What To Make Of The New NFL Brain Injury Study

Yesterday, a new study on brain injuries in NFL players that was published in the Journal of the American Medical Association made news.

As you may have heard, the study looked at brains of 111 former NFL players, and 110 of the brains had evidence of chronic traumatic encephalopathy (CTE).

I’ve been trying to process the results, and I’ve reached a couple of conclusions.

First, you have to be careful with the results.  The only way to truly test for CTE is by doing an autopsy once the person is deceased.  In this case, all of the brains in the study were donated by the players’ families.  Obviously, most of the brains would have been donated because the family had a concern about the player’s condition before the player’s death.  Even the doctors who did the study confirm this.

Second, regardless of what I said above, the numbers are startling.  This is a lot of players who have had problems, and it’s something that we can’t ignore.  For a long time, there was a debate about whether CTE was even a real disease.  These numbers, along with other similar research, show that ti is a real problem.

Third, for safety’s sake, we need to make sure that we’re not limiting the focus to the NFL or even football.  With regards to CTE, it isn’t limited to football, soccer and hockey and at least one former major league baseball player have been diagnosed with CTE.  We need to looking at ways to make all sports safer in terms of protecting the brain.

Beyond that, we can’t let our attention be focused on CTE and sports.  Many, many more people will sustain severe brain injuries in car wrecks and falls than in sports.  We need research to continue to help us determine how brain injuries can be limited in the average person and not just in the athlete.

For more information on the new study, you can read the following articles:

 

U.T. Looking To Cut Football Brain Injuries

My University of Texas football team hasn’t been on the cutting edge of winning the last few years (and we’re hoping that’s changing), but we are on the cutting edge of trying to protect players from brain injuries.

It’s no secret that an increasingly difficulty issue in football is the rise (or at least heightened awareness of) brain injuries suffered by players.  There are some things that can be done, such as teaching proper technique and making sure that helmets are state of the art, but until now, what a school or coach can do to protect kids has been largely limited.

Now however, Riddell and Texas are taking a big step towards safety by including monitoring devices in players’ helmets.  Starting this year, all University of Texas players’ helmets will have sensors that send signals to the trainers’ hand held devices when the player sustains a significant hit in the head.  The trainer can then monitor the player and look for signs of a concussion or head injury.  Texas will be the first Power 5 school to provide this technology to every player.

This is important.  While concussions are bad, one of the biggest risks in sports is known as second impact syndrome.  Second impact syndrome occurs when a player sustains a significant blow before the brain has healed from the original concussion.  The second impact, which can occur minutes, days or weeks after the first concussion, typically causes much more severe problems than the original impact.    While some concussions are obvious, some people don’t show signs of symptoms until hours or even days after the event.  Thus, the ability to monitor the impact of a hit in real time, will make it much easier to look for problems in real time, minimizing the risk of second impact syndrome.

Now, if we can only find some technology to help us find a few more wins each year…..

 

 

Emergency Room Not Diagnosing A Concussion, Revisited

A few months ago, I wrote a short article describing why emergency rooms do such a bad job at diagnosing concussions/brain injuries: The emergency room didn’t say anything about a concussion. Does that mean I don’t have a brain injury?

Recently,  I came across a study that really quantifies the problem I discussed.

The study, primarily led by several doctors from the University of Washington, was laid out in an article entitled Accuracy of Mild Traumatic Brain Injury Diagnosis, which was published in the August 2008 issue of the Archives of Physical Medical Rehabilitation.

The article starts by noting:

Accurate identification and diagnosis of a mild TBI is the first step toward providing clinical care.

Unfortunately, despite the accurate diagnosis of a brain injury being so important, the study found that emergency rooms are not very good at making the diagnoses.

The study looked at 197 patients who had been to emergency rooms.  They looked at medical records, and in some cases interviewed the patients, to determine whether they patients had a brain injury, as defined by the Centers for Disease Control mild Traumatic Brain Injury work group.  The researchers then took those patients who were diagnosed with a brain injury and looked at the patients’ emergency room records to see what was diagnosed in the emergency room.

The results were startling.

The emergency room doctors failed to make a diagnoses of a head injury or concussion in 56% of the patients who were later determined to have a brain injury.

That’s a stunning number.

There are some things that can help improve the accuracy of the emergency department physicians.  If the patient complained in the emergency room about confusion, feeling dazed, or having memory problems, then the diagnoses was more accurate.  However, even with those findings, the emergency department still missed the diagnoses on 37% of the patients.  That’s still a substantial number of patients who have a brain injury that doctors are missing.

Oddly, the emergency room physicians’ diagnoses weren’t dramatically better even when the patient reported a loss of consciousness — which should be a red flag.  The doctors still failed to make the proper diagnoses of a head injury in about 50% of the patients who had told the doctors that they had lost consciousness.

This means that you have to be diligent about noticing symptoms.  I’ve repeatedly written that misdiagnoses is a problem and that the best way to find the problem and to get proper treatment for the problem is for someone close to the person to look for symptoms.

