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Injury to the brain can come from vehicular accidents, falls, industrial accidents, physical assaults, hypoxia, sports injuries or a host of other potential causes. Most brain injury cases involve what is called a “closed head injury” meaning that there is not an actual skull fracture. A common diagnosis following a brain injury is post-concussion syndrome. Brain injuries are frequently classified as either being mild, moderate or severe.
A head injury can have life long consequences. If you or a loved one have suffered such an injury you need aggresive and skilled representation. That attorney must be able to recognize the symptoms of brain injury and be able to identify the scope of the injury.
As an aggressive advocate for a brain injured client one of the most difficult things to do is to fully comprehend the scope of the client’s injury.There are a multitude of symptoms and signs that can be associated with brain injury but they include such things as:
The brain consists of four different lobes plus the cerebellum and the brain stem. Injury to any one of those parts can produce specific symptoms that may be indicative of where the injury occurred.The brain is a composite of neurons which are small cells that may be very short in size or may be extremely long. Some nerve cells or neurons extend from the lower back all the way down to the feet. As such a single neuron can be millimeters or it can be many feet long. Any injury to one or more of those neurons can impact the ability of the brain to function.
The brain and spinal cord are surrounded by cerebral spinal fluid which acts as a cushion to protect them from injury. The cerebral spinal fluid is also a conductor of electrical impulses. The brain as a soft, gelatinous material contained within the skull can be easily damaged by any sudden motion. A blow to the head that causes the head to move in one direction, may result in the brain not moving as quickly as the skull and as a result the brain is in effect slapping up against the interior walls of the skull. Some of those interior walls are ridged and those ridges can produce significant injuries to the brain as the brain impacts against those components of the skull.Rotational and shearing type injuries may produce further damage to the blood vessels.
Although a loss of consciousness may be associated with a brain injury, not all people who suffer a significant brain injury have a loss of consciousness.
There are a number of tests that may be undertaken to confirm the existence of traumatic brain injury:
The standard radiological studies such as CAT scans and MRIs have only limited ability to pick up any of these injuries since the injuries themselves are of a microscopic nature and these studies only pick up macroscopic injuries. Likewise, an EEG is not going to necessarily pick up this type of injury because it only records gross brain activity.
The best determinant of injury may well be neuropsychological testing.
Mild to moderate brain injury is probably a misnomer. Physicians, however, use this term to describe brain injuries that may indeed in many instances be quite significant but not to the point of being severe, i.e. totally disabling.
Personal injury attorneys are accustomed to seeing mild to moderate brain injuries with a host of potential symptoms such as those listed above.
Any person that has suffered a mild to moderate brain injury needs to have someone act as an advocate. Frequently they cannot do this themselves because they are either unwilling to or cannot accept the scope of the injury they have suffered and therefore they frequently become their own worst enemy in terms of being able to explain what they have experienced.
It is quite common that people with brain injuries learn how to compensate but they can only compensate in familiar settings. For example, at work they are familiar with the environment and through post-it notes and “cheat sheets” they may be able to perform their office tasks if they are fairly routine from day to day.The same may be true at home. But take that person outside of their comfort zone and confusion,frustration and even panic may reign.This can present a problem as far as proof because the injured person may have learned to compensate so well that fellow employees may not even be aware of the problems being experienced.
In a new case filed in the Superior Court of California in September 2014, Chelsea Oliver has sued the National Football League.
Mrs. Oliver was the wife of Paul Oliver, former San Diego Charger and New Orleans Saint who had been suffering from Chronic Traumatic Encephalopathy (CTE) and other forms of traumatic brain injury.Mr. Oliver and his family had not known that at the time.
The diagnosis of brain trauma came to light after Paul Oliver shot himself in the head in front of his wife and family in 2013.
The 88-page Complaint reads, “At the time of his death, decedent Paul Oliver was suffering from then, still undiagnosed, severe and debilitating brain injuries including Chronic Traumatic Encephalopathy as a result of the repetitive head trauma and concussions he suffered while playing professional football for the San Diego Charters and the New Orleans Saints from 2007 through the 2011-2012 season.”
The Complaint went on, “From the first snap of a youth football until his tragic death, Paul Oliver’s decision-making regarding football was materially impacted, to his detriment, by defendants’ misconduct,” “Since its inception, the [National Football League] has gone outside of any labor agreement to gratuitously and voluntarily control and regulate every aspect of the football community at large, particularly with respect to safety and health.”
The old culture within NFL players used to be to shake off a head injury and get back on the field.Many would go back on the field within minutes of sustaining a concussion. That culture has resulted in many of these men living for years after their career ends with severe impairments. The impairments frequently go untreated as was the case here.
