What survives of a marriage when a spouse suffers brain injury?

According to an article in The New York Times, that’s the question being investigated by Dr. Jeffrey S. Kreutzer and other psychologists at Virginia Commonwealth University (V.C.U.) in Richmond. In addition, the psychologists are working to develop marriage counseling techniques for affected couples.

According to a 2007 article published in the journal NeuroRehabilitation, when a spouse suffers a brain injury, the risk of divorce is surprisingly low—approximately 17 percent. Well below the national average for uninjured couples. But the statistic may not be an accurate reflection of the health of the marriages—the couples aren’t necessarily happy. According to Dr. Kreutzer: “While people may technically be married, the quality of their relationship has been seriously diminished.” According to The New York Times:

Dr. Kreutzer and other psychologists at V.C.U. are among the few therapists in the country trying to develop marriage counseling techniques tailored to couples dealing with brain injuries. Traditional marriage counselors often hope to restore people and their relationships to their original luster. For Dr. Kreutzer and his team, recovery often means teaching uninjured spouses to forge a relationship with a profoundly changed person — and helping injured spouses to accept that they are changed people.

“Changed” doesn’t begin to describe what some spouses experience.

Depending on the severity of the brain injury, an individual may be considerably changed by the injury…so much so that he or she may seem like an entirely different person. Injured people often have difficulties with attention, concentration, memory, reading, writing, and speaking. They may appear confused, have trouble with physical coordination, and become impulsive—buying expensive items they can’t afford, take off on trips without notification, or other potentially damaging behaviors. And then there are the possible personality changes:  aggressiveness, irritability, mood swings, depression, lack of motivation, and poor judgment. While every person experiences a different constellation of symptoms, even a small number of these symptoms can make the spouse of a brain-injured individual wonder what happened to the person they married.

The article in The New York Times talks about the experiences of Terry Curtis—who suffered brain injury from a tumor and the surgery needed to remove it—and his wife Vicky:

Mrs. Curtis, 60, was once drawn to her husband’s “sparkle,” she said. After the injury, he “flat-lined” emotionally, and he suffers from depression, anxiety and a lack of motivation. Her husband sometimes makes erratic decisions, she added, like the time he decided to take a do-it-yourself approach to the plumbing at their home in Coralville, Iowa. “Not a good picture when I got home,” Mrs. Curtis said. “And you can yell at him like a little kid, but he didn’t know any better.”

Once a software programming analyst, Mr. Curtis, 57, has “a lot fewer interests” than he did before the injury, and he estimates he has lost 90 percent of his friends.

“It’s a new you,” he said, “and they just can’t cope with that.”

It’s worse for a spouse, who lives with the changed person. According to the psychologists, the factor that seems to keep marriages from falling apart is guilt. It’s hard to be the kind of person who gets a divorce from a brain-injured person. The goal in therapy is to help the couple see that the person will not ever be exactly the same…that they will have to deal with a “new normal” in their lives…but that it may be possible to rediscover a new facet to the old relationship.

That may be the real definition of hope.

To read the full article in The New York Times, click here:  When Injuries to the Brain Tear at Hearts

To learn more about traumatic brain injuries, visit our dedicated webpage here:  HensonFuerst TBI page

Over the course of a year, we write hundreds of blogs. In case you missed some, here is a round-up of the most important traumatic brain injury (TBI) stories of the year. (To read any of the blogs, click on the title and you’ll be taken directly to the story.)

U.S. Representative Gabrielle Giffords

The year did not start off well. On January 8, 2011, a man went on a shooting rampage in Tucson, Arizona. Six people were killed, 13 were injured, including U.S. Representative Gabrielle Giffords, who was shot in the head. The rapid response of the medical team saved the lives of a dozen people shot in the rampage, including Giffords’. Over the course of the year, her recovery has been better than anyone could have predicted, a tribute to the medical advances in brain injury treatment.

• Arizona Shooting Spree Aftermath
• Gabrielle Giffords’ Recovery Called Ideal

Long-Term Effect of Concussion

The biggest brain injury story by far is about the long-term effects of concussion, especially in athletes. This year, scientists linked multiple concussions to chronic traumatic encephalopathy (CTE), a kind of central nervous system damage that happens when people suffer repeated head injuries, typically soldiers or athletes in high impact sports, such as football or ice hockey. Early symptoms of CTE include memory problems, difficulty concentrating, and disorientation. As the disease progresses, people with CTE show behavioral problems—poor judgment, aggression, sexual compulsiveness, erratic behavior, and drug and alcohol abuse—as well as increasing nervous system symptoms, including tremors, staggering gait, deafness, and dementia. Unfortunately, the only way to definitely diagnose CTE is to examine the brain of the affected individual during an autopsy. From kids to football players to hockey teams, concussion has been the biggest TBI story of the year.

