New Baseball Study Shows Even When Brain Injured People Appear “Normal”, They’re Not

baseball2I recently saw a study that is near and dear to my heart on two subjects — baseball and concussions.

One of the biggest frustrations of people with head injuries is that even though they look normal to their friends and family members, something is off.  Now, a new study involving professional baseball players provides a strong example of how people are impaired even though they look (and even feel) normal.

The study, reported in the American Journal of Sports Medicine and summarized in the New York Times, followed Major League Baseball position players (non-pitchers) who returned to action following concussions.  What the researchers found was stunning.  These batters, even though they themselves felt they were no longer impaired, performed significantly worse in the weeks following their return to play.

The study looked at 66 players over several years who had concussions.  In the two weeks before their concussions, they players had an average batting average of .249, an on-base percentage of .315, and a slugging percentage of .393.  For the two weeks after their return from the injury, the batting average had dropped to .227, on-base percentage had fallen to .287, and slugging percentage had fallen to .347.

Despite these players feeling that they were fine and back to normal, their batting averages and on-base percentages had each fallen by almost 9%, and their slugging percentages had fallen by almost 12%.

In order to rule out the idea that the drop off was just from the players being away from the game, the researchers also studied players who had taken a similar amount of time off for bereavement or paternity leave.  For those players, the batting averages, on-base average, and slugging percentages all INCREASED after their breaks.

This study is strong evidence for two things:

1) even though victims of brain injuries may appear normal to the outside world, they may still be impaired; and

2) that victims of concussions and head injuries are likely impaired in all types of ways for far longer than even the injured persons suspect.

Vanishing Lawsuits and Jury Trials

Warrior Award 2015The statistics from the Texas State Office of Court Administration are startling.  In the last ten years, the number of lawsuits having been filed has dropped 17%.  At the same time, the number of civil jury trials have dropped 34%.

What’s that mean for you?

It makes a difference when you’re hiring a lawyer.

The reality is that while the number of “litigation” lawyers or “trial lawyers” have been on the rise, the actual number of lawyers who have actually participated in a jury trial has been plummeting.  Lawyers calling themselves “litigators” may file lawsuits and do discovery and go through alternative dispute resolution and settle cases, but most rarely, if ever, see a jury.

A recent Texas Bar Journal reported on a survey of lawyers who called themselves litigators.  Of those with ten years of experience, 30 percent had NEVER tried a case to a jury.  And perhaps even more remarkable, only 36 had tried two or more cases to a jury.  That means that almost one third of the lawyers calling themselves litigators had never had a jury trial and another third had only had one trial.

Unfortunately, when you’re hiring a lawyer, you may never know whether the lawyer has ever tried a case or whether the lawyer has ultimate plans to just settle your claims.  This can often affect the ultimate recovery that you make.

Some of us are trying to do something about it.  I’m proud to be an active member of the Capital Area Trial Lawyers’ Association (I’m the immediate past president).  We have started giving out a “Warrior Award” to our members who take cases to jury trials.  This is a way of acknowledging those of us who have actually tried cases, and a way to encourage other lawyers to take their cases to trial.  We have also started a system where lawyers help one another with voir dire or other parts of the case to make trying cases a little easier.

I certainly don’t think our system will change the face of the state’s lawsuits, but I do hope it can help provide better representation for injured persons throughout Central Texas.

 

Painful Lessons

broken armIn our injury cases, we spend a lot of time really trying to understand our clients’ injuries.

As I tell clients, it’s one thing to say that an injury causes you pain or causes you to be limited in your daily activities.

But it’s another thing entirely to hear anecdotes about your pain or your limitations. Those anecdotes paint a much better picture of how an injury really affects you.

Unfortunately, my family and I have a recent reminder of that lesson.

In February, my twelve year old son was taking part in an activity in his Sports and History class at school (and yes, they have better classes than we had). While doing the activity, my son fell and broke his arm.

The last month has been a real reminder on how injuries truly affect a person’s every day life.

For one, I’ve been reminded of the limitations that an injured person experiences — in ways that many of us take for granted.

But in addition to that, I have had a number of conversations with people about my son, the injury, and how he’s doing. And I’ve again been reminded how the anecdotes really tell the story.

For example, it’s one thing to tell people that my son has been limited by the injury. But people have a different reaction when I explain that his cast over his hand prevents him from wearing any pants with buttons or that because of his cast, I have to help him wash his hair every night.

I hope that he’s at the end of the road with his recovery, but that the lessons will stay with me.

 

 

Auto Accident: New Study Shows Stoned Drivers Are Safer Than Drunk Drivers

drunkdriveA new National Highway Transportation Safety Administration study has found that driving while drunk is more dangerous than driving under the influence of other drugs.    Under the data, positive test results for several types of drugs found only small increases in the risk of a crash, but being under the influence of alcohol caused an almost 600% increase in the risk of being in a wreck.

