Tag: TBI

Serious brain injury: life will never be the same

doger stadiumOne year after a brutal beating in the Dodger Stadium parking lot left San Francisco Giants fan Bryan Stow in a coma, the former paramedic who suffered severe brain injuries now uses a wheelchair. He can respond to questions with a few simple, halting words and  has short-term memory loss. He needs nearly around-the-clock care.

Dr. Mayumi Prins, an associate professor in residence at the UCLA Brain Injury Research Center studies how metabolism is affected after a brain injury. She said glucose sometimes has a tough time getting to the brain. She compared a normal brain to a Los Angeles freeway. “There are divergent pathways but one main pathway that allows glucose to go through,” she said. “With a traumatic brain injury, there are detours and SIG-alerts.”

Tyler Sutton, 38, crashed his motorcycle in December 1992, then fell into a coma. “I used to be No. 1 on the Oxnard High School golf team. I had three or four girlfriends,” the Camarillo man said. “Now I can’t tie a tie. I have to have Velcro on my shoes.” Formerly right-handed, he’s now left-handed. He has to keep his right foot from dragging. “Sometimes, people don’t understand.”

TBI affects all ages, all ethnic communities, and all professions, but is particularly prevalent in young children and older people where it is now the leading cause of death and disability. Among older people, falls are the primary cause of TBI, and among younger people, car crashes and sports injuries are significant contributors.

People are becoming more aware of brain trauma, but it’s important to continually educate yourself.

“Since anyone can sustain a brain injury at any time, it is important for everyone to have access to comprehensive rehabilitation and ongoing disease management,” Dr. Brent Masel, National Medical Director of the Brain Injury Association of America said. If patients with TBI get proper medical care, they are less likely to experience medical problems, permanent disability, job loss, homelessness, suicide and even involvement with the criminal or juvenile justice system. ”

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.

Child Safety

According to the National Highway Traffic Safety Administration (NHTSA), motor vehicle crashes are the number one killer of children ages two to 14. Top 10 Do’s for Child Passenger Safety.

While installing and using child safety seats may appear to be easy enough, the NTSA has estimated that close to 3 out of 4 parents do not properly use child restraints. Car seat safety isn’t child’s play. Understand 10 common mistakes parents often make when installing and using car safety seats. You can also check your child seat installation at a Child Safety Seat Inspection Station.

More links and resources can be found on my website: Let’s keep our Kids safe.

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.

 

It can’t be said enough – pledge to drive distraction free

Distracted driving is the cause of thousands of preventable injuries each year and has cost many families the life of a loved one. You can start solving the problem by pledging to change your own behavior and drive distraction-free from now on and then sharing this pledge with friends and family.

Tips from the AAA Foundation for Road Safety to help you to be a more alert (and alive) driver:

PLAN AHEAD.

Set your GPS, read maps and check traffic conditions before you get on the road. Plan your route and a potential alternative. If you need to set your GPS with a new route – pull over to the side of the road.

REMOVE THE TEMPTATION.

Turn off your phone before you drive so you won’t be tempted to use it while on the road.Put your phone away in a purse or briefcase.  If you must text or all, pull over to a safe place to do so.

A majority of drivers – 94% – agree that texting or emailing while driving is unacceptable and 87% support laws against reading, typing or sending text messages or emails while driving, according to the AAA Foundation’s 2011 Traffic Safety Culture Index, yet more than one-third of drivers reported texting or emailing while driving in the previous month. This “do as I say, not as I do” attitude is one of the greatest obstacles preventing us from improving safety on our roads.

PREPARE YOUR FAMILY FOR THE TRIP

Get the kids safely buckled in and situated with snacks and entertainment before you start driving. If they need additional attention during the trip, pull off the road safely to care for them. Similarly, prepare and secure pets appropriately in your vehicle before getting underway. Your car isn’t a dressing room. Brush your hair, shave, put on make-up, and tie your necktie before you leave or once you reach your destination.