• Concussion Has Long-Term Effects for Teen Athletes
• Football Player Dave Duerson Donates Brain to Research
• NFL to Diagnose Player Concussions on the Sidelines
• Will NHL Take Action Against Concussion?
• Athletes’ Dementia: New Name for an Old Disease
• What You Need to Know About Youth Sports Concussion
• Football Players Sue League Over Concussion Risks
• Football Players Demand Better Health Monitoring
• Repeated Head Trauma Can Lead to CTE
• Kids Suffer Long-Term Effects from Head Trauma

Cheer Safety

What do you call an activity requires strength, stamina, flexibility, agility, planning, and coordination with team members?  What if the participants were required to train with weight-training and aerobic exercises?  And what if that activity was performed in gymnasiums, in stadiums, and on outdoor fields?  And what if teams competed regionally and nationally? Sounds like a sport, right? Well, not to sports authorities. Cheer (what used to be called “cheerleading”) injures participants like a sport, including some devastating head injuries. That’s why we wrote a 3-part series on cheer as a sport.

• Cheerleaders Are Athletes, Part One
• Cheerleaders Are Athletes, Part Two
• Cheerleaders Are Athletes, Part Three

How to Hire an Experienced Brain Injury Lawyer

TBI is a difficult, complex injury for doctors to treat…and for lawyers to pursue. If you are considering pursuing a legal case, it’s important to choose an attorney who knows the complicated ins and outs of brain injury. That’s why we’ve provided this guide:

• How to Hire an Experienced Brain Injury Lawyer

VIDEOS

In addition to blogs, we also create videos about important health, medical, and legal topics. To see all of our available videos, please visit our YouTube channel here:  HensonFuerst YouTube Channel

Here are links to some of our brain injury videos:

Symptoms of Concussion

Epidemic of Concussion in Youth Sports

Hiring an Experienced Brain Injury Lawyer

A new product is the latest tool to  combat sports concussions. The Impact Indicator (by manufacturer Battle) is a chin strap that connects to a player’s helmet.  It measures the force and duration of a hit to the head: When first connected, the impact indicator LED light on the chin is green…but after a hard hit, the indicator turns red. This can be a signal of a potential head injury, so that coaches and players can act appropriately.

The device, which costs about $200, is endorsed by former hockey star Keith Primeau. It is currently being worn by more than a thousand youth football players in the United States, and it can also be used by hockey and lacrosse players.

Primeau, now age 39, played in the NHL for 16 years before his fourth documented concussion forced him to retire from the Philadelphia Flyers. He still feels crippling effects of his head injuries: headaches, head pressure, dizziness and fatigue.

According to an article in The Globe and Mail:

Primeau said the Impact Indicator doesn’t prevent concussions but indicates when someone should come out of a game. Information is a weapon in the fight against concussions, he said. People can have an objective measurement rather than just subjective judgment of coaches, teachers, administrators and even physicians on the sidelines.

Once the LED turns red, there is a 50% probability of a concussion. At that point, a player shouldn’t take anymore head hits. It takes the guesswork out the equation:  When the light turns red, the player should be removed from play and see a doctor.

Whether players, coaches, and team owners will ever fully adopt the new technology remains to be seen, but it seems like a no-brainer. We support measures that help preserve health and prevent brain injury. Paralympian Paul Rosen won a gold medal with Canada’s sledge hockey team. He believes that losing his leg in 1999 was easy compared with post-concussion symptoms. As he told TSN:

“Losing my leg was an absolute joke in the way I dealt with it compared to what I’m dealing with on a day to day basis,” said Rosen, who suffered a concussion after a sled hit him in the head. “Thing was, they told me to suck it up. We have to get out of this mentality, whether kids are 10 years old or playing professional hockey, is get out of that mentality of suck it up.

“One hit to the head is one hit too many.”

To read the full article in The Globe and Mail, click here:  New chin strap flashes red

To read the full article on TSN, click here:  Primeau believes helmet can cut down on concussions

Researchers from the Mayo Clinic and UCLA have discovered that people who suffer from traumatic brain injury (TBI) are four times more likely to develop Parkinson’s disease than people who have never had a head injury.

According to an article on Digital Journal, the researchers reviewed the past medical records of about 200 patients, looking to see if those who had experienced head trauma at some time in their lives later developed Parkinson’s disease. Why might this be true? The answer comes from another research study:

The UCLA team found that brain trauma causes an immediate 15% loss in brain cells called nigrostriatal dopaminergic neurons. The loss of these cells continued so that after about 6 months, up to 30% of those neurons were lost. It is the loss of these dopaminergic neurons that make a person more susceptible to Parkinson’s disease.

