Cognitive problems are the most common lingering symptoms of those who have made a good recovery from a traumatic brain injury.  Fortunately, cognitive rehabilitation can at least help reduce some of these problems.

Cognitive rehabilitation is training for the brain and for the victim of a brain injury.  Depending on the extent of your brain injury, cognitive rehab can help repair your brain’s neurological connections so that you can function at a higher level, or it can train you how to function with your limitations.

Some cognitive rehabilitation processes focus on retraining your entire brain.  In these, you might undergo repeated exercises doing the same thing over and over.  While these are necessarily repetitive, they are designed to reorganize your brain’s “wiring” so that the brain is more functional across a number of different areas.

Some cognitive rehab processes focus only on certain skills that are giving you problems.  For example, if your brain injury causes you problems with drinking out of  cup, you will undergo specific training to help you re-learn how to use a cup.  Alternatively, if it is too difficult to re-learn how to use a cup, you might be trained in alternatives, such as easily using a straw.

Because attention deficit and memory issues are the two most common symptoms of brain injuries, there are a number of different cognitive therapy procedures that can be used to help you improve in these areas.  In a typical situation, you would undergo exercises designed to re-train your brain, as described earlier.  You might also receive training in how to use memory strategies, such as mnemonic training (mnemonic’s are learning/memory aids — such as the old Roy G Biv we all learned to remember that Red, Orange, Yellow, Green, Blue, Indigo and Violet were the colors of the rainbow). You would receive training to teach you how to create and use these type of memory aids in a number of different areas of your life.   Memory training might also include learning how to use external cues — things that are designed to remind you of other tasks — or learning how to use a “memory notebook” — to journal things you are supposed to remember in the future.

Fortunately, studies have shown that a holistic approach that incorporates a number of different types of cognitive rehab processes can help you improve on your brain function, though most studies show that even with the best cognitive rehabilitation, victims of traumatic brain injuries still show problems.

Unfortunately, cognitive rehabilitation is very expensive.  In a 2009 letter to the United States Congressional Budget Office officials, the president of the Brain Injury Association of America estimated that the average cost of cognitive rehabilitation was $27,000.00.

If you want to learn more about cognitive rehab, additional resources are available:

• What Is Cognitive Rehabilitation Therapy?  (Society for Cognitive Rehabilitation)
• Cognitive Rehabilitation For Children & Youth (Brainline.org)
• Taking On The Military Establishment: Keith Cicerone Is Working To Ensure That Soldiers With Traumatic Brain Injuries Are Getting The Help They Need (American Psychological Association)

Brain injuries are devastating in children.

Today, traumatic brain injuries remain the leading cause of both death in children.

For those children lucky enough to survive, an early brain injury can have life-long consequences.  Brain injuries often affect a child’s ability to learn even years after the injury.   Young victims are particularly vulnerable because most brain development occurs between the ages of 1 and 5.  Even as children get older, studies still suggest that the younger they are at the time of injury, the more serious problems they will face.

And even when a child has a satisfactory or normal IQ levels, emotional problems caused by the head injury set them back.  One study found that 19 of 22 children with  brain injuries showed long-term emotional issues.

These problems have a real economic value.  One study found that only 27 percent of kids who sustained brain injuries were working full-time by the time they reached age 21.

Unfortunately, auto accidents are the leading cause of brain injury-related deaths in children.  Proper use of seat belts and car seats can really help minimize these risks.

Falls still account for most brain injuries in children, including falling down stairs, falling off of playground equipment, and falling out windows.  Parents can help reduce the risk for these types of injuries by child-proofing the house and making sure that playgrounds are protected by twelve inches of soft surface material (such as mulch, gravel,  etc.)

Bicycle accidents also account for thousands of brain injuries per year.  Parents can reduce the risk of bicycle-related brain injuries by teaching their children bicycle safety and making sure that children are properly using bicycle helmets.

A common argument that we hear from insurance companies is that our client’s brain injury couldn’t have been caused by the accident because the client’s head didn’t hit anything.  That is a fallacy.    It is true that most head injuries are caused by a trauma to the head.  For example, in a car wreck, the victim’s head may hit the window, the steering wheel or the dash board.  However, there are a number of other common situations that lead to brain injuries where there aren’t any direct blows to the head.  Some of those are listed below.

1.  Forces applied to the brain.   You don’t have to hit your head to apply forces to the brain.  When your head moves rapidly, your brain moves inside your skull and impacts the brain.  These forces, slamming your brain around in your skull, are often hard enough to cause brain injuries.  For example, one study found that in car wrecks of 35 miles per hour, 27% of drivers and 21% of passengers who were wearing seat belts were at high risk of head injury even when their head didn’t contact anything on the interior of the car.

