Although the sense of smell is controlled by the olfactory nerve, this nerve is seldom tested as part of the standard neurological examination and frequently victims of head trauma do not associate their loss with the trauma producing event. In our brain injury legal practice, we have encountered several individuals who lost their sense of smell following skull fractures, yet many months went by before their complaints were addressed by medical personnel. 

A drug once used to treat asthma and other respiratory conditions shows promise in restoring a sense of smell according to a study that appears in the June issue of the American Journal of the Medical Sciences.

The drug, theophylline has shown promising results in patients that have sustained a partial loss of smell but has not shown good results in those with a total loss.

The Appropriations Subcommittee on Labor, Health and Human Services and Education begins consideration of the FY10 funding bill today!

Over the next few days, the House Appropriations Subcommittee on Labor, Health and Human Services and Education will be considering a bill which will provide the funding allocation for programs authorized through the TBI Act and for NIDRR's TBI-related research programs, including TBI Model Systems of Care.

Federal funding for these important TBI programs has remained stagnant over the last several years, as Congress has not provided increases sufficient to keep up with the increasing cost of doing business. The urgent need for increased federal support for a national TBI public health infrastructure and TBI research is further heightened by the recognition of TBI as the signature wound of the wars in Iraq and Afghanistan.

The time is now to urge Members of Congress to adequately fund TBI programs!

Please contact your congressional representative as soon as possible to urge funding for traumatic brain injury programs.

The findings could help prevent one of the most common forms of adult epilepsy, called acquired epilepsy, or traumatic epilepsy which is often found in people who have suffered a brain injury or infection.

For decades researchers have focused on neurons as the culprits in seizures, which can be characterized as debilitating "electrical storms" in the brain. However, this new research suggests that the brain damage is caused by the release of chemicals which attempt to repair the damage at the site of brain injury. These chemicals then cause the neurons to become excited resulting in seizures.  The researchers are developing drugs that would shut down the release of these chemicals to prevent seizures from occurring.  When these seizures continue to occur, this is called epilepsy. .

It can take days, weeks or even months for the seizures to become apparent following a traumatic brain injury. Our brain injury attorneys have represented many individuals who have developed seizure disorders and epilepsy as a result of head injury. 

The case was significant because the school system never offered this learning disabled child any services.  In the past the Supreme Court had ruled that where an offer of services was inadequate, parents could be reimbursed for the cost of private education. But the law was unclear as to whether the school system would have to make reimbursement when the school system unreasonable withheld any services.  The court agreed with the parents that the failure to provide reimbursement when services where inadequate but not when the school just refuses to supply any services would be absurd and contrary to the intentions of Congress in passing the Act.

The IDEA has very specific requirements that parents must follow in obtaining special education services and parents seeking these services for their children are advised to seek legal assistance to help them through this process.

Read the full supreme court special education decision.

The film is scheduled to premiere on the public broadcast network (PBS) on July 7, 2009.  You can check out the full broadcast schedule on more information by clicking here.

The group they will start up in the fall is aimed at patients and also their families and friends. The purpose is to provide a refuge for area people who have suffered brain injuries from accidents, illnesses or even drug use.

No decisions have been made as to where or when the group will meet, but the founders are putting together a list of interested people. If you would like to participate, contact Ms. Slade  or Ms. Myers .

It has previously been shown that unrecognized seizures are common in the critically ill, particularly in those with acute brain injury, and that these seizures are associated with unfavorable outcomes.
 
The two studies found that electroencephalography (EEG)  was effective in detecting subtle seizures that are often impossible to detect by visual observation.

The findings demonstrated the value of continuous EEG (where electrodes are placed on the scalp – a noninvasive procedure used in nonsurgical ICUs)  and intracranial EEG (ICE), an invasive technology where a probe is placed in the cortex of the patient's brain. ICE is mainly used in Neurological ICUs for serious acute brain injuries, such as subarachnoid hemorrhage, severe head trauma and very large strokes (hemorrhagic or ischemic), which require other invasive brain monitoring devices.

The papers, are entitled  "Intracortical Electroencephalography in Acute Brain Injury," and  "Continuous Electroencephalography in the Medical Intensive Care Unit".

The Mission of The Sarah Jane Brain Project is to create a model system of care for children suffering from all Pediatric Acquired Brain Injuries. You can learn more about the Sarah Jane Foundation by viewing their web site.

The foundation has joined together  51  health care institutions representing states across the country to address issues related to the treatment of brain injury, the number one cause of death and disability in children and young adults in the United States. The goal is to develop a national collaborative network to address brain trauma in children.
 
