Imagine you are a parent whose child has sustained a brain injury through something as enjoyable as playing a sport or as horrific as abuse by a caretaker or as patriotic as serving our country as a member of the armed forces. Wouldn’t you want the best system of care possible to maximize the chances of recovery and quality of life for your child? There are many tragic stories about children and youth with brain injury; Congress has an opportunity to provide support and hope for them.

That’s the goal of H.R. 2600, a new bill introduced in the U.S. House of Representatives. Also known as the National Pediatric Acquired Brain Injury Plan Act (PABI Plan Act), this bill would help create a standardized, evidence-based system of universally available care for young people (ages 25 and younger), including those serving in the armed forces. The PABI Plan Act would ensure care at all stages of brain injury, beginning with prevention, and including emergency and acute treatment in medical facilities, reintegration into schools and communities, and transition into an adult system of independent living.

H.R. 2600 was introduced to Congress on July 20, 2011 by Republican Leonard Lance of New Jersey, and it has been referred to committee. But the bill has seemingly stalled, despite the fact that the bill has more than 100 co-sponsors in a rare bipartisan effort. Co-sponsors from North Carolina include:

• Rep. Walter Jones [R, NC-3]
• Rep Larry Kissell [D, NC-8]
• Rep. Mike McIntyre [D, NC-7]
• Rep. Bradley Miller [D, NC-13]

Funding for H.R. 2600 would come from discretionary money held by the Secretary of Health and Human Services, and would not add to the budget deficit.

This is an important bill that would help children and young adults recover as much as possible, and receive support as they age into adults.

“The ultimate goal of the PABI Plan Act is to maximize recovery, enhance quality of life and ensure that New Jersey — and American — youth have the best chance to live productive and meaningful lives,” said Barbara Geiger-Parker, president and CEO of the Brain Injury Association of New Jersey, a nonprofit organization whose mission it is to support and advocate for individuals affected by brain injury and raise public awareness through education and prevention.

We urge concerned individuals to contact their Representative and voice support for the PABI Plan Act. To find contact information for your Representative, click here:  GovTrack.us

To read the full article on NJ.com, click here:  More support needed

“]

[from Montreal Gazette

So you can only imagine the guts it took for Jack Todd, the famous sports columnist writing in the Montreal Gazette, to suggest an outright ban on fighting in the National Hockey League (NHL). In his own words:

Enough is enough. It’s time to outlaw fighting in hockey, to put an end to the game’s goon culture for once and for all…. The toll fighting takes on the fighters is too great. The stress is too much, the constant pain, the accumulated affects of too many punches, too many painkillers, too much alcohol mixed with the painkillers.

The article comes on the heels of the death of 35-year-old Wade Belak, a former hockey enforcer who just retired in March. He committed suicide August 31, 2011, in a hotel room in Toronto, where he was preparing for a TV reality show called “Battle of the Blades.” Belak’s death has raised more questions about the possible effects of chronic traumatic encephalopathy (CTE)—a degenerative brain disease linked with repeated hard hits. According to an article on MercuryNews.com:

“We’ll never know with any certainty when someone commits suicide whether CTE played a role,” said Dr. Robert Cantu, a prominent neurosurgeon who is co-director of the Center for the Study of Traumatic Encephalopathy at Boston University’s School of Medicine. “We do know CTE attacks the portion of the brain that controls functions of memory, emotion, addictive behavior and impulse control, the latter associated with suicide. And so we’re clear, in some cases the people involved may well have had emotional issues before its onset. But every time I read or hear about these tragedies, my first question is, ‘Did CTE play a role?’ “

Belak’s death was the third in this recent post-season. About two weeks earlier, 27-year-old Rick Rypien was found dead in his home. And four months before Belak killed himself, 28-year-old hockey player Derek Boogaard died from an accidental overdose of the narcotic painkiller oxycodone and alcohol. Dr. Cantu’s group is now studying Boogaard’s brain.

“There’s no way to know how much was damage caused by fighting as opposed to hits to the head sustained in the normal course of playing the game. Personally, though, I suspect it’s caused more by fighting,” Cantu said. “In my practice, when I’ve studied ‘enforcer-type’ guys and we discuss fights, they say roughly one in four times they get concussed. But they never bring it to the trainer’s attention. They just go to the box and try to recover enough to make it back to the bench when the penalty’s over. It’s the code. They’re afraid if they admit it, they’ll be out of a job.”

