term. He’ll share that story and the experience of the case with you.
  • Maybe those of you who have children with special needs are familiar with the local (Maryland and Washington, D.C.) resources to help you and your child. For those who may not be or just want to learn more, Jason Penn will be providing information on this next week.
  • You may have heard the recent news about labeling of certain medications for children. Sarah Keogh will report on this and also delve into some practical problems and issues that parents face every day in terms of medicating their children.
  • We’re going to begin a new series on exactly what is recoverable in our jurisdictions (Washington, D.C and Maryland) under what is known as the Survival Act and the Wrongful Death Act. We’ll be paying particular attention to issues involving what’s known as pecuniary benefits, loss wages and diminished earning capacity. Should be educational. We hope you enjoy it.

Have a great weekend, Everyone!

Acquired Brain Injuries: Causes and Impact

Tuesday, May 17th, 2011

On the heels of Jason Penn’s blog regarding calling “911″ for signs of a possible stroke, I decided to introduce a variety of acquired brain injuries for further discussion in future blogs since damage to the brain results in some of the most catastrophic injuries possibly sustained by the human body with significant “collateral damage” for all of the friends and family involved in the individual’s life.

What is an “acquired brain injury”?

Wikipedia defines acquired brain injury as damage to the brain occurring after birth but not including neurodegenerative diseases, such as Parkinson’s or Alzheimer’s, that occur later in life.  These injuries can further be divided into traumatic and non-traumatic acquired brain injuries.

Traumatic brain injuries are a result of some kind of trauma to the cranium/brain, but the actual causes can vary significantly. Trauma, in general, is the leading cause of death in the young-adult age group. An obvious example of a significant head trauma is the gunshot wound to the head sustained by Arizona Representative Gabrielle Giffords earlier this year. Other examples are assaults with blows to the head, falls with blows to the head, car or bicycle accidents with head injuries, sports-related head injuries/concussion, childhood playground head injuries, and even damage sustained during brain surgery. The degree of damage and permanent sequellae obviously varies as well, ranging from fully recoverable within a few days to catastrophic permanent deficits and even death. Interestingly, the amount of external damage (or lack thereof) does not necessarily reflect the damage inside the cranial vault.

Non-traumatic acquired brain injuries, on the other hand, have a wide range of etiologies not related to head trauma that have just as wide of a range of catastrophic effects and recovery times. One of these causes is a stroke, as described by Jason Penn; however, strokes can be either ischemic (blockage of blood flow to the brain by, for example, a blood clot) or hemorrhagic (when a blood vessel in the brain ruptures), and each is treated very differently!  Other possible causes are infections, brain tumors, failure of other body organs (liver, kidney), loss of oxygen delivery to the brain (heart attack, blood clot in lungs), other chemical or drug ingestions with toxic effects, aneurysm rupture, and build-up of carbon dioxide in the blood stream from other lung pathology, including smoking!

A Virtual Tour of the Brain

Described as the most complex organ in the human body, the brain has been the subject of numerous educational videos, which attempt to give the layman a better understanding of the parts and functions of the human brain. YouTube has numerous “brain anatomy” videos for you to peruse. Here’s one from the University of Bristol that does a good job of providing the basics of this incredible organ.

httpv://www.youtube.com/watch?v=9UukcdU258A

Effects of Brain Damage

The brain is the body’s 3-pound computer that controls every conscious and unconscious function of the body. Different areas of the brain control different cognitive, behavioral and emotional functions as well as the everyday metabolic functions of the body. Damage to specific areas of the brain result in specific functional losses, which is why someone with a “stroke” might experience numbness and weakness of one side of the body or no weakness but loss of balance or loss of vision. Larger injuries result in more brain tissue damage and more functional deficits. The object of “the game” is to rapidly diagnose the problem and rapidly treat the problem in order to minimize the amount of brain damage, and thus, minimize the functional deficits. Many acquired brain injuries progressively worsen due to different “normal” pathophysiologic mechanisms. It is imperative to intervene sooner whenever possible.