Member centers in the new network will share information and research findings on pediatric brain injuries in an effort to establish a standardized national medical plan for dealing with these injuries.

Health care reform however should not be confused with medical malpractice deform and proposals to link changes in the medical malpractice compensation system with health care reform should be disregarded as ill founded and without merit in attempting to solve our health care crisis.

The following guest editorial from the president of the American Association for Justice is reprinted here for your review. 

The health care crisis is one of the most complex issues facing our country. Ultimately, a national solution will boil down to two major tenets: lowering costs while improving quality, and covering the uninsured.

Changing the legal system will not solve any of these problems. Doing so will only make it harder for patients injured by medical negligence, through no fault of their own, to pursue legal recourse.

Discussing negligence as part of health care reform is a distraction from the debate. Numerous studies and economic experts, such as the Government Accountability Office and Congressional Budget Office, have detailed how tampering with the legal system will save health care practically no money. One study showed that medical negligence lawsuits were a tiny percentage of civil cases.

Fixating on the legal system ignores the larger issue: patient safety. As many as 98,000 people die every year because of medical errors. If medical negligence becomes rarer, so will the number of injured patients who need to seek legal recourse.

A few hospitals are using programs that encourage doctors to disclose errors and apologize to injured patients as a way to avoid litigation. As long as there are strict protocols to protect the legal rights of patients, these programs offer compelling ways to foster openness and defuse what is often an emotional and difficult experience. Even so, these programs are not one-size-fits-all. For patients injured by clear negligence, saying "I'm sorry" does not repair physical disfigurement or relieve pain and suffering. Proper compensation must be provided.

Any "reform" that makes it more difficult for injured patients to seek legal recourse is unacceptable. Alternatives such as health courts not only deny people their guaranteed right to trial by jury, but they also nonsensically create a whole new bureaucracy to accommodate just one select profession.

Limiting the legal rights of patients will do nothing to provide insurance coverage or lower health care costs. Eliminating errors and keeping patients safe will most certainly accomplish these goals. And this is something all of us can support.

The brain injury attorneys and medical malpractice attorneys at the New York law firm of De Caro & Kaplen, LLP support changes in our health care system without limiting patient right's to sue for full and fair compensation.

More details about the Feres Doctrine and the Carmelo Rodriguez Medical Accountability Act of 2009 can be found at the American Association for Justice website.

Our law firm, DeCaro & Kaplen, LLP  handles medical negligence cases causing brain injury as well as other catastrophic personal injuries. 

Sounds similar to the fate of Natasha Richardson who also died suddenly after she struck her head.

The condition causing these sudden deaths is termed, "talk and die" syndrome.  What is implied by this terms is that someone hits their head and seems to initially be OK, but due to a rapid accumulation of blood, called epidural hemorrhage (bleeding between the skull and the brain), their are serious pressure changes within the brain, leading to death. 

The take away message is that any head injury must be taken seriously.  The individual experiencing the head trauma needs to checked out by qualified medical personnel to determine if the head injury requires treatment.

Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI.

It is important to determine if this procedure is really effective in reducing death and disability following a severe brain injury because there are many complications that can develop as a result of this procedure.

The complications surrounding this procedure are discussed in an article in the June issue of NeuroSurg Focus, vol.  26 No. 6  To evaluate the complications of decompressive craniectomy, a review of the literature was performed restricting information to literature pertaining to decompressive craniectomy for patients with TBI.

An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy.

The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI.

During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy.

The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.

It is important to realize that the impact of a traumatic brain injury may have long term consequences including premature death. Traumatic Brain Injury (TBI) for to many years has been overlooked as a source of long term disability and premature death.  The investigation and the studies cited in the news report have serious implications for the many service members returning from oversees with brain damage.  This signature wound may be a cause of premature death.  Who would argue that these service connected deaths are not entitled to proper compensation?

The following statistics are shocking:

Every year, about 5,000 people die and over 100,000 people are injured in large truck crashes. Despite only making up 3 percent of all registered vehicles, large trucks represent 9 percent of all vehicles involved in these fatal crashes and are responsible for 12 percent of all crash fatalities.

Fortunately, Congress is working on a new transportation spending bill that would prevent increases in truck sizes and weights on the National Highway System, including the Interstates – increases that endanger the safety of the motoring public, our roads and bridges.

America's highway infrastructure is crumbling, in part due to oversized trucks, which also are responsible for far too many crashes resulting in deaths and injuries. Also, the bigger the rig, the bigger the impact on greenhouse gas emissions and fuel consumption. We simply cannot afford all of the costs of allowing bigger and heavier trucks on our roads and highways.