SATISFY THAT CRAVING OFF THE ROAD.

Eat meals and snacks before getting behind the wheel, or stop to eat and take a break if driving long-distance.

STORE YOUR POSSESSIONS.

Something loose and rolling around in the car can take your attention away from driving. Attemtping to grab something that is moving around can certainly make your driving risky.

MAKE SURE YOUR VEHICLE IS ROAD-READY.

Adjust seat positions, climate controls, sound systems and other devices before you leave or ONLY while your vehicle is stopped. Make sure your headlights are spotless so you can see everything on the road and every other driver can see you better. Keep your windshield clean and remove dangling objects that could block your view or distract you.

GET YOUR BRAIN IN THE GAME.

Focus on the task at hand – driving safely. Scan the road, use mirrors and practice identifying orally what you just saw to enhance your engagement as a driver. Keeping your head ‘in the game’ behind the wheel will help you improve your overall awareness and behavior as a driver. AAA offers classroom and online defensive driving courses that directly address distracted driving and offer tips for for avoiding these behaviors.

EVALUATE YOUR OWN BEHAVIOR FROM THE ‘OTHER’ SIDE OF THE ROAD.

When you’re on the road as a passenger or a pedestrian, take a look around and honestly evaluate whether you engage in poor driving behaviors that worry you when observed in other passengers or pedestrians.

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.

 

Gabby Giffords: Finding Words Through Song‏

According to ABC News, in the 10 months since a bullet to the brain left her in critical condition, Congresswoman Gabby Giffords has relearned how to talk — a feat partly credited to music therapy.

Giffords suffered from aphasia — the inability to speak because of damage to the language pathways in her brain’s left hemisphere. But by layering words on top of melody and rhythm, she trained her brain to use a less-traveled pathway to the same destination.

“Music is that other road to get back to language,” said Meaghan Morrow, Giffords’ music therapist and a certified brain injury specialist at TIRR Memorial Hermann Rehabilitation Hospital in Houston. Morrow compared the process to a freeway detour. “You aren’t able to go forward on that pathway anymore,” she said, but “you can exit and go around, and get to where you need to go.”

According to Dr. Gottfried Schlaug, associate professor of neurology and director of the Music and Neuroimaging Laboratory at Beth Israel Deaconess Medical Center and Harvard Medical School: “The brain’s ability to pave new pathways around damaged areas is called neuroplasticity. An adult can relearn to speak — with the right training and a lot of practice.”able to go forward on that pathway anymore,” she said, but “you can exit and go around, and get to where you need to go.”

Read more about this on ABCNews.com

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.
 

Depression following Traumatic Brain Injury

One thing that I see over and over in my personal injury practice is depression following traumatic brain injury or TBI. The fact is, about half of the people suffering a TBI experience depression within the first year following the injury; that number rises to nearly two-thirds within seven years.

Depression symptoms include things like feeling down or hopeless, losing interest in usual activities, difficulty sleeping or concentrating, as well as thoughts of death or suicide.

Scientists point to different factors that contribute to depression after TBI, such as physical changes to the brain due to trauma, emotional responses to injury or factors that are unrelated to the injury, but that make the person more likely to experience depression, things like inherited genes, personal or family history, or other factors.

The bottom line? If you have depression symptoms, seek professional help from a qualified health care professional. Depression isn’t a sign of weakness and its not your fault. Don’t be afraid to seek the care you need.

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.
 

Concussion symptoms can persist in children a year after injury

Each year about half of a million children suffer mild brain injuries. A new report says that, when a child has a head injury, there may be more damage than we initially suspect.

“The majority of kids in the study were injured in sports or recreational activities,” said Keith O. Yeates, PhD, director of Behavioral Health Services at Nationwide Children’s Hospital and one of the study authors. FoxNews.com. “A small number were injured in motor vehicle accidents, but most were sports-related or falls.  Not all mild traumatic brain injuries are alike. It’s important to assess risk factors for symptoms that persist.”