The study makes for a good headline, but it certainly doesn’t make for good science.  You see, the findings don’t mean that driving under the influence of other drugs is safe.  Far from it.  But what the study does highlight is the need to find better tests to determine when the driver is under the influence of drugs.

The best example was the study relating to marijuana.  There is no doubt that driving under the influence of marijuana is dangerous.  The real issue is determining who is under the influence of marijuana.  Positive tests for marijuana usage could go back to usage for several days.  A driver, therefore, may test positive long after the impairment is worn off.  And that’s the problem.  A driver may test positive for marijuana while driving at a point when the driver is no longer under the influence, and someone would say that they’re a safe driver despite the positive test.  Reading the data the wrong way, it could be argued then that marijuana doesn’t impair the driver.  But that’s not the case; driving under the influence is still dangerous, but the test being used to determine marijuana usage doesn’t determine whether the person is still under the influence.

In contrast, blood alcohol tests for alcohol have a high correlation to impairment.  If a driver tests positive, that driver is still impaired, and you can easily identify the risks.

The long and short of it is that the study can’t be read to argue that drivers under the influence of drugs other than alcohol aren’t impaired.  Driving under the influence is still dangerous and regardless of the substance causes a risk to the driver and others.

 

Brain Injury Symptoms: Balance, Dizziness, Smelling, Hearing & Sight

The human brainAs I repeatedly tell clients, brain injuries often go undiagnosed following car wrecks or other accidents because doctors don’t usually know you well enough to make a pre-injury and post-injury comparison of your intelligence, emotional well-being, and general personality.  As a result, it’s often up to you or your family members to notice the symptoms of a brain injury and convey those to medical providers so you get the best care possible.  But to do that, you need to know the symptoms of brain injuries.  This series is designed to help you do that.

These are the final common symptoms on my list.  They seem unrelated, but they’re all related to a change in the senses.

Balance & Dizziness Issues.  Unfortunately, many  of you may experience balance or dizziness issues following your brain injury.  These are very common symptoms of brain injuries and sometimes they can be severe.  Some with brain injuries can feel the immediate problems, but tests can help make the diagnoses.  (With my son’s concussion, he appeared healed and ready to return to baseball until his medical provider ran balance tests on him, which revealed he was still experiencing significant problems despite seeming normal.)  For persons with severe cases of balance and dizziness issues, the person can undergo vestibular therapy that can help fight these symptoms.

Smelling & Tasting.  Oddly enough, many victims of brain injuries experience problems with their sense of smell and taste.  These can run the gamut from completely losing the ability to smell or taste, to a decreased ability to do both, to always experiencing a foul or unpleasant taste or smell.  Unfortunately, there is little that can be done in many of these cases.

Hearing.  Some studies suggest that between 48 and 74% of all people who sustain head trauma will have some type of hearing loss.  These losses could be caused by actual damage to the hearing system (ear canal, etc.) to neurologic problems that are a result of damage to the brain itself.  The treatment options obviously change based on the type and severity of the injury sustained.

Vision.  Recent studies at some VA hospitals have found that more than 74% of the patients with brain injuries had vision problems.  There can be a number of different causes of vision problems.  There can also be a number of different treatment options ranging from waiting, to patching one of your eyes, to vision therapy, to surgery.

Brain Injury Symptoms: Speech and Language Problems

The human brainAs I repeatedly tell clients, brain injuries often go undiagnosed following car wrecks or other accidents because doctors don’t usually know you well enough to make a pre-injury and post-injury comparison of your intelligence, emotional well-being, and general personality.  As a result, it’s often up to you or your family members to notice the symptoms of a brain injury and convey those to medical providers so you get the best care possible.  But to do that, you need to know the symptoms of brain injuries.  This series is designed to help you do that.

Unfortunately,  brain injuries often affect a victim’s ability to communicate.  These are not only scary problems to encounter, but they can greatly affect the victim’s quality of life going forward.  Some of these issues are as follows:

Cognitive issues.  Many victims find their communication problems resulting from cognitive issues such as problems with word recall, inability to tell stories or other thoughts in sequence, or difficulty understanding more complex thoughts or expressions.  There are often some coping strategies that can be used to help with these problems.

Slurring or other speech problems. Another common problem is slurring of speech.  Technically, brain injury patients can develop a motor speech disorder called dysarthia.  The symptoms of dysarthia may be slurred or choppy speech, slow rate of speech, inability to fully move mouth, tongue and jaw, and other changes in voice quality.  These are obviously scary problems, but they can often be treated with speech therapy.