Although there is still no cure for Parkinson’s disease, this research may provide another piece of the puzzle that could eventually lead to prevention or more effective treatments. But in the meantime, the sad news is that people who suffer TBI need to be watchful for signs of Parkinson’s disease as they grow older.

The post-game video review was especially difficult at John C. Birdlebough High School. Administrators and coaches examined every frame of what will forever be known as “THE game.” The game when 16-year-old Ridge Barden died.

According to an article in The New York Times, the coroner ruled that Barden’s death was due to a brain bleed, also known as a subdural hematoma. But while the reason for his death is known, the actual cause is still a mystery.

“There’s nothing here; there’s still nothing there; there’s nothing there; there’s nothing there — and now he’s laying on his stomach,” Jeff Charles, the head coach, said while watching the sequence frame by frame.

Apparently, Barden had no preexisting condition, no history of head trauma, and no symptoms of concussion during the game. He had a state-of-the-art Riddell Revolution helmet. On hand at the game were two certified athletic trainers, and emergency medical technicians arrived with an ambulance within minutes. And yet, a catastrophic injury resulted in an untimely death.

“You can have the perfect plan in place but if all of these things happen, it can still result in a catastrophic injury and death,” said Kevin Guskiewicz, the chairman of the department of exercise and sports science at the University of North Carolina and a leading researcher on sports concussions.

During the game, Barden told his coach that he had a helmet-to-helmet hit, and that his head hurt. When he tried to stand up, he collapsed. He went into cardiac arrest in the ambulance. Two hours after the injury, he had died.

This is a tragic story all around. The coach is considering not returning for another season, despite the fact that everyone agrees he did nothing wrong. No doubt, his teammates—and their parents—will also be reconsidering whether to continue playing football.

The lesson seems to be that any head injury is dangerous, and you can’t predict the outcome of any one hit. Barden never had a chance to say “Yeah, I already had one concussions…I think that’s enough. Time to quit.” His first hit was his final hit. The fatal hit.

All we can say is stay safe. Protect your head. Barden’s death was a fluke. Nothing could have been done differently or better. Sometimes, life is dangerous.

To read the full article in The New York Times, click here:  An ordinary football game

To learn more about legal options in the event of a traumatic brain injury, visit our website at www.lawmed.com.  If you have questions, HensonFuerst has answers.

According to an article in Bike World News, two major cycling organizations have jointly released recommendations for how to treat cyclists who have sustained head trauma.

Medicine of Cycling, an independent group of physicians and psychologists working to improve processes that can have a meaningful impact on the way care is delivered to cycling athletes, recently formed the Medicine of Cycling Concussion Task Force which aims to increase awareness of concussion and improve safety for cycling athletes. The guidelines pertain to adult athletes only, as younger riders are even more vulnerable to brain injury. These guidelines are intended to educate cycling team managers, coaches and athletes on the symptoms and management of concussion in athletes. The guidelines are not a surrogate for evaluations by appropriately trained medical professionals.

The guidelines include actions to take in the pre-season, how to evaluate for concussion after a head injury, and considerations for returning to cycling after a concussion.

If you are a serious cyclist—especially if you are a member of a cycling team—you need to read these concussion guidelines so that you, team coaches, and teammates are all on the same page when it comes to head injury.

Ride like the wind… but stay safe!

P.S.  If you would like to join the HensonFuerst Cycling Team, we are adding new riders to our group. We ride for fun, and for community support, fundraising for health organizations, and disease awareness. Cyclists of all skill levels are welcome.

RESOURCES

To read the full article in Bike World News, click here:  Medicine of Cycling releases concussion guidelines

To read the concussion guidelines, click here:  Concussions in Cyclists

Can motherhood cause brain injury?   Yes… indirectly.

An article in the Deseret News recounts the experience of mom Erin Stewart, whose preschooler gave her a concussion:

Motherhood is rough. I’m not talking about emotions here. I’m talking physically rough. I’m talking just-got-back-from-the-doctor-with-a-minor-concussion rough. Seriously. My preschooler gave me a concussion.

In what will forever be known in our family as the day mom officially became a wimp, my 4-year-old daughter slammed her head into the back of mine. She was fine; I screamed in pain. A week of headaches later, I went to the doctor (despite my husband’s mockery) and was told I likely have a concussion.

This article is humorously written, but also educational. Concussions don’t just happen to football or hockey players, skateboarders, or daredevils. Concussions also happen to moms… or grandpas… or anyone who has a brain. All it takes is a blow to the head, even if the blow is delivered by a little girl.