There are a growing number of people who believe that the deaths of these three young men should be a call to arms…or rather, a call to lay down arms. To remove fights from the hockey equation. To get rid of the goon squads.

On the other side of the proverbial table are the fight proponents, who believe that the passion of hockey requires that the passion be expressed in battle, and battering. But, as Jack Todd says, Football is also fast, passionate, and violent, but fighting is not allowed on the gridiron. And he continues:

As long as the NHL permits fighting, it will be a bit bushleague, with one skate in the big-time and the other firmly planted in roller derby. The league is growing up in the way it is beginning to deal in a meaningful way with concussions and the awful toll they take on its talent. (You need look no further than the probable end of Marc Savard’s career to know how serious the concussion issue is.)

Now it’s time to move on and to put an end to fighting. Call it the Wade Belak Rule if you like. If his death can help bring about an end to fighting in the NHL, then something good might come of what is otherwise a senseless, heartbending tragedy, the death of a father of two young girls at a time that should have been the prime of his life.

Here’s to the Wade Belak Rule. Let’s hope the owners, fans, and players find a way to make this happen.

RESOURCES

To read the full article in the Gazette, click here:  The NHL must ban fighting

To read the full article on the MercuryNews.com, click here:  Questions linger over recent deaths of three NHL enforcers

To read the article about Wade Belak, click here:  Wade Belak Found Dead

“]

[The New York Times

According to an article in The New York Times, the university disagrees:

Liz Medcalf, a spokeswoman for Frostburg State, said Sheely had been participating in “regular drills” with his teammates Aug. 22 when he began feeling woozy. He was being helped off the field when he collapsed.

Every year, two to five high school football players died as a result of on-field brain injuries. According to research by the University of North Carolina National Center for Catastrophic Sport Injury Research, teenagers are more susceptible to brain injury from multiple hits to the head—a condition known as second impact syndrome. That’s because their teenaged brains are still developing. In a young man of Derek Sheely’s age, second impact syndrome is quite rare, which is why the university doesn’t believe that the cause of death was head trauma. According to The New York Times:

Sheely was first taken to the emergency room at Western Maryland Regional Medical Center in nearby Cumberland and was later transferred to the shock trauma center in Baltimore when the severity of the injury was recognized. He was listed in critical but stable condition last Wednesday after multiple operations, according to hospital officials. But the pressure in his brain from swelling could not be alleviated.

Derek’s father says that he needs to find the cause of his son’s death…not to find a place to lay blame, but to make sure that other young men don’t have to die.

“We’re not blaming anybody; that isn’t our mission right now. But hopefully, somebody does make sure that if there’s a lesson to be learned and it can help protect somebody else, then that should be done. I wouldn’t want my son to just die in vain, and if something can be made better, through education or equipment or whatever it is, that would be helpful.”

On July 4, 2011, ABC World News reported that Philip A. Contos, 55, died while participating in a ride with 550 other motorcyclists to protest the state’s mandatory helmet law. With so many witnesses, the details are clear: Contos hit the brakes, and his Harley Davidson motorcycle fishtailed. He was thrown over the handlebars, hit his head on the pavement, and was pronounced dead at the hospital. According to a State Trooper interviewed by ABC News:

“The medical expert we discussed the case with who pronounced him [Contos] deceased stated that he would’ve no doubt survived the accident had he been wearing a helmet,” state Trooper Jack Keller told ABC News 9 in Syracuse. [ABC World News]

The rally rid was sponsored by ABATE–American Bikers Aimed Toward Education. Their goal is to promote motorcycle awareness and freedom. Despite the death, ABATE still supports the repeal of helmet laws. According to the ABATE of New York website:

“Mandatory helmet laws do nothing to prevent accidents. The decision on when to wear a helmet while operating a motorcycle should remain with each responsible adult rider.”

It is true that wearing a helmet does nothing to prevent accidents. However, it is also true that in the event of an accident, a biker wearing a helmet is more likely to survive a head injury, and will have less brain injury than a biker not wearing a helmet. It’s like saying steel-toed shoes won’t prevent warehouse accidents–true, but they will protect your toes should something fall on your foot.

According to a recent report by the Insurance Journal, Delaware (the only state included in the report) saw deaths from motorcycle crashes increase by more than 300% in the past year, compared with the previous year. Of those deaths, 80% occurred when riders were not wearing helmets.

At HensonFuerst, we have seen the aftermath of severe head and brain injury caused by auto and motorcycle wrecks, and we have represented and consoled many families grieving the loss of a loved one. From our perspective, helmet laws are in place to protect people who might be too short-sighted to recognize the physical damage that can occur after just a split second of poor judgment…or after another motorist causes an accident…or when road conditions become treacherous.