Swallowing problems.  Though not a true communication problem, a somewhat related symptom is swallowing problems.  Many victims of head injury develop issues with swallowing.  This is obviously not a symptom that you would normally associate with brain injuries, but it is one that you can easily recognize if you’re looking for it.

Brain Injury Symptoms: Pain Disorders

The human brainAs I repeatedly tell clients, brain injuries often go undiagnosed following car wrecks or other accidents because doctors don’t usually know you well enough to make a pre-injury and post-injury comparison of your intelligence, emotional well-being, and general personality.  As a result, it’s often up to you or your family members to notice the symptoms of a brain injury and convey those to medical providers so you get the best care possible.  But to do that, you need to know the symptoms of brain injuries.  This series is designed to help you do that.

Problems with pain are common following brain injuries.

Headache.  Perhaps the most common symptom of a brain injury is a headache.  Symptoms can range from routine post-traumatic headaches to post-traumatic migraines.  The severity of the headache and the duration of the symptoms depends on the severity of the injury and the type of head injury sustained.

Neuropathic pain.  Neuropathic pain is a condition caused by injuries to the nervous system.    This is hard to describe, but the nerves are excited so pain is prevalent.  This pain may be treated by medication.

Central pain syndrome.  Central pain syndrome is pain that follows lesions to the central nervous system.  If the brain develops lesions from the brain injury, then central pain syndrome may develop.

Brain Injury Symptoms: Neurological Disorders (Seizures, Movement, Fatigue, etc)

The human brainAs I repeatedly tell clients, brain injuries often go undiagnosed following car wrecks or other accidents because doctors don’t usually know you well enough to make a pre-injury and post-injury comparison of your intelligence, emotional well-being, and general personality.  As a result, it’s often up to you or your family members to notice the symptoms of a brain injury and convey those to medical providers so you get the best care possible.  But to do that, you need to know the symptoms of brain injuries.  This series is designed to help you do that.

There are a number of neurological symptoms of brain injuries that, though sometimes rare, can be extremely traumatic for the injured person.  The most common neurological injuries are as follows:

Fatigue.  Fatigue is a very common symptom of people with brain injuries.  Some studies have found that up to 73% of persons with head injuries suffer from fatigue after the injury.   Unfortunately, many of the other symptoms of brain injuries, such as depression, also have a component of fatigue, and fatigue is also a side effect of many medications used to treat other brain injury symptoms.  Thus, treatment of fatigue remains difficult.

Post-traumatic seizures and epilepsy.  Seizures and epilepsy are fairly common symptoms of brain injuries.  Traumatic brain injury accounts for about 5% of all epilepsy cases and is the leading cause of epilepsy in young adults.  The development of seizure or epilepsy symptoms are very dependent on the type of injury sustained.  Many brain injury victims will undergo EEG testing to determine whether or not the patient is having seizures.  It’s important to note that a normal EEG does not mean that you don’t have a brain injury, it only means that you’re not having seizures at the time of the test.

Tremors. Many brain injury victims will develop tremors following their injury.  The most common cause of brain injury tremors is car wrecks where the brain has a history of quick deceleration injuries.

Dystonia (involuntary muscle contractions). Dystonia is a fairly rare, but significant symptom of brain injuries.

Vision problems.  Many brain injured patients have injuries to the optic nerve so the patients experience blurry vision or other changes to their eyesight.  There are other potential causes of sight issues associated with brain injuries that are discussed elsewhere in this series.

Smell problems.  Many brain injuries end up damaging the olfactory nerve so the victim will have an impaired sense of smell.  It is obviously difficult to test for smell issues, and smell is not something you might normally be concerned with after you’re injured, but if you or a loved one mentions smell problems, be alert that it could be related to a brain injury.

Vestibulocochlear nerve problems.  This nerve works on both hearing and balance.  Thus, when it is damaged as part of a brain injury, it can cause problems with hearing and also vertigo symptoms.  Vertigo is very common following a brain injury and a number of our clients have had to undergo vestibular therapy as part of their treatment.

Sleeping disorders.  Sleep-wake disorders and alterations in sleep patterns are very common following brain injuries.   The variety of sleep disorders include insomnia, excessive daytime sleepiness, narcolepsy, and sleep apnea.  Sleep issues need to be addressed because poor sleep can lead to other health concerns.

 

 

Brain Injury Symptoms: Behavioral and Emotional Symptoms

The human brain

INTRODUCTION

As I repeatedly tell clients, brain injuries often go undiagnosed following car wrecks or other accidents because doctors don’t usually know you well enough to make a pre-injury and post-injury comparison of your intelligence, emotional well-being, and general personality.  As a result, it’s often up to you or your family members to notice the symptoms of a brain injury and convey those to medical providers so you get the best care possible.  But to do that, you need to know the symptoms of brain injuries.  This series is designed to help you do that.