A Personal Story

My uncle had a stroke 1 month ago while working in the yard.  ”911″ was called immediately, and he was transported to the closest hospital.  He apparently had an undiagnosed abnormal heart rhythm (atrial fibrillation) that caused a large blood clot to form in the heart. This clot ultimately got pumped out into the carotid artery and lodged itself at the beginning of the middle cerebral artery on right side of his brain.  He was initially unconscious, but he later “came to”, only to deteriorate into unconsciousness again as the brain swelled from the blocked artery and infarcted brain tissue. He was transferred to another hospital that was capable of performing brain surgery, and he had back-to-back brain surgeries on 4/10 and 4/11 to try to minimize the damage. They actually had to remove a large part of his skull to allow for the brain swelling to occur without the brain’s tissue being compressed against the skull so as to prevent herniation of the brain.

He was in a coma for several days, but he is slowly making some recovery. In the meantime, he needed a tracheostomy and feeding tube in his stomach, both of which he still has. His entire left side remains completely paralyzed. It is difficult for him to stay awake, although he does seem to know who is around at any given time. My aunt, God bless her, has spent the last month at the hospital, 8 hours or more every day, and she is just exhausted. It is unclear when he will be going home or even if he will be going home. We are hoping and praying for the best recovery possible, but the future remains uncertain.

Collateral Damage

In addition to the person affected by acquired brain injury being functionally limited, whether temporarily or permanently, there is often collateral damage to himself/herself as well as to friends and family members. Emotional issues often arise, whether through mood disorders like depression and anxiety, or with actual personality changes. Those affected can become more belligerent or difficult, angry, withdrawn, and a host of other characteristics, making it very difficult on the person caring for the affected individual. The physical demands alone can overwhelm the care-provider (like bathing, toileting, feeding, transporting to appointments, etc.) and lead to care-provider stress and mood disorders.  Financially, these injuries are often devastating. Marriages end; relationships among family members suffer; sometimes, physical abuse and neglect can even occur when frustrations become overwhelming.

There are support groups available many of which can be accessed through local hospitals, associations or your health department.

Locally, you may want to visit the Brain Injury Association of Maryland and the Brain Injury Association of Washington, D.C.

Stay posted for more details on some of these causes of acquired brain injury specifically. In the meantime, do you have a story to tell?

 

Image from neuroskills.com

An Unpleasant Truth About Insurance Coverage For Patients With Traumatic Brain Injuries

Thursday, March 10th, 2011

traumatic brain injury

Since Arizona Rep. Gabrielle Gifford was shot in the head about three months ago, the internet was flooded with articles about her recovery and the nature of her injuries. During this time, some news sources began to explore the nationwide availability of rehabilitation resources and insurance coverage for patients with traumatic brain injury (TBI). The truth about the availability of insurance coverage for TBI rehabilitation is truly frightening.

According to an article published by ABC News, insurance coverage and rehab services are quite scarce when it comes to patients who require long-term TBI rehabilitation. It appears that private as well a publically funded insurance plans, including Medicare and Tricare, exclude many types of cognitive rehabilitation services, particularly when the patient requires long-term placement in a nursing home or rehabilitation facility. As a result, thousands of patients, including U.S. military members and veterans are left without necessary TBI rehabilitation.

The Tricare Coverage Manual, for example,  states that “[c]ognitive rehabilitation services designed to improve cognitive functioning after a brain injury are not supported by reliable scientific evidence of efficacy.” Apparently, this attitude towards cognitive rehab is not uncommon in the insurance industry. Even America’s Health Insurance Plans (AHIP) claims that cognitive rehabilitation has no benefit to patients with TBI, according to Susan Pisano, a spokesperson for AHIP.

To better understand traumatic brain injury and how rehabilitation can give a TBI victim a meaningful life, watch this video by the Research Channel.

httpv://www.youtube.com/watch?v=FgtHvBF4t-E&feature=related

This resistance from the insurance industry persists despite the fact that cognitive rehabilitation has been shown to be quite helpful. According to the Brain Injury Association of America, a number of studies have shown cognitive rehab to be very effective for patients with TBIs.  If you or a loved one were denied coverage for TBI rehabilitation, we encourage you to share your story with our readers. How did you handle the situation?  If you were ultimately successful in securing insurance coverage, how did you do it? If you found other sources of funding for TBI rehabilitation, please share your story and information so others might benefit from your experience.