We’re not saying motorcyclists are unsafe–some of the bikers we know are better and safer on the road than many car drivers. We’re saying that protections are needed so that everyone stays as healthy and intact as possible should the worst occur.

To read more about motor vehicle safety, please feel free to visit our website at http://www.lawmed.com/.  If you have questions, HensonFuerst has answers.

Rep. Gabrielle Giffords’ attending physician called the Arizona congresswoman’s recovery “ideal” and “typical for those who have the ability and access to the right resources” to recuperate from a debilitating injury.

But not everyone has those resources, said Dr. Gerard Francisco during a congressional briefing in Washington on Thursday [June 23, 2011] to support rehabilitation in America’s health care system.

According to Giffords’ doctor, Giffords stayed 4 months in the hospital, but not everyone can stay that long because of insurance limitations…and that she was allowed 4 months in-patient treatment because she is a public figure. In most hospitals, an individual with Giffords’ type of injury would be sent home after less than a month as an in-patient.

“Many people now do not have the appreciation for how brain injury rehabilitation has to be done,” Francisco said. “Unfortunately, we have had to take a lot of shortcuts in the past decade, when patients stay for under a month.”

If there is any good to come from this tragic shooting, perhaps it might be the start of a national discussion and change in how health insurance deals with the rehabilitation of people with brain injuries.

To read the full article, click here:  Giffords’ recovery praised by doctor, who tells Washington to support rehab

There is some good news in the report:  The death rate from TBI-related injuries decreased by 8.2% compared to the previous 10 years. However, the bad news far outweighs the good. According to the CDC:

• About one-third of all injury-related deaths—or about 53,000 cases—involve traumatic brain injury.
• Despite the overall decreased death rate, the rate of TBI-related death increased for people age 75 and older.
• TBI deaths are three times higher among men than women.
• The top three causes of TBI-related deaths are firearms, automobile wrecks, and falls. Compared to the previous 10 years, the incidence of deaths related to falls is the only one to have increased.

To read a full copy of the report, click here:  CDC report on TBI

• Bethany Norwood, a Texas cheerleader who was paralyzed in 2004 when her teammates failed to catch her after tossing her in the air. A squad member told Norwood’s father that the squad was practicing without the supervision or assistance of a coach or adviser. Norwood subsequently died of complications from the injury.
• Elizabeth Knicks, a cheerleader from California, who toppled to the ground during a pyramid-style stunt. She landed on her head, and ended up with massive brain damage, retardation, and paralysis. Knicks can no longer eat or walk on her own.
• Jessica Smith, a 4-foot-11-inch cheer “flyer” who was paralyzed from the waist down. According to sacmag.com, the injury occurred during a practice session with the squad at Sacramento City College. She was asked to perform a new trick requiring her to perform an airborne handstand, be caught belly down and then thrown again before landing in the arms of her teammates. But things went awry when the cheerleader whose head she was being hurled over lost his balance, leaving Smith wide open to sail down from a height of some 15 feet.
• Laura Jackson, who was paralyzed from the neck down after trying to perform a back tuck, but landing on her head. According to Jackson, there was no spotter during the stunt, even though coaches were present.

Questions Parents Can Ask

Dr. Amy Miller Bohn, a physician with the University of Michigan Health System, suggests that parents of cheer athletes can play a role in helping to prevent severe injuries. They should ask questions about:

• The coach’s experience
• What type of athletes the coach has worked with
• Whether coaches have experience with gymnastics stunt work
• What the plan for the squad is
• What types of activities the squad will be asked to perform
• Who will be supervising the practices
• Where activities will be performed
• What type of safety equipment will be available during practices

According to an article in U.S. News & World Report, parents should check out the practice space to make sure it is safe. Foam mats should always be used for training. Stunts should not be practiced on a hard basketball gym floor. Spotters should stand by when a new stunt or gymnastic move is being learned—that’s trained and competent spotters, not another teenage girl just learning the routine. In addition, if your child’s coach expects a high level of gymnastic ability, consider supplemental lessons at a certified gymnastics gym, rather than relying on cheerleading practice alone.

According to nationally recognized cheer safety expert Rusty McKinley:

Safety, first and foremost, will allow any athlete to reach his or her physical and mental potential.  Only when athletes recognizes that the Coach/Leadership values safety will they feel safe enough to give their best efforts.