You may only realize that you or a family member has a brain injury because you notice changes in you or your family member’s behavior or emotional status.  Some of the common emotional or behavioral issues that we see from brain injuries are as follows:

Irritability.  Many survivors or friends of survivors find that the injured person is more irritable and much more easily angered.  The injured person may also have an angry response to a situation that is greatly out of proportion to what you would normally expect.

Impulsivity.  Many brain injury survivors have problems with impulse control.  They say things they wouldn’t normally say; they take physical actions they wouldn’t normally take; or they demonstrate poor judgment failing to fully think things out.

Affective instability.  Many persons with brain injuries show exaggerated displays of emotion that are way out of proportion to the situation or to the person’s pre-injury self.  As mentioned above, some persons become explosively angry at something that doesn’t seem justified.  Others may become extremely sad over something that doesn’t warrant such a response.

Apathy/Lack of Motivation.  Apathy is very common in persons with brain injuries.  One study has found that more than 60% of brain injury victims suffer some form of apathy.

Depression.  Some studies find that between 30 and 60 percent of brain injury victims have depression.  This doesn’t include the significant percentage of victims who experience some symptoms of depression, but not enough for a formal diagnoses.  Additionally, if victims had depression prior to their injury, a brain injury can make that depression much more severe.

Psychosis.  Psychosis is an infrequent (but high impact) occurrence with brain injuries.  Typical symptoms of psychosis might be delusions, hallucinations, or schizophrenia-like problems.  As I said, these are rare problems in brain injuries, but when they occur, they are very problematic for the affected person.

General Anxiety Disorder. Many brain injury victims describe feelings of anxiety.  If a person has experience anxiety before their injury, then they are much more likely to experience even worse anxiety after the injury.

Obsessive Compulsive Disorder.  A small percentage of brain injury victims develop OCD after their injury.

Post-Traumatic Stress Disorder.  There are a number of studies finding that victims of brain injuries are also likely to experience PTSD.  This is a problem that is being highlighted by the experiences of our soldiers in the middle east conflicts.  PTSD is also problematic because it makes recovery much more difficult.

Substance Abuse.  Several studies find that victims of brain injuries are much more likely to experience substance use disorders.

Dementia.  There are substantial studies finding that brain injuries both increase the likelihood that the victim develops dementia and also may result in earlier-onset dementia for those who are already pre-disposed to developing dementia.

 

Brain Injury Symptoms: Cognitive Impairments

The human brainAs I repeatedly tell clients, brain injuries often go undiagnosed following car wrecks or other accidents because doctors don’t usually know you well enough to make a pre-injury and post-injury comparison of your intelligence, emotional well-being, and general personality.  As a result, it’s often up to you or your family members to notice the symptoms of a brain injury and convey those to medical providers so you get the best care possible.  But to do that, you need to know the symptoms of brain injuries.  This series is designed to help you do that.

The fist set of symptoms that many people notice are the cognitive symptoms.  The major cognitive issues that are associated with brain injuries are as follows:

General Intelligence.  This is difficult to quantify without proper testing, but many people suffering from brain injuries feel that they have lost intelligence compared to their pre-injury intelligence.

Memory Issues.    The memory issues associated with brain injuries take many different forms.  The most common memory issues are post-traumatic amnesia, short -term memory problems (not remembering what you’re doing, not remembering your typical tasks, etc.) and long-term memory problems.

Attention Span and Working Memory.  Many victims of brain injuries also have more difficult paying attention to things, especially for longer periods of time, and they have difficulty with working memory — the short-term memory needed to process tasks.  These deficits can be tested through tests that show the person shapes or various patterns and then ask the person to recall those same shapes and patterns a few moments later.

Reaction Time.  Numerous studies have found that persons with brain injuries have a slower reaction time to different events.  The reaction time becomes worse when the task is more difficult, the person has more information leading to information overload, or the person is fatigued.  Again, this is a symptom that is difficult to quantify without proper testing.

Spatial Cognition Issues. Brain injured persons might recognize spatial cognition issues in terms of getting lost, not remembering where objects were placed or put, and not understanding directions.

There are other cognitive issues that can arise, but these are the most popular that we see.  Unfortunately, one problem of brain injuries is that there is a well known phenomena that injured persons are often unaware of these deficits.  Therefore, it’s critically important that friends or family members pay attention for these symptoms.

 

 

 

Perlmutter & Schuelke, LLP maintains offices in Austin, Texas. However, our attorneys and lawyers represent clients throughout the state of Texas, including Dallas, Houston, San Antonio, Forth Worth, El Paso, New Braunfels, San Marcos, Kyle, Buda, Round Rock, Georgetown, Lockhart, Bastrop, Elgin, Manor, Brenham, Cedar Park, Burnet, Marble Falls, Temple and Killeen. By Brooks Schuelke

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