To learn more details about potential symptoms, you can read our other articles:

If you or a loved one has sustained a brain injury in an accident, please call us at (512)476-4944 and we’d be happy to see if we can help.

Brain Injuries: New Study Finds Fewer People Recover From Post-Concussive Syndrome

The April 2017 issue of the Journal of Neurotrauma reports on a new study about post-concussion syndrome.

The study followed 110 patients who had post-concussive syndrome symptoms for more than three months, and the findings were stunning.  Of those patients, only 27% made a full recovery.  Of the 27% who made a recovery, 67% made a recovery within the first year.  And no one who had symptoms over three years ever made a recovery.

For those groups that didn’t recover, the continuing symptoms (in order of frequency) were:

  • Headache
  • Difficulty concentrating
  • Fatigue
  • Dazed/don’t feel right/in a fog
  • Pressure in the head
  • Sensitivity to light
  • Difficulty remembering events
  • Neck pain
  • Sensitivity to noise
  • Depression/sadness
  • Insomnia/sleep disturbance
  • Irritability
  • Anxiety
  • Frustration
  • Feeling slowed down
  • Noise in the ears
  • Vision changes
  • Lightheadedness
  • Imbalance
  • More emotional
  • Dizziness
  • Nausea
  • Increased sensitivity to alcohol
  • Confusion
  • Personality changes
  • Vivid dreams
  • Numbness
  • Vertigo
  • Panic attacks
  • Disorientation
  • Stomach ache
  • Loss of appetite
  • Slurred speech
  • Seizures
  • Vomiting

These findings are significant to our brain injury cases.

Most insurance companies argue that brain injuries typically heal themselves and symptoms disappear after six months or a year. The insurance companies use that argument to reduce the value of the claim.

This study refutes that.  If a client has had symptoms lasting more than three months, then this study is evidence that the client will likely never make a full recovery.   Obviously, if an injury is permanent then the value of the case is higher.

The study is also interesting because it has a good list of symptoms of a brain injury.  It’s important for people to know these symptoms to help them recognize when they might have a brain injury.

Another interesting fact was the distribution of the symptoms.  Generally, post concussion syndrome has three classes of symptoms:

  1. Cognitive symptoms — affect your thinking
  2. Affective symptoms — affect your mood (depression, irritability, etc)
  3. Somatic symptoms — separate symptoms (headaches, light sensitivity, etc).

The study found that the persisting symptoms were quite evenly distributed between the three classes of symptoms.

 

 

My MRI or CT Scan Was Negative. Does This Mean I Don’t Have A Brain Injury?

This is another question I’ve recently received from potential clients.  They were involved in an incident — a car wreck, a slip and fall, or something similar.  They went to the ER, and the ER performed an MRI or a CT san looking for problems, but scan came back negative.  Does this mean that the was no brain injury?

Absolutely not.

While an MRI or a CT scan can find some brain bleeds or some damage, they don’t find most problems.  As a result, the vast majority of people who have brain injuries have a normal (what we call negative) MRI or CT scan.

Indeed, while insurance companies sometimes try to argue about claims when you have a normal MRI or CT scan, virtually all scientific literature and all neurologists agree that you can still have a normal scan.  Not only that, virtually all neurologists will agree that most of the patients they see for brain injuries have normal scans.

So if you feel like you’re off or your family members are telling you that you’re different after a car wreck, a fall, or another event, don’t rule out a possible brain injury just because you had a normal CT scan or MRI.  You may very well still have a mild traumatic brain injury that needs to be treated

The Emergency Room Didn’t Say Anything About A Concussion. Does That Mean I Don’t Have A Brain Injury?

This is a question I’ve seemed to be answering for clients lately.  You are in a wreck or other event.  You go to the emergency room.  They look you over, they never say anything about a brain injury, and they send you home.  Does this mean you don’t have some type of brain injury?

Absolutely not.

Emergency rooms (and even other doctors) are notoriously bad at diagnosing brain injuries.  Why is that?

First, emergency rooms are triage facilities.  They are only really looking for the things that are life-threatening or need to be treated immediately.  Too often, this means that they don’t look for brain injuries unless the brain injury is the type that’s completely obvious.

Second, emergency rooms (and most other doctors) don’t know you.  For the most part, there’s not a readily available test that we can use during a doctor’s visit to say whether you have a brain injury.  The first time a brain injury is diagnosed is usually based on your complaints of your symptoms and comparisons of how you were before you got hurt to how you are after you got hurt.  Doctors can compare your symptoms to common brain injury symptoms, but the doctors have to be looking to put two and two together.  And doctors usually don’t know you well enough to compare your condition from before the wreck to your condition after the wreck.  As a result, it’s often difficult for a doctor to make the diagnoses of a brain injury.

