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)

If you have suffered a brain injury, you might be referred to a neuropsychologist, who will often recommend neuropsychological testing.

A neuropsychologist is a psychiatrist with a specialty in the science of brain-behavior relationships.  In other words, they deal with how brain function affects your behavior.   The neuropsychologist uses a number of methods, including neuropsychological testing, to evaluate your injury.

Neuropsychological exams usually consist of a series of questions about your condition.  Some tests may be brief, but some may be much more detailed, taking up to a full day.

The test results are used for a number of different purposes.   Depending on the need, the purposes may include (1) diagnosis of an injury; (2) patient care and planning; (3) treatment; (4) evaluation of treatment; (5) research; and (6) forensic neuropsychology — for use in litigation and lawsuits.

For personal injury purposes, we’re interested in all of those categories.  We’re interested in 1-4 to make sure you get better and get the care you need, and we also seek a forensic evaluation for your case.  In the litigation context, the neuropsychologist can help confirm you have a brain injury, document the extent of your injury, evaluate your future course of treatment, and provide opinions about your recovery, both in terms of your daily activities and your work life.

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.

I’m a huge fan of TED, the Technology, Entertainment, & Design conference.  It’s an annual event that asks some of the world’s most brilliant people to give short speeches on a wide-range of topics.  People pay thousands (or tens of thousands) of dollars to attend live, but most of the talks are presented on the TED website.

This weekend, I was listening to NPR’s Ted Radio Hour Podcast, and I heard the story about Jane McGonigal’s Ted Talk.  Ms. McGonigal is a video game designer, and the thesis of her talk was how video games can be used to solve some of the world’s problems.

But the amazing thing about her story is that she has proven it herself.  You see, in 2009, she suffered a traumatic brain injury.  She was on the brink of suicide when she decided to try to develop a video game that could help her recover.   And it did.   Within months of being on the verge of suicide, she was not only able to improve her condition and cope with her limitations, but she was able to develop and present her TED talk.

That game, Superbetter, is now available to all.  It was released in March of this year and is being used by people all over the world to help them deal with their ailments.  You can watch a video of Ms. McGonigal discussing the game here.

For those of us in the Austin Independent School District, today is the first day of “summer” so I thought I would mark the occasion by sharing some summer safety tips.

SUNBURN:  The number one summer ailment in Austin has to be sunburn.  Make sure to limit your exposure to peak sun, use sunscreen, and keep covered.  If you experience a sunburn, remember that ibuprofen or aspirin can help relieve the pain. You can also use moisturizing cream and cold compresses/washcloths as long as the skin isn’t blistering.  If the skin does have significant blistering, seek medical care.

HEAT EXHAUSTION:  We all hope this summer won’t be as bad as last summer, but even in a “typical” Austin summer, heat exhaustion is a concern.  Remember to drink plenty of liquids and modify your activities as the weather requires.  But most importantly, be aware of the signs of heat exhaustion.  Common symptoms include:

• You quit sweating.  If heat stroke sets in, your body can’t compensate and you quit sweating.
• Pale skin.
• Muscle cramps.
• Confusion or disorientation.
• Headaches.
• Nausea or vomiting.

If you or a friend experience heat exhaustion, know what to do.  Get to a cooler area, apply water to the person (or immerse them in a cool pool or bathtub), and apply ice to neck or armpits.  If the symptoms are severe enough, call 911.

SPORTING INJURIES:  As kids have more free time, the number of sporting injuries increase. Whether biking, skateboarding, or riding scooters or horses, make sure your kids are wearing helmets.  As a personal injury lawyer, I’ve seen too many head injuries that could have been minimized or even eliminated by a helmet.  Protect your kids.

Make sure that your other sporting equipment is safe.  If your kids frequent playgrounds, make sure that the playgrounds have a safe surface (falls account for over 60 percent of playground injuries).  Watch out for movable soccer or basketball goals that can fall over on children, and if your kid is playing on a trampoline, make sure that they know the safety rules and that the trampoline is well maintained.

Like many of you, I’ve never been to a hockey game.  But despite that, we have much we can learn from the National Hockey League.

You see.  The NHL has a concussion problem.

The NHL’s most recognizable player is young star Sidney Crosby.  But last January, Sid the Kid took a high hit and sustained a concussion.  His concussion caused him to miss half the 2010-2011 season, the 2011 Stanley Cup playoffs, and the first quarter of the 2011-12 season.  He finally came back, but after eight games back, Crosby sustained another hit and symptoms of concussions and is again out indefinitely.

Crosby isn’t alone. In about a quarter of the season, 23 different NHL players have been limited by concussions.

What I take from this is that the NHL, unlike the NFL or some other sports, take concussions and head injuries seriously.  And I think it’s important for all of us to learn that.

I frequently tell people that the thing that scares me the most about our car wreck or other personal injury cases are the potential head injuries.  They are difficult to diagnose, and the consequences can be life-altering. 

So if you or a loved one is hurt in an accident, make sure you’re on the lookout for potential signs of head injuries.  Don’t dismiss those headaches, changes in temperament, feelings of confusion, nausea or vomiting, or fatigue.  Take them seriously, and seek the care you need.

In the past, I’ve praised the NFL for leading the way in the study of the prevention and care of head injuries and brain injuries.  But last night, they took a step backward.

Fellow University of Texas alum Colt McCoy was absolutely blown up by a shot to the head by James Harrison.  After the play, Colt was slow to get up and a little wobbly.  He understandably left the game only to return a few plays later.

According to at least one report, Colt’s dad Brad (whom I’ve had the pleasure to meet at a ”meet the team” greeting before a UT football game)  was livid because no in game testing was done to test Colt for potential head injuries.

If the NFL is serious about protecting its players, it can’t let players who have likely suffered head injuries return to action.  This type of behaviour makes it more likely that brain injuries are permanent and more debilitating. 

And it has to trickle down to other sports.  The NFL is a model for how other levels of sports treat players.  It needs to remind colleges and high schools that head injuries are serious business that can’t be ignored.