This risk is often made worse because multiple impacts occur.  Studies have repeatedly shown that repeated brain injuries have a cumulative effect on people, and in high impact accidents, there are often multiple injuries.  For example, in a simple rear-end case, upon impact, the head is immediately thrown forward, causing the brain to hit the front of the skull.  And then the head whips back, causing a second impact with the back of the skull.  With more complications, such as impacts with other cars or quick stops, there are additional opportunities for more impacts and more injuries, all occurring without the head ever hitting anything on the interior of the car.

Even hearing the above description, some may discount the non-impact cause of head injuries.  But remind them of shaken-baby syndrome.  Countless children are harmed or even killed from head injuries suffered by shaking — and they all occur without any impact.

2. Blast Injuries.  One legacy of the Iraq war is that we are learning more and more that people around explosions can suffer severe brain injuries without any type of impact on the head.  These same type of injuries are often found in construction-site accidents or in various types of manufacturing plant accidents.

3.  Lack of Oxygen.  Brain injuries are also often caused by anoxia, or lack of oxygen to the brain.  These types of injuries often occur in near-drowning cases, but they also arise in other situations.

4.  Loss of Blood.  An injured person who loses a lot of blood may also develop a brain injury even though the head never impacted anything during the actual accident.

5.  Electrical Injuries.   Many doctors miss this, but any type of electrical injury can potentially cause a brain injury in a person.

Just because you or a loved one doesn’t have an impact on your head, don’t dismiss the possibility of a brain injury.  Recognizing the brain injury and getting prompt treatment can make a difference in your outcome.

If you think you or a loved one has sustained a head injury, it’s critical to know potential symptoms of brain injuries.

Knowing the symptoms can help you understand when a brain injury is possible so that you know to speak to your doctor about it.  A 2003 Centers For Disease Control report to Congress noted that in many instances, persons with mild traumatic brain injuries fail to timely seek medical care because they don’t recognize their symptoms. Even worse, the report notes that once care is sought, many medical providers still fail to diagnose the head injury or recognize the severity of the brain injury.  Knowing the symptoms of brain injury and looking for them in yourself or your spouse can help make sure a diagnoses is made as soon as possible.

Knowing the symptoms can also help you understand what you or your loved one is going through.  Often, a spouse or loved one will become frustrated with the way injured person’s conduct.  In those situations, it’s important to understand the symptoms of brain injuries and to know that the injured isn’t choosing to act that way.  Instead, the injured has a serious condition with serious consequences and needs to get medical care.

There are literally thousands of potential symptoms of head injuries.  If you come to our office with a potential head injury, you will be given a form that asks you about the following symptoms, which we commonly see in brain injury cases:

• Headaches
• Feelings of dizziness
• Nausea and/or vomiting
• Noise sensitivity (easily upset by loud noise)
• Sleep disturbance
• Fatigue/tiring more easily
• Irritability
• Feeling depressed or tearful
• Feeling frustrated or impatient
• Forgetfulness/poor memory
• Poor concentration
• Processing issues/taking longer to think
• Blurred vision
• Light sensitivity
• Double vision
• Restlessness
• Reading problems
• Writing problems (writing letters out of order, etc.)
• Word recall/inability to remember words, names or numbers

If you have a head injury, you’re not likely to have all of these symptoms.  Most people only have 2-3, and many only have one.  What is important is to know the symptoms and look out for them following a wreck or other event.

Doctors had long thought that in cases of mild injuries these symptoms would slowly disappear as the brain heals.  But new research is beginning to reveal that even mild brain injuries can have permanent damage and be related to long-lasting symptoms.  For example, in the summer of 2012, a new study of brain injured veterans (and sadly, our veterans are now suffering too many brain injuries) found that symptoms of post-concussion syndrome can last for years.   This and other studies are confirming what we see in our practice — even the most “minor” brain injuries can last a life-time.

Over the years, we’ve been fortunate to help a number of clients who have suffered brain injuries in various types of accidents.  After speaking to some recent clients, one of their biggest frustrations is that it’s difficult to find easy to understand information about brain injuries, brain injury treatment, and brain injury prognosis.  As a result, we’ve spent a good amount of time trying to help them find accurate, easy-to-understand information.

Over the next few weeks, I’ll be writing a series of blog posts that try to give some basic information.

Keep in mind, this isn’t medical advice, and patients with brain injuries, more than anyone else, should get the help they need as quick as they can.  But I maintain that people who know more about their condition and their case, make better decisions and get better results.

I also think the information is particularly important in head injury cases.  Sometimes doctors are slow to diagnose head injuries because the doctors don’t know you well enough to compare your condition after the wreck to your condition before the wreck.  Therefore, it’s important for you, your friends and family members to know the symptoms of head injuries and potential causes of head injuries to help with the diagnosis process.