Young people with mild traumatic brain injury (TBI) are at heightened risk of developing postconcussive symptoms, including cognitive symptoms such as inattention and forgetfulness, report researchers.

Mild TBIs are common in children and adolescents, and every year more than 500,000 young people under the age of 15 sustain head injuries that require hospital care.

Health providers need to be able to identify children with mild TBI who are at risk for persistent postconcussive symptoms so that they can target such children for appropriate management.

The prospective, longitudinal study was published online March 5, 2012 in Archives of Pediatrics and Adolescent Medicine.

Spread the word. 

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.

 

Leading cause of death from sports-related injuries is traumatic brain injury

The American Association of Neurological Surgeons the leading cause of death from sports-related injuries is traumatic brain injury.  The AANS says a total of 446,788 Americans went to hospital emergency rooms in 2009 with sports-caused head injuries

They go on to report these numbers by the top 20 sports/recreational activities contributing to the highest number of estimated head injuries treated in U.S. hospital emergency rooms:

Cycling: 85,389

Football: 46,948

Baseball and Softball: 38,394

Basketball: 34,692

Water Sports (Diving, Scuba Diving, Surfing, Swimming, Water Polo, Water Skiing, Water Tubing): 28,716

Powered Recreational Vehicles (ATVs, Dune Buggies, Go-Carts, Mini bikes, Off-road): 26,606

Soccer: 24,184

Skateboards/Scooters: 23,114

Fitness/Exercise/Health Club: 18,012

Winter Sports (Skiing, Sledding, Snowboarding, Snowmobiling): 16,948

Horseback Riding: 14,466

Gymnastics/Dance/Cheerleading: 10,223

Golf: 10,035

Hockey: 8,145

Other Ball Sports and Balls, Unspecified: 6,883

Trampolines: 5,919

Rugby/Lacrosse: 5,794

Roller and Inline Skating: 3,320

Ice Skating: 4,608

The top 10 sports-related head-injury categories among children ages 14 and younger:

Cycling: 40,272

Football: 21,878

Baseball and Softball: 18,246

Basketball: 14,952

Skateboards/Scooters: 14,783

Water Sports: 12,843

Soccer: 8,392

Powered Recreational Vehicles: 6,818

Winter Sports: 6,750

Trampolines: 5,025

These numbers are frightening. Protect your brain. It’s the only one you have.

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.

Even mild head injuries can cause significant abnormalities in brain function

According to new research published in the Journal of Neuroscience even mild head injuries can cause significant abnormalities in brain function that last for several days.

Scientists at the Virginia Commonwealth University School of Medicine say this may explain the neurological symptoms experienced by those who have experienced a head injury associated with sports, accidents or combat.

Previous research has shown that even a mild case of traumatic brain injury (TBI) can result in long-lasting neurological issues, such as slowing of cognitive processes, confusion, chronic headaches, post-traumatic stress disorder, and depression.

Protect your brain. Head injuries can occur from playing sports, a motorcycle crash, an auto accident, falling on the ground and many other accidents. TBI affects all ages, all ethnic communities, and all professions, but is particularly prevalent in young children and older people where it is now the leading cause of death and disability. Among older people, falls are the primary cause of TBI, and among younger people, car crashes and sports injuries are significant contributors.

People are becoming more aware of brain trauma, but it’s important to continually educate yourself.

Drive safe, be aware of other drivers on the road, including motorcycle riders, bicyclists and pedestrians. Wear a helmet when you ride a motorcycle, a bicycle or play certain sports.

Share the road.

 

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.

Scientists are starting to map brain connectivity loss due to traumatic brain injury

Gray versus white: Which is more important?

“Use your gray matter,” we are told when someone believes we need to think a little harder.

Certain gray matter regions in the human brain are known to by affected disproportionately by traumatic injury. Yet, there is an ongoing debate about whether a less understood brain structure, the connections known as “white matter,” are as important as gray matter when assessing brain injury.