Where Erin was mistaken—and where the article fails—was when she waited a week to seek treatment for her constant headaches. (All the worse if she really delayed her visit to the doctor for fear of more mockery from her husband.)

A concussion is also known as mild traumatic brain injury (MTBI). While the symptoms are often mild and temporary, some concussions are serious. Depending on the exact nature of the injury, the symptoms of concussion can last many long months.  After multiple concussions, some people can develop permanent, debilitating neurologic symptoms that mimic Lou Gehrig’s disease.

So, read this article for the humor Ms. Stewart intends, but keep in mind it’s lesson, also:  Concussions can happen to anyone, and often occur when we least expect it. And sometimes they are caused by cute little girls.

At about 2:00 pm, second grade student Michael Rodriguez slipped on some water at school and hit his head. By 6:00 pm, his mom was rushing him to the hospital. The basic story is simple, but the lessons are in the details.

According to a Texas-based news source, VictoriaAdvocate.com, by the time 7-year-old Michael got proper medical care, he was screaming “My brain hurts…I’m going to throw up.” After a CT scan, he was diagnosed with a skull fracture and contusion.

Michael’s mom, Michelle Robinson, who also has three other children reported that she had had previous difficulty communicating with the school nurse about her kids’ medical problems. According to VictoriaAdvocate.com:

“I personally went to the office and told her, ‘I don’t care if it’s something as little as a cut on his knee, I want to know,’” Robinson said. “At that time, she pulled all my kids’ emergency medical cards and wrote on there in red pen, ‘Call mom for anything.’ She led me to believe that communication was going to be better.”

Robinson did not receive a phone call about her son’s afternoon head bump.

The issues raised involved the nurse’s qualifications (the school said that the nurse was certified as a “licensed vocational nurse” who was in her first year with the school); the nurse’s treatment of Michael (the nurse’s clinic notes indicate he was treated for about a minute, and the child was sent back to class with just an ice pack); and protocol for head injury (standard protocol involves monitoring a student for 20 minutes to watch for symptoms of slurred speech, blurred vision, headache, etc.).

“What if it happens again? What if it happens to another child, and it’s worse next time? I will be more than happy to use my son as an example and do something to reprimand this nurse, or it can happen again,” Robinson said.

It is frightening to think how easily a slip can change from a “bump” to a skull fracture.

While there is no way to prevent all accidents, there are some tips provided by Dr. Jeffrey Lehman, Director of the Huff & Puff Allergy and Asthma program at St. John’s Children’s Hospital (on FoxIllinois.com) about how to ensure that your child receives the best care possible in school:

• If your child needs specialized treatment, make sure the school’s staff knows how to administer medications and other treatments;
• For chronic medical problems, provide the school with a personalized management plan to take the place of the school’s standard plan;
• Give the school a recent photo of your child to include in the child’s medical file, as well as up-to-the minute contact information for you and any other emergency contacts.
• Ask about the school’s protocol for dealing with common injuries, including falls and head bumps. Make sure you understand exactly what will happen if your child is injured.
• And even though it didn’t work for Michael’s mom, ask to have the school contact you anytime your child visits the school nurse.

To read the full story on VictoriaAdvocate.com, click here:   7-year-old Suffers Skull Fracture

This feels like a win for everyone in North Carolina, and for everyone who loves an individual with traumatic brain injury (TBI):

Kevin Guskiewicz, Ph.D., works at the University of North Carolina, Chapel Hill in the UNC Injury Prevention Research Center. Through is research, he has made strides in the diagnosis, treatment and prevention of sports-related concussions. According to an article in the News & Observer, Dr. Guskiewicz, 45, said he wants to use some of the grant money to develop rehabilitation plans for athletes and soldiers who suffer concussions. The foundation noted Guskiewicz’s combination of laboratory and in-the-field investigations to further his research.

Based on the idea that balance and posture can help to evaluate concussions objectively, his diagnosis and rehabilitation system uses a symptom checklist as well as an inexpensive device made of foam and a stopwatch. According to an article in The New York Times:

Acknowledging that his work has the potential to save lives, Mr. Guskiewicz said he was still “floored, surprised and honored, all at the same time,” by the MacArthur grant.

Congratulations, Dr. Guskiewicz!
To read the full article in The New York Times, click here:  MacArthur Foundation Selects 22 ‘Geniuses’

To read the full article in the News & Observer, click here:  http://www.newsobserver.com/2011/09/20/1503230/macarthur-foundation-reveals-2011.html#ixzz1YVMuEd1h

In Canada, kids pick up an ice hockey stick about the same time American kids pick up a Wiffle ball bat. They get their first pair of ice skates not long after they start walking. From Vancouver to Nova Scotia, Winnipeg to Yellowknife, hockey is the national sport of our northern neighbor.

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