This is an important issue, with potentially devastating results for cheer athletes who are not given the appropriate training and protections. Perhaps in the next opportunity, the courts will finally see what seems obvious: Cheerleaders are athletes.

It seems clear that cheer athletes need all the safety measures they can get.

Dr. Frederick O. Mueller is the director of the National Center for Catastrophic Sports Injury Research (NCCSIR), located at the University of North Carolina at Chapel Hill.  The center collects catastrophic (fatalities and permanent disability) injury data for high school and college athletes on a national level. The center has been in existence since 1982 and is funded annually by the National Collegiate Athletic Association (NCAA). According to the latest report on catastrophic injuries:

Catastrophic injuries to female athletes have increased over the years. As an example, in 1982-83 there was one female catastrophic injury and during the past 27 years there has been an average of 8.8 per year. A major factor in this increase has been the change in cheerleading activity, which now involves gymnastic type stunts. If these cheerleading activities are not taught by a competent coach and keep increasing in difficulty, catastrophic injuries will continue to be a part of cheerleading. [Twenty-seventh Annual Report; italics added by blogger]

Rusty McKinley, a pioneer and nationally recognized expert in cheer safety, agrees. He reports that the total number of cheer-related injuries has been rising as the raw numbers of participants have been increasing; however, the percentage of injuries has increased significantly faster in comparison to the competitors. This is because, without proper coaching by highly trained individuals, cheer athletes are being asked to attempt new, complex skills… without necessarily mastering the fundamentals.

To me, this situation is similar to a parent handing their 15-year-old child the keys to a brand new car, without any safety training, and without having been taught safe-driving skills by an experienced and licensed driver:  It will result in an injury. [personal communication with Mr. McKinley]

So, where will that skilled, educated, and experienced coaching come from?  It’s not clear.

“Chunk It”

Right now, the only certification can come from the American Association of Cheerleading Coaches and Administrators (AACCA). This organization began in the late 1980s under the disguise of providing safety training for different levels of advisers. Today, the distinctions among the various levels of leadership have been blurred.  According to McKinley, the AACCA basically:

…allows anyone who desires to hang out a sign as a “Coach” the ability to start or sponsor either a school-based squad or an All Star squad.  I received a certification after only 2.5 hours of book-learning and an open-book test–no hands-on experience was required or tested.

Given Dr. Mueller’s work on catastrophic injury to cheer athletes, wouldn’t it be logical to assume that the largest cheer industry organization would welcome more safety measures?  Unfortunately, the answer isn’t logical:  The Cheer industry not only ignores Dr. Mueller’s safety recommendations, but they actually have gone so far as to say the work is inaccurate. (This is despite the fact that Dr. Mueller is recognized by all U.S. and many foreign sport officials as the first researcher of historic injury data for all competitive sports requiring the need for rule, equipment, and technique changes to keep the sport safe.)

The Cheer industry expresses its attitude toward safety in one of the more colorful phrases in Cheer terminology: Just Chunk It! When a cheer athlete isn’t sure of her part in performing a movement, she’s likely to hear, “Well…just “chunk it.” It means just try and do something and we’ll work out the details later.  That’s how severe injuries occur.

“Chunk It” is really a great term for the Cheer industry reaction to all the research that could create a safe environment:   just chunk it!

Check in next week for the last installment of our 3-part series on why Cheerleaders are Athletes, and why safety cannot…and should not…be ignored.

That sure sounds like a sport to me. What would you call it?

Well, officially, cheer is not a sport. (And by the way, advocates now prefer the term “cheer” to “cheerleading,” mainly because the nature of the activity has changed almost to the point of being unrecognizable since the early days of pom-poms and calls of S-U-C-C-E-S-S.)  But in July 2010, U.S. District Judge Stefan Underhill ruled that cheer is not a sport because it is “too underdeveloped and disorganized.” I’m not sure what he looked at to make his decision, but cheer is one of the most organized activities around–there are cheer squads in nearly every middle school, high school, and college…participants are taught and coached in standard moves…and the competition circuit is big business.

Why definitions are important

Whether cheer is defined as a sport or as merely an athletic activity has repercussions that go beyond ego. Sometimes it’s a question of available funding from colleges or sponsors, and sometimes it’s about reputation and respect–cheerleaders are admired, but rarely honored for their combination of brains and athleticism.