In recent years, scientists have begun describing the combined gray and white matter structures as a connected network. Injury to one part of the network, under this view, can result in consequences that are more or less severe, depending on the relative prominence of the injured structure.

There is a notion that, by using network theory, someday doctors will be able to map exactly why a certain type of insult (injury) to the brain will result in a certain type of problem for the patient.

Two University of Southern California researchers studied structural MRI findings from 110 healthy, right-handed males aged 25-36 in an effort to begin mapping how disruption in various brain circuits (white matter connecting gray matter) may lead to specific functional deficits. Their findings are published in the February 2014 edition of Frontiers in Human Neuroscience.  (Irimia, Van Horn, Front.Hum.Neurosci., 11 Feb. 2014 | doi:10:3389/fnhum.2014.0051.)

The researchers rely on network theory in discussing how the brain works – or doesn’t work – when it is injured. Their findings, they write, support the notion that even though gray matter nodes are critical in brain function, “the brain as a network also contains a distinct core of network edges consisting of [white matter] connections whose damage dramatically lowers the integrative properties of brain networks.”

“The findings of this study contribute substantially to current understanding of the human [white matter] connectome, it’s sensitivity to injury, and clarify a long-standing debate regarding the relative prominence of gray vs. [white matter] regions in the context of brain structure and connectomic architecture.”

Network theory and the brain

In network theory, gray matter is parsed into distinct regions with white matter acting as the connection. Think of a computer network, with the computers made up of gray matter and the wiring made up of white.

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.

A Brain in Hand and a Brain Test Out of Control

Holding a human brain in your two hands triggers odd thoughts. So does reading the Wall Street Journal, though I’m not suggesting the two experiences are exactly equivalent.

My close encounter with a thought organ took place on the last day of an excellent four Saturday UCLA Extension class: Gross Anatomy: The Fundamentals Litigators Need to Know. The course was the brainchild of CAALA Board of Governors member Steve Goldberg and UCLA Professor David A. Hovda, Ph.D. If it’s offered again in the future, I highly recommend you attend.

Briefly, UCLA/Goldberg/Hovda put together a science-based program designed to teach 26 enrolled attorneys human anatomy from top to bottom.The course materials closely track the basic human anatomy class every first year medical student must pass. Dr. Hovda assured me that, as a graduate of the program I am now entitled to wear a UCLA Medical School sweatshirt and, I guess, root against USC.

We’re talking detailed lectures, introductions to everything from functional MRIs and PET scans to cutting edge orthopedic surgery, followed by four afternoons in the laboratory dissecting human cadavers. Lawyers studying real science to improve their courtroom advocacy is a good thing. Especially since it goes directly against the stereotype that plaintiff attorneys care more about junk science than scientific fact when they bring a case in court.

On the other side of the spectrum was a Journal article that caught my eye. I found it on the front page just after my UCLA brain-holding experience, which is probably why I took such strong notice

“Malingerer Test Roils Personal-Injury Law” blared the headline. The subtitle offered a bit more explanation, adding: “’Fake Bad Scale’ Bars Real Victims, Its Critics Contend.” “Great,” I remember thinking. “What kind of junk have they come up with now?”

I found the news story both enlightening and disturbing. Enlightening, because I’ve always found traumatic brain injury cases to be among the most challenging and interesting matters a trial lawyer can handle.Disturbing because the Journal described a controversy surrounding the oddly named “Fake Bad Scale” validity (read “malingering”) test that was recently made an official subset of the Minnesota Multiphasic Personality Inventory, aka the MMPI.

The MMPI, just in case you aren’t familiar with it, is a psychological assessment test that has been around since the early 1940’s and is frequently used to evaluate personal injury victims, particularly those alleging mild traumatic brain injury.