When an emergency call goes out for help involving a child, the crews know it will be a tough call.

This story had one of the worst endings possible, the death of a toddler. A three-year-old boy was run over by a truck backing up through a parking lot. For some reason, like most small children do, the boy bolted away from his mother and ran off. A short time later, a truck ran him over. Although the boy was only pinned under the truck for a short period of time, it was enough for him to sustain life-threatening injuries. He died at the hospital later that day.

Stories like this bring home the very real safety issues that we all need to be concerned about. Small children simply do not understand why they can’t run free in places like parking lots, and drivers in those lots, and other locations need to be on constant alert to avoid accidents like this one. Drivers need to be even more cautious during holiday seasons, as there are far too many distractions for everyone.

Although many people condemn the use of child leashes as being inhumane and humiliating, a restraint such as that would have saved this boy’s life. Perhaps the most important thing to consider in keeping a child safe is not what looks odd or punitive, but what will keep them alive when they are out in dangerous situations, even if they are with a parent.

Being with his mother in the parking lot did not help this three-year-old, and once he had broken free from his mother, there was no way she could catch up to him before the accident. It’s a devastating blow to watch a child get run over, not only for the parents, but for the driver that struck the boy.

In this instance, there will be more questions to answer before the police get a clear picture of how this misfortune happened. For instance, was the driver under the influence of drugs or alcohol? Was the driver texting while driving? Or otherwise distracted and not paying attention? Not to mention the biggest question of why was the truck driving backwards through a crowded parking lot? It is not clear whether charges will be laid, but should law enforcement discover the truck driver could have avoided the accident, but for a negligent action, there may be charges pending.

In a wrongful death case such as this, parents may wish to speak with an Austin injury lawyer. They need to know what their rights are and how to move forward with a lawsuit seeking compensation for the sudden death of their loved one. Avoid dealing directly with insurance companies, as their main goal is to settle quickly and cheaply. They do not consider the agony of the parents. They are more interested in their fiscal bottom line. Take any questions about personal injury accidents to an Austin injury lawyer, particularly if you want justice.

Brooks Schuelke is an Austin personal injury attorney with Perlmutter & Schuelke LLP. Contact an Austin injury lawyer at Civtrial.com or (512) 476-4944.

This gruesome case demonstrates that bicycles and large trucks do not mix.

“This is a horrific case. A seven-ton U.S. Postal Service truck crushed a woman on a bicycle and then left the scene of the accident,” said Brooks Schuelke, an Austin personal injury lawyer with Perlmutter & Schuelke, L.L.P. “As the facts unfolded, it turned out the man driving the truck hadno idea he had hit anyone.”

The victim in this case was a former State Supreme Court special referee, and she was out biking with her husband one day in Manhattan, when she fell under the right rear tire of the postal vehicle. She was hit as she pedaled through a small gap between a moving truck and the parked postal truck. The driver, a 64-year-old man, indicated to police his vehicle bumped and rocked all the time, due to the nature of the streets in the city. He had not been aware of anything unusual that day and finished his run, returning to headquarters later, where he learned there had been an accident.

He did not connect the dots for some time. “However, roughly two hours later, in the middle of another postal run, the trucker began to have a sinking feeling he might has been the man who hit the cyclist. When he asked his supervisor for more details of the accident, he advised him he thought it was his truck that hit her,” Schuelke explained.

This case made it to trial and the prosecution wanted to know why the worker had waited two hours or more to talk to his supervisor. They did not accept his explanation that he did not feel anything out of the ordinary that day, when running over a human on a bike would certainly engender more than just a mere bump. Facing up to seven years in jail, if convicted, the man stuck to his story, and the jury believed him.

Leaving the scene of an accident is more common than people think. Some leave as a result of being under the influence of something. Some leave because they are scared and have no driver’s license or a suspended license, and some leave because they are not aware anything happened. Far too often death comes to cyclists on Americas streets. “It’s brutal for the families of those killed in this manner. Many wish to file wrongful death lawsuits, to ensure something like the loss of their loved one does not happen to anyone else,” Schuelke added.

Contact Perlmutter & Schuelke LLP at http://www.civtrial.com or (512) 476-4944.

Yesterday’s Austin American Statesman had a story about the government’s efforts to condemn (purchase) land on the US-Mexico border for construction of the border wall.  It follows the story of Teofilo Flores, who accepted the government’s $1,650 offer for a slice of his backyard.  That didn’t seem like a bad deal until Mr. Flores learned that a neighbor had received 40 times that amount for a similar piece of property and that another nearby farmer had received almost $1 million in exchange for his cooperation.