That’s why I tell clients that it’s so important to have friends and family members look for changes in your condition or behavior.  For our clients, we have forms that we give you to fill out that can help figure out what problems you’re having.  That way, you’ll be in a better position to articulate to your doctor the problems you’re having and the doctor can more easily and quickly make a referral to a neurologist or other treating physician.

Brain Injuries: New Study Finds Even One Concussion Can Have Lasting Effects

The human brainMany of us that deal with these injuries routinely have suspected it, but a new study confirms that even one concussion can have lasting effects.

The study was based on extensive data on the health of people in Sweden.  The researchers found 104,000 people who experienced head injuries between 1973 and 1985.  The researches then looked at the these brain injured persons’ records after their injuries and compared those results with the results and history of the siblings of the brain injured persons.

The researchers found that persons who had even one concussion were more likely to receive future disability payments, more likely to need mental health care, less likely to graduate high school, and much more likely to die prematurely.

The researchers also found that the problems increased significantly if the person had more than one concussion, and if the persons had their head injuries after the age of 15.

The good news is that most of the people who had just one concussion were fine.  But people who have suffered concussions will still have to worry about what their future must hold.

The article also noted that the leading causes of brain injuries are what we see often in our practice.  For the very young, the leading cause of concussions is falls.  For teens, the leading cause becomes sports.  And for adults, the leading cause of brain injuries is car wrecks.

If you or a loved one has experienced a concussion or other brain injury because of another person or business’s carelessness, call us at (512)476-4944.  We will try to help you navigate the difficult process of pursuing your claim.

 

 

 

Brain Injuries: Risk Of Suicide May Increase Three Fold After A Concussion

brainI’m part of a nation-wide group of lawyers who regularly exchange articles and other information with one another about brain injury cases.

This week, we were having an online discussion about suicide, and we shared a study from earlier this year finding that persons who have suffered even a single concussion may be at a much higher risk for suicide.

What really struck me is how these risks apply to my clients.

In a Scientific American article about the study, Dr. Donald Redelmeier, one of the study’s lead authors stated:

The typical patient I see is a middle-aged adult, not elite athlete.  And the usual circumstances for acquiring a concussion are not while playing football; it is when driving in traffic and getting into a crash, when missing a step and falling down a staircase, when getting overly ambitious about home repairs — the everyday activities of life.

These are the things we routinely see in our practice. Over the last year, I’ve represented clients who have had brain injuries in car wrecks, bicycle wrecks, slip-and-fall accidents, and more.

Too often the diagnoses of these injuries is slow, and in many cases, not recognized until very late in the process.   This delays the treatment, including the psychological treatment, that clients need to help them start the road to recovery from these devastating injuries.

 

Playground Concussions Are On The Rise

brainOne of the recent headlines on Yahoo News was a story that playground concussions are on the rise.

You might be surprised to find that I think this is great news.  Why?

I don’t think the actual number of concussions are rising.  Instead, I think parents and school nurses and such are getting much better at looking for and diagnosing concussions.

This diagnoses is important.  I not only see kids affected with brain injuries in my practice, but I’ve watched my own kid struggle with a concussion.

These are serious injuries that need to be treated seriously.  But they can’t be properly treated if they’re not diagnosed.

There are also potential legal aspects in these claims.  For example, depending on the circumstances, a playground injury may give rise to a claim or lawsuit against:

  • the party that owned the playground
  • the party who designed the playground
  • the party who built the playground
  • the party who was responsible for maintaining the playground
  • the party who made modifications to the playground

If your kid is hurt on a playground, the first order of business is to make sure they get the care they need.  After that, if the problems are serious, then talk to a lawyer to discuss your options.

Unprecedented Actions: HoverBoard Industry Is Deemed Unsafe

Last Thursday, the Consumer Product Safety Commission took the unprecented step of sending a letter to all hoverboard manufacturers, importers and retailing telling them that all hoverboards are potentially unsafe.  One major manufacturer, Swagway, has also told people who own its hoverboards to quit using them until they are deemed safe.

This is a shocking turn of events.  Two months ago, hoverboards were among the most popular Christmas gifts, and now the entire industry is in a bit of turmoil.

There were a couple of things that were very interesting about this to me.  First, in the letter, the CPSC declares that no manufacturer in the industry meets the CPSC’s safety standards.  This is amazing.  I can’t think of another instance off the top of my head where the government has declared an entire industry unsafe.

Second, the reason provided by the CPSC was also interesting.  The CPSC declared hoverboards unsafe because of their risk of fires caused by the batteries.  This is certainly a known risk, but in my mind, not the greatest risk.

For me, the most significant risk from hoverboards is the risk of falls and related injuries.  There have been hundreds of reports of people falling off of their hoverboards and incurring significant injuries, including numerous brain injuries and fractures of various bones.  Those types of injuries have the potential to be permanently life-altering.

I don’t know how this will turn out.  At some point, after more testing is done, perhaps the government will declare that some hoverboards are safe.  But we’re clearly not at that point yet.

 

 

Perlmutter & Schuelke, PLLC 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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