PUBLIC CITIZEN, the national non-profit  public interest organization of which I am a proud supporter is seeking support for legislation currently pending in the United States House of Representatives:  H.R. 1618, the Safe Highways and Infrastructure Preservation Act of 2009.  They have requested that you contact your congress person and ask them to both co-sponsor and support this legislation.

Here is some language that you can use when writing to your congressal representative:

I am  writing to relay my strong support for H.R. 1618 and S. 779, the Safe Highways and Infrastructure Preservation Act of 2009 (SHIPA), and urge you to co-sponsor this important legislation. The SHIPA bill is co-sponsored by more than 80 Democratic and Republican Members of Congress, and supported by national highway and truck safety groups, victims and survivors of truck crashes, as well as leading national environmental and public interest organizations.

Every year about 5,000 people die in truck crashes including more than 800 truck
drivers and over 100,000 are injured. Large trucks represent 9 percent of all vehicle involved in fatal crashes, are responsible for 12 percent of all crash fatalities but make up only 3 percent of all registered vehicles.

The purpose of SHIPA is to prevent the constant increases in truck sizes and weights on Interstate and non-Interstate portions of the federal National Highway System (NHS) that endanger the motoring public as well as our roads and bridges. Enactment of SHIPA will extend the safety and infrastructure protection that was achieved in 1991 when Congress overwhelmingly enacted the freeze on longer combination vehicles (LCV) in the Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA).

Enacting H.R. 1618 and S. 779, the SHIPA Act, would save lives and prevent injuries, limit damage to our crumbling roads and bridges, reduce global warming pollution and curb our dependence on oil, and help achieve a balanced multi-modal transportation system. I urge you to support this sound and sensible legislation and look forward to working with you to build a safer, cleaner and more efficient transportation future for our nation.

Your assistance in protecting our nation’s roads and the health and safety of the public is appreciated.

In a new report  titled, Recommendations from the Expert Panel: Advanced Automatic Collision Notification and Triage of the Injured Patient  the  CDC looks at inboard car computer programs that provide information following a car crash.
 
This report presents the findings of a national expert panel and outlines recommendations for the use of new technologies, such as Advanced Automatic Collision Notification (AACN) or vehicle telematics, to help identify the likelihood of severe injuries, including traumatic brain injury (TBI), among individuals involved in a vehicle crash. 
 
The panel found that using available technology, such as AACN, shows promise in helping save lives through: 

•  the potential to predict the severity of injuries of vehicle crash victims, including Traumatic Brain Injury (TBI),  which can help emergency care providers more quickly identify, diagnose, transport, and treat injuries; and  
• Use of rapid communication and vehicle locating capabilities, which can help decrease response time by emergency medical services (EMS) providers.
  
  Read the full advanced automatic collision notification report now.

Whether you are a pool owner or guest, go to the lake or beach, safety is a priority. Kessler Institute for Rehabilitation has offered these  Top 10 Water Safety Tips:

• If you are a pool owner, be sure to have clearly marked depth indicators around the entire pool. Post “No Diving” signs - and enforce that rule!
• Watch your guests. More than 90% of injuries occur to visitors, rather than owners.
• Never dive into an above-ground pool and be careful around ladders and other equipment.
• Never drink and dive. “Drinking impairs an individual’s judgment and slows reactions,” explains Kirshblum. “Nearly half of all diving accidents resulting in a serious injury involve alcohol consumption.”
• Don’t swim alone. Ideally, a lifeguard or someone trained in water safety should always be present.
• Always check the depth of water before going in. Levels may be deceptive, especially where drought conditions existed. Be sure that there are no rocks or debris below the surface.
  Enter the water at lakes and ponds feet first to avoid injury.
• Never dive into the ocean. It’s difficult to see what’s under the surf, particularly sand bars. And tides constantly cause the ocean sands to shift.
• Even if areas are marked as being safe for diving, do not dive if your trajectory will place you in less than nine feet of water. When diving from a board, the water should be deeper than 12 feet.
• Educate children. Safe water behaviors should be taught at an early age so children can make smart decisions when involved in water activities.

Now the National Institute of Health (NIH) has provided an additional 14.5 million dollars for a three year comprehensive study that will enroll 1,140 patients at 17 medical centers across 17 states to further study the protective effects of progesterone in minimizing death and the long term consequences of traumatic brain injury. 

Read the full Emory press release: progesterone for traumatic brain injury.

The absence of proof is not proof of the absence of an injury and the fact that often times brain injury is not detected using MRI Studies does not mean that an individual did not suffer a traumatic brain injury. 