Even though the story talked about the MMPI, I think the reporter meant the MMPI-II, since that’s the restandardized version of the original test and is the version most widely in use. Any way, it didn’t really matter, since the point of the story was, a widely used test has been compromised by an apparent junk scientific validity scale designed to wash out deserving brain injury victims. As the Journalexplained:

In two Florida court cases last year, state judges, before allowing the [Fake Bad Scale] test to be cited, held special hearings on whether it was valid enough to be used as courtroom evidence. Both judges ended up barring it.

“Virtually everyone is a malingerer according to this scale,” says a leading critic, James Butcher, a retired University of Minnesota psychologist who has published research faulting the Fake Bad Scale. “This is great for insurance companies, but not great for people.” . . .

Paul Lees-Haley, the psychologist who created the test, says that while individual items “can be made to seem like evidence for a flawed” measuring process, what’s important is the total score. He says the scale has “been tested empirically and shown to be effective.” . . .

Working for litigants is Dr. Lees-Haley’s main source of income. He has said in court cases that 95% of this work is on behalf of the defense. He charges $3,500 to evaluate a claimant and $600 an hour for depositions and court appearances, his fee schedule says.

In one episode mentioned in the article:

The experts’ disagreement spilled over into the courtroom in a case brought against a Florida gasoline carrier, Strawberry Petroleum Inc. Lloyd Davidson was sitting at a stoplight in May 2004 when his pickup was rear-ended by one of the gasoline company’s loaded tanker trucks, sending the pickup crashing into another truck ahead of him. His lawsuit said his head shattered the rear window and he ended up with diminished mental capacity and symptoms of depression and inattention.

A psychologist hired by the defense said in a deposition there was reason to believe Mr. Davidson was faking. The witness cited his “very high” score of 31 on the Fake Bad Scale.

Before the expert could testify at the trial, held in Hillsborough County Circuit Court, the plaintiffs moved for a hearing on the scientific validity of the Fake Bad Scale. Judge Sam Pendino ruled in June that “there is a genuine controversy surrounding use of this test” and “no hard medical science to support the use of this scale to predict truthfulness.” He said that drawing conclusions from a test that gives points for malingering when a plaintiff gives honest answers to questions based on actual injuries “has no place in this courtroom.”

In January, a jury determined that Mr. Davidson had suffered a permanent injury from the crash and awarded him $1.4 million from the gasoline carrier.

Okay, so what does all this add up to? I think the answer is simple.

There’s no shortage of quackery for hire that is ready, willing and able to use pretend science against our clients in the courtroom. Our best defense is to keep educating ourselves and improving our knowledge skills so that we can face trickery head-on and expose it effectively when it shows up on the defense side of our cases. Hence the importance of programs like what Steve Goldberg and Dr. Hovda put on at UCLA, or even just keeping up on changes in medical technology, like the abuse of the Fake Bad Scale.

The better educated we become, the better we can serve our clients and win the favor of Lady Justice. In the old days, maybe hitting a couple of seminars on tort law and getting your minimum MCLE was enough. I don’t think that’s the case any longer.

We need to find more ways to keep our skills at and beyond the state of the art. That’s one of the thoughts that went through my brain while I was holding someone else’s in my cupped hands. Another was a quiet prayer for a generous soul who made the most personal of gifts to help further human knowledge.

Sometimes you can’t help but be humbled in our profession.

Bill Daniels is a trial lawyer and shareholder with the law firm of DANIELS LAW in Sherman Oaks, CA.  A graduate of Loyola Law School of Los Angeles, he is a former member of the Consumer Attorneys Association of Los Angeles Board of Governors, a founding member of Loyola’s Civil Justice Program and a past president of the Encino Lawyers Association.  Since 2007, he has been named a Southern California “Super Lawyer” by Los Angeles Magazine.  Mr. Daniels focuses his practice on serious personal injury, insurance and employment. For information, visit our website at www.daniels.legal or contact us through e-mail: Info@danielslaw.com.