Traumatic Brain Injury Blog

April 11, 2014

“Unprecedented breakthrough” offers potential for recovery from paralysis

Scientists announce dramatic research where epidural stimulation offers potential for recovery from paralysis following spinal cord injury

Nearly six million Americans are living with paralysis, including 1.275 million spinal cord injuries. Most have been told that no recovery is possible and that complete paralysis is permanent. This belief was fundamentally challenged with the announcement on April 8, 2014 by international team of scientists at the University of Louisville, UCLA and the Pavlov Institute of Physiology, that four young men who had been paralyzed for years were able to voluntarily move their hips, ankles and toes following the implantation of an epidural electrical stimulator. These results were published in journal Brain. Read More

March 25, 2014

Visual Dysfunctions following Concussion and other Traumatic Brain Injuries

Recent literature has highlighted the prevalence of dysfunctions in vision following traumatic brain injuries of all levels of severity (including concussion.) Research published by the Veterans Administration (VA) in 2012 indicates that the percentage of TBI victims with vision problems could be as high as 60%.  They explain that this prevalence is not surprising, since over 50% of the brain is involved in visual processing. Alvarez et. al. explain how visual and other symptoms occur when the brain is subjected to  “acceleration/deceleration” forces: Read More

March 3, 2014

The Power of Mindfulness

I travel between two worlds that may appear far apart – by day I am a trial lawyer with a focus on traumatic brain injury; nights and weekends I am a yoga teacher. I increasingly find that these worlds are very close together. 

As a brain injury lawyer I work with people struggling to recover from the loss of sense of self so often caused by brain injury as well as associated depression and chronic pain. Many of my clients have reported meaningful increases in the quality of their lives following injury through “mindfulness” practices such as yoga and meditation. Practices such as yoga are designed to increase awareness of the present moment, to increase awareness of our thoughts, emotions and physical sensations without filtering them through past experience or fears of the future – to recapture our sense of ourselves. Read More

February 4, 2014

New Guidance for Patients and Clinicians on Managing Concussion Symptoms

Defense and Veterans Brain Injury Center logoOn January 23, 2014 the Defense and Veterans Brain Injury Center released new clinical recommendations with a standardized approach for concussion recovery.  Included in the recommendations for managing concussion symptoms is a first of its kind five-stage approach for return to activity following a concussion.  Detailed “do”s and “do not”s  are specified for each stage. Movement from stage to stage is determined by scores on a simple twenty-two item “neurobehavioral symptom inventory” included in the recommendations.  Read More

January 7, 2014

NFL and NCAA Under Increased Pressure to Manage the Long-Term Effects of Concussions

In August, 2013, the NFL announced that it had reached a $765 million dollar settlement of claims by more than 4,500 players alleging that they were suffering from long-term consequences of concussions that the NFL had known about for years, hid from players, and failed to minimize by establishing appropriate protocols for return to play.  The alleged cover-up by the NFL, with co-conspirators in the medical community, was recently the subject of an extensively researched PBS Frontline special titled “League of Denial.” 

By settling the players’ claims early in the litigation it appeared that the league would avoid further examination of what the league knew and when it knew about the long-term effects of concussion. However, several recent developments indicate that these issues will likely be examined further. The judge overseeing the litigation has appointed a “special master” to make recommendations concerning the settlement and the Brain Injury Association of America has  petitioned to intervene in the litigation to make sure that the settlement takes proper account of the

“progressive physical, psychiatric and cognitive disease processes that are caused and/or accelerated by brain injury, but may not  manifest in clinically significant symptoms on initial presentation.”

Read More

December 11, 2013

Functional Brain Imaging Helps Explain Post-Concussion Symptoms and Role of Exercise in Healing

Using functional brain imaging (fMRI) a multidisciplinary team of researchers at the University of Buffalo have documented metabolic and physiologic changes in the brains of patients experiencing post-concussion symptoms. They found improvements in both imaging findings and in patient symptoms following a  controlled, progressive aerobic exercise program. The results have been published in both the Journal of Head Trauma Rehabilitation   and in Current Sports Medicine Reports and are summarized in UB news releases. Read More

December 4, 2013

New Blood Biomarker Accurately Predicts Long-Term Disability Following Concussion

In a study published November 18, 2013 in Frontiers in Neurology, researchers from Penn and Baylor report that they have identified a blood biomarker – SNTF – that if found on the day of injury predicts with substantial accuracy both cognitive impairment persisting more than 3 months and the existence of abnormal brain imaging finding in the corpus callosum and uncinate fasciculus of the brain (using diffusion tensor imaging (DTI). Read More

November 25, 2013

American Academy of Neurology: Brain Shows Evidence of Injury Following Concussion after Acute Symptoms have Dissipated

There has been much debate over what happens to the brain following a concussion, much of it recently focused on concussions in sports. One side of the debate maintains that concussions, also referred to as “mild traumatic brain injuries,” involve only a very short term disruption of brain function with no damage to the brain.  As discussed in previous posts, this view has been discounted by a growing body of research  involving advanced imaging technologies as well as post-mortem  pathological studies showing that in a minority of cases concussions can cause lasting damage to the brain as well as persistent symptoms.

On November 20, 2013 the medical journal of the American Academy of Neurology, a professional organization representing 21,000 neurologists and neuroscientists, published findings that after a “mild” concussion, brain scans using diffuse tensor imaging technology, showed grey matter abnormalities on both sides of the frontal cortex. Read More

October 24, 2013

Classifying TBI as Mild, Moderate or Severe is Outdated and Counterproductive

The August issue of the Journal of the American Medical Association (JAMA) includes a “Viewpoint” by two leading neuroscientists promoting the use of an “International Knowledge-Based Approach” to traumatic brain injury (TBI).

One of the causes of the failure of clinical trials to successfully treat TBI, the authors contend, is the common classification of TBIs as “mild, moderate or severe.”  These classifications do not incorporate newer insights and findings from diagnostic tools such as imaging and biomarkers and therefore do not promote “mechanistic targeting” for clinical trials. The authors support the transition to a more nuanced approach, a precise disease classification model that is based on the precise pathoanatomical and molecular features of the injury.  Read More

September 25, 2013

Flaws in the Defense Case that mTBI has no Lasting Effect: The Problem with Meta-analysis

Defense attorneys often cite “meta-analytic” reviews of neurological studies to make the argument that “mild” traumatic brain injuries (mTBIs)  cause no lasting effect beyond three months post-injury.  A “meta-analysis” involves a statistical study of multiple studies published in the literature. 

Meta-analyses in mTBI are often used to show that persistent symptoms are “neurotic” rather than “organic”

Fortunately, it is generally agreed that the majority of people who suffer mTBIs, sometimes referred to as “concussions”, report full recovery from symptoms within three months of the injury – in fact many recover much faster. A great deal of research over the past few years has focused on the minority of people who do not fully recover within three months, described as having a “persistent post-concussion symptoms (PCS).”  These patients are sometimes referred to as the “miserable minority.” The “meta-analyses” are often cited as demonstrating that changes in performance after three months have “limited statistical and clinical significance;” in other words, that persistent symptoms must be psychological or “neurotic” rather than “organic” or neurologic. Read More