Newer MRI techniques such as the more powerful Tesla 3 MRI machines are now capable of detecting brain injuries that were missed in the past. Other useful techniques for detecting subtle brain injury include functional MRI studies (fMRI)
 
Three years ago, the Department of Veterans Affairs established a laboratory at the University of Texas at Austin with high expectations that it would conduct state-of-the art research into combat-related brain injuries using powerful MRI technology.  However after 3 years no studies have ever taken place!

Last month, the VA announced it was moving the facility to Waco, Texas, after spending more than $3 million without testing a single veteran with traumatic brain injury.  The Waco facility is reported to have the world’s most powerful research MRI machine.

The decision follows a two-year battle between VA and the former director of the Brain Injury and Recovery Laboratory, who has accused his superiors of fraud, mismanagement and wasting taxpayer money.

The uproar has sparked a congressional inquiry, an investigation by the federal Office of Special Counsel and several internal investigations.

Hopefully, research will finally get underway to objectively document subtle brain injuries in returning vets.

You can read more on the controversy and investigation of the Austin facility by clicking a story in the Washington Post , “VA Moves Texas Brain Laboratory After Years Pass Without Testing”

The researchers hope to determine whether single, non-impact blasts in battle can cause the same type of brain damage found in the brains of football players who have been subject to years of repetitive head injury.

They researchers also are interested in determining whether their are physical changes to the brain in service members who have been diagnosed with post traumatic stress disorder (PTSD) since many of the symptoms associated with this condition, such as depression, erratic behavior , diminished ability to concentrate are all similar to the post concussion symptoms faced by professional athletes and other concussion victims.

This semester’s lecture is focused on examining the various sources of information that is available on the internet in the area of traumatic brain injury. We will be exploring government web sites such as the Center For Disease Control and the National Institute of Health, great brain injury resource sites such as BrainLine, web sites that emphasize management of sports concussions, web sites that provide useful information on special education, various neuropsychological accrediting groups, brain injury association pages, brain injury professional societies and of course the brain injury news and information blog and brain law and the brain injury legal guide web site.

The Master's Degree Program in Special Education: Emphasis in Acquired Brain Injury is focused in addressing the national shortage of special education and related service personnel qualified to meet the needs of students with traumatic brain injuries (TBI) and their families. Graduates are uniquely prepared to be educators and systemic improvement specialists in schools, hospitals, rehabilitation programs, advocacy programs, and related organizations. Scholarship support for qualified students is available. You can obtain more information on the GW Acquired Brain Injury Program by clicking here.

The federal government has now recognized the need to address these behavior issues and has targeted funds and grant programs to address the special obstacles faced by incarcerated and about to be incarcerated youth who are at high risk of having and undiagnosed and untreated TBI that interferes with both physical and mental health.

These grants are part of the Presidential New Freedom Initiative to reduce barriers to community living for people with disabilities and to address lack of access of families to the services, advocacy and assistance they need as mandated in The Family Opportunity Act of 2005.

According to an announcement from the offices of Health and Human Services:

“ This initiative ultimately will provide for State systems change that is needed to assure that all high risk youth that are part of a juvenile corrections systems can be identified accurately and receive services that are appropriate for individuals with TBI. The overarching goal of this activity is to treat rather than just incarcerate youth with TBI so that they can ultimately become educated, productive, and contributing members of their communities Specifically, a State or Territory receiving these Targeted Issues in TBI Funds will be able to work across State systems to provide identification, appropriate treatment, including alternative education and training, mental health and substance abuse treatment, and diversion into those State Programs that can provide an environment that will encourage good decision making skills, risk avoidance, and independence. Because TBI is a multi faceted condition, requiring the skills of many professional disciplines, these grants will permit training for all involved professionals, including State Corrections and Probation officers. A careful evaluation of activities and their outcomes will provide much needed data to the field, as well as informing program progress monitoring to allow for program changes as needed. The evaluation of targeted issues grants should be particularly rigorous as they are first Step efforts in expanding knowledge in a particular field of interest in TBI. Core values across all MCHB programs include family-centered care, family professional partnerships and cultural and linguistic competence. These MUST be integrated throughout project policies and activities. MCHB will also require additional data and will provide technical assistance, as needed. Review criteria for all of these issues will be described in the guidance. Although a Letter or Email of Intent is not required, it is encouraged.”

You can link to the full announcement by clicking here.
 
     
   

The Brain Injury Association of Ohio is hold their 28th annual conference on Oct 1-2 in Columbus, Ohio.  More information is available at the Ohio Brain Injury Association web site.

You can view the video from the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

According to the Department of Defense, this multimedia public education effort makes reaching out easier by providing access to psychological health information and resources 24 hours a day, seven days a week. Individuals can chat online with psychological health coaches through the campaign website,  They may also reach out by calling the Outreach Center at 866-966-1020.