I won’t bore you with the details of the story, but the general theme was that those who retained attorneys to represent them in the negotiations received significantly more in the process than those without attorneys.  Of interest to me – a trial lawyer – those who asked for a jury to decide their cases received settlement checks that were on average 1,200 percent more than the original offers.

It immediately struck me that this is virtually identical to what happens in injury cases.  People think they’re saving themselves money by not hiring a lawyer to pursue their claims.  But that’s a mistake.  Even insurance company studies prove that injured persons who retain lawyers recover more than those who are not represented.

And there are good reasons for that.  People don’t know the ins and outs of making a claim, what the fair value of a claim might be, and how to best present the claim.  Even if lay people study up on those issues, they still don’t have the hammer necessary to force insurance companies to take them seriously.  In our cases, if the insurance company isn’t playing fair, we’ll file a lawsuit and take it to trial, if necessary.  That’s the biggest bargaining chip we have.

But insurance companies know that unrepresented people don’t know the process, don’t know the fair value of the claim, and know that if they don’t treat an unrepresented person fairly, there’s not a lot that person can do if the person isn’t willing to hire a lawyer.  And because insurance companies know this, you can rest assured that they’ll take advantage of this.

If you or a loved one is injured, don’t try to resolve the claim yourself.  At least talk to a lawyer first.  You don’t want to find yourself in poor Mr. Flores’s shoes, settling your case and only learning later that you’ve been taken advantage of.

Late last week, Austin American Statesman writer Ben Wear had a great story on auto accident fatalities.

The good news: a Texas Department of Transportation report found that traffic fatalities in Texas have decreased by almost 15 percent since 2006.

The bad news: Texas is still significantly more dangerous than the United States as a whole.

There’s also a catch.  The improvement numbers are based on number of deaths per miles driven.  In 2010, Texas saw 3,028 traffic deaths, equating to 1.29 deaths per 100 million miles driven.  In 2006, the death rate was 1.5 deaths per 100 million miles driven.  I haven’t been able to find raw data on the actual number of traffic fatalities in 2006, but given the states’ increased population growth and increasing miles driven, I am guessing that the actual number of deaths were pretty similar for both years.

The other bad news:  There wasn’t a decline in highway deaths 2011.  The number of US highway traffic fatalities decreased for much of the country, but the numbers for Texas stayed flat.

Generally, the number of deaths should be decreasing.  Vehicly safety has improved significantly; people are getting better about wearing seat belts; there is increased awareness about drunk driving and distracted driving.

One reason that Texas may not be improving as much as the rest of the country is the trucking industry.   With I35 being a huge trucking corridor and the increased number of trucks in the South Texas area due to the resurgence of the oil and gas industry in Eagle Ford shale areas, Texas has a disproportionate number of trucks and big rigs on the road, increasing the likelihood of fatal accidents.

If you or a loved one has been injured or killed in a traffic accident, please allow us the opportunity to help by calling (512)476-4944 or submitting a case using the forms on this site.

One of the most frustrating issues for our personal injury clients is dealing with hospitals and hospital charges that don’t seem to make any sense.

Yesterday, Austin American Statesman writer Mary Ann Roser had a great story that looks at the mysterious world of emergency room and hospital charges.  She took the time to research the costs of various procedures at different facilities, and her results are stunning.

For example, she found that the cost of treatment for a stroke could range anywhere from $68,188 to $7.990 depending on which hospital provided the care.  Similar disparities existed for all other kinds of treatment.

This generally isn’t a problem for those who have health insurance because the insurance companies have negotiated rates (usually MUCH lower than these rates) with the various hospital systems, but it is a huge problem for those who don’t have insurance.  The uninsured are left to try and negotiate reductions for themselves, and without the leverage of a large health insurance company behind them, most of those negotiations are unsuccessful.

It’s even worse for injury victims.  Hospitals who provide emergency care to injury victims are entitled by law to file a lien against the victim’s recovery in any future personal injury case.  That lien removes what little negotiating power the patient has, and injury victims are often exploited for a large portion of these made up charges.

One of my favorite examples of these abuses is a relatively new “Trauma Activation Fee” that Brackenridge Hospital is trying to add to many patients’ bills.  If you’re unlucky enough to be taken to Brackenridge and they activate a trauma team (regardless of whether you need it), they charge a trauma activation fee ($14,247.50 for a Trauma II charge; I don’t know the charge for Trauma I).  You get charged this fee even though you didn’t request and often when you don’t need it.  And yet, if you’re uninsured, you have little leverage to negotiate it down.

As I wrote earlier this month, the Patient Protection & Affordable Care Act (Obamacare) is supposed to help prevent these abusive practices, but we’re still not seeing those results yet.  Often, when I talk to hospital representatives to negotiate bills and inform them of the law, the representatives have never heard of it before.

It is a problem, and I appreciate the Statesman bringing it to light