The liability of the NFL is premised on the idea that they knew of the severity of these impacts and resulting head injury and took no steps to prevent them or to treat the players who were experiencing them.
It is expected that the case will be tried in front of a jury.
The January 2011 issue of the Journal of Athletic Training reports, based upon studies conducted over a two year period of a hundred different American high schools, that males and females show variable symptoms after receiving reported concussions. The symptoms reported by males more often fall into the cognitive area dealing with reports of feeling like they are in a fog, difficulty concentrating, difficulty remembering. Females on the other hand tend to report more behavioral and somatic symptoms such as sleeping more than usual, drowsiness, fatigue, nervousness, headaches, nausea, sensitivity to light and noise and balance problems.Any injury attorney handling sports cases needs to be sensitive to this distinction.
Athletic trainers and physicians should be sensitive to these variable reports. The report is significant because many of the symptoms reported by females may be missed or more likely attributed to problems other than a concussion and as such sensitivity needs to be developed as to the somewhat more subtle symptoms frequently reported by females.Brain injuries by their very nature involve rather diffuse symptoms that trained professionals may not always relate to the concussive event. These symptoms are now more important in light of this study.
The most common way to diagnose a closed head injury is through a CT scan. CT scans will identify skull fracture. They will also identify any pocket of blood inside the skull. These pockets of blood are called hematomas. A hematoma may be epidural, meaning that it is between the skull and the dura. The dura is the protective layer of tissue over the brain. Collections of blood that are beneath the dura are referred to as subdural. They are more ominous because they are more likely to be putting pressure on the brain. As part of a physical examination of a person that has suffered closed head injury, it is important to examine the ears. Sometimes there can be an accumulation of blood behind the eardrum. That is a clear indication of head trauma and bleeding inside the skull.
Accumulations of blood inside the skull that are not supposed to be there can be dealt with surgically. One surgical technique is to cut holes in the skull. The purpose of those holes is to relieve the pressure. Once the pressure is relieved then the brain’s swelling from the impact can subside.
Hypoxic brain injury results from the brain being deprived of oxygen for an extended period of time. Hypoxic brain injury can result from choking, trauma, drug overdose, smoke inhalation, carbon monoxide poisoning or near drowning. Brain cells need oxygen to survive. If they do not receive sufficient oxygen, then those brain cells may start to die within minutes.
Signs and symptoms of hypoxic brain injury:
Traumatic Brain Injury treatment typically has been fairly simple: rest. Lots of rest is thought to give the brain an opportunity to heal.
Although rest may well be a significant component of any treatment mode, there is now emerging thought that rest alone may well promote depression and an overall worsening of symptoms.
First a clear diagnosis needs to be made as to what component of the brain or vestibular system is injured and then treatment needs to be tailored to that injury.
The vestibular system is a network involving sensory organs in the inner ear with connections to various areas of the brain, the eyes and muscles throughout the body. In regards to concussion or traumatic brain injury treatment, doctors have typically focused on vestibulo-spinal system treatment. That is the system that helps control posture and maintain balance.
Some concussions however may affect the vestibular-ocular system which allows us to maintain stable vision while moving our heads. Injury to this system causes dizziness, nausea and other symptoms. Other concussions may simply involve the vision system. The vision system is what allows us to track moving objects effortlessly. Injuries to this part of the brain can cause blurred vision, headache, difficulty reading and difficulty walking in a crowded area.
Many brain injuries involve all of these systems. As such treatment may need to include balance exercises along with activities requiring focus on moving objects along with gaze stabilization exercises designed to improve vision while moving the head.
Fairfax Family Practice in Fairfax, Virginia has a comprehensive concussion center providing traumatic brain injury treatment which follows the philosophy that sometimes the brain has to be taxed a bit in order to encourage it to heal and adapt.
The traditional testing of someone who has potentially suffered a concussion is to assess their balance in multiple positions i.e., standing on two legs, standing on one leg, on the ground and then on a foam board and then with eyes open and eyes closed. Eye movement and the ability to track a moving object are also measured and a determination is made as to whether or not symptoms seem to worsen with any of these tasks.
Concussions are mild traumatic brain injuries that can damage cells. They can cause chemical imbalance. They can disrupt the brain’s normal functioning in a number of ways. Although rest, staying in a dark room, turning off screens, limiting movement and cutting out activities that require attention or concentration have been the traditional modes of treatment, that theory is beginning to change. Although rest is still critical especially in the first days after an injury, if there is not a fairly prompt recovery then there may be a need for more aggressive intervention. That aggressive intervention as part of traumatic brain injury treatment is designed to pinpoint the problem and prescribe targeted therapy. There are some studies that have shown positive effects of single therapies such as exercise or vestibular therapies. Just as every stroke patient is not treated the same way, traumatic brain injury treatment does not necessary follow a cookie cutter approach. If the patient has a language problem, trouble with their eyes, trouble with their gait, then those things need to be measured and those specific problems need to be treated.