The Defense Department claims that this campaign is part of a larger effort "to ensure that warriors and their families can access necessary treatment for the invisible wounds of war as well as the visible wounds. Many service members and veterans deny themselves treatment for psychological wounds out of the fear that doing so would hurt their careers, embarrass them or harm their families."

The group had previously said that such athletes could return if cleared by a doctor or certified athletic trainer, but now contend that such determinations are too difficult and dangerous for same-day return to be considered safe.

When it comes to concussions, children and teens require different treatment, according to  the international experts who recently published their consensus recommendations. The British Journal of Sports Medicine's new guidelines say children and teens must be strictly monitored and activities restricted until fully healed. These restrictions include no return to the field of play, no return to school, and no cognitive activity.

The guidelines also point to the important role parents, coaches, and teachers play in assessing and treating young athletes."

For children and adolescents, the guidance strongly reiterates several key points for coaches, parents, and physicians:

• Injury to the developing brain, especially repeat concussions, may increase the risk of long term effects in children, so no return-to-play until completely symptom free.
• No child or adolescent athlete should ever return to play on the same day of an injury -- regardless of level of athletic performance. Children and adolescents may need a longer period of full rest and then gradual return to normal activities than adults.
• For children, "cognitive rest" is a key to recovery. While restrictions on physical activity restrictions are also important, cognitive rest must be carefully adhered to, including limits on cognitive stressors such as academic activities and at-home/social activities including text messaging, video games, and television watching.

The group's recommendations for children and adolescents were based on the fact that though 80 to 90 percent of adult concussions resolve in seven to 10 days, for children and adolescents, the recovery time is often longer. In all cases, the decision to "return-to-play" should be made based on the individual's progress, not a standard time period. Careful post-injury evaluation of the injured student-athlete is essential.

Health Care Reform Update

On June 9, 2009, the Senate Health, Education, Labor and Pensions (HELP) Committee released a draft health care reform bill.  In summary, the draft would expand Medicaid eligibility to those with incomes up to 150 percent of the federal poverty level, impose federal tax penalties on most individuals failing to purchase coverage, mandate a public plan option, require employers to provide coverage or pay into a pool, and stiffen regulation of private health insurance plans.

Importantly, the plan eliminates life-time insurance caps as well as provides for the establishment of a medical advisory council that will submit a report to the Secretary of Health and Human Services including recommendations on essential health care benefits eligible for credits which includes rehabilitative services. In issuing the report, the council will ensure that the recommendations take into account the needs of diverse segments of the population including persons with disability.

The HELP committee plans to begin considering this bill on June 16, 2009.  BIAA will continue to monitor the situation carefully.

NIDRR Grant Forecast

This week, The National Institute on Disability and Rehabilitation Research (NIDRR) announced it will include two TBI grant programs in its forecast for 2009. 

The first grant application notice, rehabilitation research and training centers (RRTC) on traumatic brain injury interventions, will be available on June 30, 2009, while the second, RRTC on developing strategies to foster community integration and participation for individuals with traumatic brain injury will be available on July 24, 2009.

BIAA will report on the details of these applications when they are released.

Coalition for Regenerative Stem Cell Medicine update

As part of the Coalition for Regenerative Stem Cell Medicine, BIAA enthusiastically endorses two important pieces of legislation aimed at advancing the therapeutic potential of newborn stem cells, the unique stem cells that can be collected immediately following birth from umbilical cord blood and the cord itself, as well as helping to advance the use of one's own newborn stem cells in regenerative medicine.

HR 1718 - The "Family Cord Blood Banking Act" amends Section 213(d) of the IRS Code to add cord blood banking services as a qualified medical expense. This change will allow individuals and couples to use tax advantaged dollars to pay for umbilical cord blood banking services through flexible spending accounts (FSAs), health savings accounts (HSAs) health reimbursement arrangements (HRAs) or the medical expenses tax deduction.

The "Family Cord Blood Banking Act" will make cord blood banking more affordable for American families and provides incentives to ensure that this valuable health resource is never thrown away.

HR. 2107 - The "Cord Blood Education and Awareness Act of 2009" will provide expectant mothers with straightforward, accurate and easy to understand information about the value of their child's umbilical cord blood stem cells. It will offer a government stamp of approval on all available cord blood banking options and will give expectant parents confidence in the information they are reviewing.

Shana is also is an officer of the American Association for Justice, Traumatic Brain Injury Litigation Group, a trustee of the Civil Justice Foundation and an editor of the New York State Academy of Trial Lawyer's monthly legal update.