But even more important is how defining cheer as a sport would affect safety of the participants. A true sport requires coaches to have a certain level of training and certification; a “sport” puts limits on the risks required of the participants; and a “sport” makes training and safety an integral part of practice and performance. Unfortunately, in most schools, cheering lacks safety, limits, and trained coaches. That’s why cheer accounts for more than 65% of of all high school catastrophic injuries, and more than 70% of all collegiate catastrophic injuries. (For the record, “catastrophic injuries” are life changing events, including traumatic brain injury, paralysis, and death.)  Less severe injuries are also common–each year, this sport sends more than 25,000 female students to hospital emergency rooms.

A Cheer Advocate Speaks Out

In June 2010, we posted a blog that listed guidelines to help prevent cheer injuries, as recommended by Frederick O. Mueller, Ph.D., Director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill (UNC-CH). It’s a long list, so we won’t repeat it now, but you can read the full blog here: When Is a Sport Not a Sport?

After it was posted, we heard from one of the all-time great cheer coaches, Rusty McKinley. In his career, McKinley was Spirit Director at the University of Southern Mississippi, followed by eight years as Cheer Advisor/Coach at the University of Memphis. He authored two books:  The Complete Partner Stunt Book and NCA Pyramids. Currently, he is a nationally known and respected expert in the area of cheer safety. (I know he’s going to be embarrassed that I put it that way.) He was even one of the featured interviews in the cheer safety episode of the Emmy-nominated television show Penn & Teller: Bullshit! (season 8, episode 1: Cheerleading).

McKinley reports that the state of cheer safety is worse than most people think. He recently obtained the AACCA Certification–a safety certification from the American Association of Cheerleading Coaches and Administrators. Sounds impressive, right? As McKinley said:

The entire course, 2.5 hours, is dedicated to walking you through the AACCA Manual and highlighting the areas that will be on the Open Book test that follows. No “hands on” experiences are required or tested in any fashion.  The periodic update requires 20 minutes online, again without hands on training or demonstrations.

McKinley has given us a wealth of information about the state of cheer safety, as well as some solid suggestions for how parents, schools, coaches and all the rest of us can help keep these athletes safe from traumatic brain injury and other catastrophes.

This is the first of a 3-part series we’re writing on cheer safety. Part 2 will be posted May 2, 2011 and Part 3 will be posted on May 9, 2011.

Meanwhile, if you have questions about cheer safety, please send them to our researcher, carol@lawmed.com. We’ll do our best to answer them online.

If someone you know has a cheer injury…

To report a cheerleading injury to make statistical reporting more accurate, go to www.cheerinjuryreport.com, sponsored by the National Cheer Safety Foundation. For more information about traumatic brain injury, or to request a legal consultation for a cheer injury, visit our dedicated web page.

If you have questions, HensonFuerst has answers.

Of course, finding a good, experienced attorney is sometimes more difficult than it might seem. Here are some guidelines to help you locate the best lawyer for you and your case.

1. Ask for recommendations. To find the top lawyers in your area, talk with the doctors and nurses…talk with families of other brain injury victims…talk with brain injury support groups. Write down the names of attorneys they recommend. At the end of this process, you should have several names that repeat. These can form the first-tier options.
2. Make appointments to speak with 2 or 3 attorneys. The initial consultation for a brain injury case should be free of charge–ask to make sure there is no fee for this first visit.
3. Evaluate the lawyers for a good personal fit. If you end up pursuing a lawsuit, you could end up in a decades-long relationship with your lawyer. You need to know that the person you hire is experienced and competent certainly, but also trustworthy, compassionate, and understanding of your situation.
4. Ask probing questions. During the initial consultation, it is the lawyer’s job to ask you about your case…and it is your job to ask questions about the lawyer’s experience and commitment to brain injury causes. Questions to ask:

• • How many TBI cases have you handled? When was your first TBI case?
  • What types of TBI cases have you handled–concussion…brain bleed…severe…moderate?
  • What is the most severe brain injury you have ever handled, and how did the case progress? (A lawyer won’t be able to give names or personal information, but should be able to talk generally about the case.)
  • How are you involved with the brain injury community? Which Brain Injury Associations are you a member of?
  • What is the most significant change in brain injury treatment you have seen over the course of your career?

By asking these questions, you’ll get a good feel for whether the lawyer really is experienced and involved, and has detailed knowledge of brain injury and its challenges.

For more information, please visit the HensonFuerst website at http://www.lawmed.com/. We have an entire section devoted to traumatic brain injury. And if you would like to speak with one of our experienced brain injury lawyers, give us a call anytime at 1-800-4LAW-MED. If you have questions, HensonFuerst has answers.