The Center for Disease Control estimates that 2.5 million people in the U.S. suffer a traumatic brain injury every year. That of course doesn’t count the many people who don’t even report these types of injuries.
The idea of exercise therapy in terms of treating these injuries is becoming more accepted. Carefully monitored exercise may help promote recovery. The thinking had been that if you stressed the brain with physical exertion you may worsen the symptoms. The thinking now is that after several days of complete rest there may be some logic in getting the patient back moving using the symptoms as a guide as to the level of activity. There is some thinking that concussions can affect the flow of blood to the brain and thereby disrupt what is called the autonomic nervous system which controls such involuntary functions as heart rate and blood pressure. Controlled exercises may help correct these disturbances.
Headaches are a frequent symptom associated with traumatic brain injury. The headache may be due to injury to the vision system. Such headaches may respond to vision therapy. Some headaches may be due to neck injury. Medication or physical therapy may help with those neck injury systems.
An article on June 8, 2012 in the Washington Post recounts some comments of Daniel Amen, a California based physician and psychiatrist who noted that he has had some degree of success with football players and other individuals who have suffered multiple concussions and has been able to improve their decision making, mood and memory and also help these individuals deal with depression.
Amen himself has worked with 117 former NFL players and says that 8 out of 10 of his patients have actually shown some substantial improvement. Nick Bell, a former running back with the Los Angeles Raiders, is one of Amen’s patients. Bell reported that he had multiple concussions and reports that after one such concussion he actually wound up going into the other team’s huddle for the next play. Bell reports that back then if you complained about a concussion to the coach you were benched and may not have seen any further action.
The routine that Dr. Amen has put Bell on involves supplements, hyperbaric oxygen treatment, fish oil and exercise. The objective is to try to regenerate brain cells and to boost the neuron connections within the brain, all of which may improve overall brain function. Dr. Amen reports that in Bell’s case there has been a 30% improvement in terms of memory, attention span and processing speed.
Some other common effects of concussive disorders is sleep apnea, which is a condition that can literally cause a person to stop breathing while sleeping, high blood pressure and a tendency to gain excessive weight.
All of these conditions are problems that can be dealt with through proper medical treatment as evidenced by the treatment rendered by Dr. Amen.
Traumatic brain injury has received some further objective analysis through some recent military studies based upon injuries to combat veterans from Iraq and Afghanistan. The soldiers suffering these types of injuries from bomb blasts show immediate evidence of stretched and damaged nerve fibers at both the front and back of the brain according to this study published on June 1, 2011 in the New England Journal of Medicine.
Part of the problem with diagnosing traumatic brain injury is the similarity of symptoms with other psychiatric disorders such as post-traumatic stress disorder.
In this particular instance the researchers did Magnetic Resonance Imaging (MRI scans) of 63 service members and found that in 18 of the 63 patients there was damage to axons, the stem fibers that connect the nerve cells and that often run several inches in length. The damaged axons were either in the front or back of the brain and were found to be present shortly after the injury and then also six months later when the scans were repeated. Damaged axons prevent proper communication between these different regions of the brain. The areas of the brain that were most often affected were areas near bony structures that could damage the brain during a blast. The areas in particular were the orbitofrontal area which is in the front of the brain and also the cerebellar peduncles.
The good news is that many associations and states have taken the lead in attempting to establish standards for dealing with sports concussions for young athletes.
The National Athletic Trainers’ Association has issued guidelines for concussion management.
The Center for Disease Control has available extensive publications on how to prevent and control traumatic brain injury in sports activity and to increase the overall awareness of the potential danger. The general guidelines established by the CDC are that the players should be removed from play, evaluated by a health care professional who is experienced in dealing with concussions, the parents or guardians should be informed about the possible affect of concussions and the athlete should be kept out of play until a health care professional experienced with concussions reports that the player is symptom free and ready to return to play.
In addition, the National Federation of State High School Associations, which is the national association to which most State High School Associations belong, has adopted the guidelines of the Center for Disease Control.
Many states have likewise passed legislation dealing with this issue. The state of Virginia in Virginia Code §22.1-271.5 has legislated the promulgation of guidelines for high school athletes dealing with concussions.
Neurotoxic brain injury can be caused by neurotoxins such as lead, paint or other toxic chemicals. The brain and nervous system control all bodily functions. Any insult or injury to the brain or the nervous system can effect the entire body. There frequently is no easy way to make the diagnosis of neurotoxic brain injury. Many doctors are simply unfamiliar with the symptoms associated with this type of injury.
To determine whether or not a person has suffered a neurotoxic brain injury there are several things to consider:
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