“This is huge,” said Gen. Peter Chiarelli, the Army vice chief of staff.

Army Col. Dallas Hack, who has oversight of the research, says recent data show the blood test, which looks for unique proteins that spill into the blood stream from damaged brain cells, accurately diagnosing mild traumatic brain injury in 34 patients. Doctors can miss these injuries because the damage does not show up on imaging scans, and symptoms such as headaches or dizziness are ignored or downplayed by the victims. (from USA Today article)

This is similar to the type of blood test used to measure the proteins associated with muscle damage, and which are now routinely used to determine whether there is heart damage after a patient complains of chest pain.

Currently, diagnosing MTBI is a matter of faith and truthfulness–it depends on the patient accurately answering questions about symptoms…and on the doctor or coach believing the answers. Although more medical testing will need to be done to confirm the early research results, this marker could remove all doubt. That means that soldiers and athletes could be forced to rest to allow their brains to recuperate. It also means that researchers will have a new way of measuring whether particular treatments actually work to reverse the brain damage, especially in infants, who have no way to communicate.

This is an amazing first step in what will probably be several more years of research. Congratulations, Army. This is a major win!

To read the full story, click here: “Army Finds Simple Blood Test to Identify Mild Brain Trauma”

And to learn more about legal options for brain injury, check out our dedicated web page here: www.lawmed.com. If you have questions, HensonFuerst has answers.

In Sunday’s game, Philadelphia Eagles player Stewart Bradley attempted a tackle that left him stumbling before he collapsed on the field. To an average fan, he appeared obviously hurt and impaired. But the team’s medical staff took him out of play for less than 3 minutes before allowing him back in the game.

It wasn’t until halftime, when he was officially diagnosed with a concussion, that Bradley’s brain and body were given a chance to rest.

According to an article in The New York Times, Eagles Coach Andy Reid and the Eagles’ medical staff all stated that they had not seen Bradley stagger and fall. (Makes you wonder exactly who is watching the players, other than the fans, of course.)

Interestingly, one of the excuses the medical staff gave was that:

…they were apparently tending to quarterback Kevin Kolb — who also was suspected of having a concussion, returned during the quarter, and then was found during halftime to have sustained a concussion.

So they didn’t catch Bradley’s concussion because they were treating Kolb…but Kolb was also returned to play because his concussion wasn’t diagnosed until halftime.

To an outside observer, it seems that the doctor who is able to diagnose concussion so easily during halftime should be made available throughout the game. There’s no safe amount of time a player can “play hurt” when the injury involves the brain. The NFL’s concussion poster ends with these lines: Work smart. Use your head, don’t lead with it. Help make our game safer. Other athletes are watching…

Hey, NFL:  You’re right…we’re watching…and we don’t like what we saw on Sunday. Brain damage is forever.

To read the full New York Times article, click here: The Return of a Stumbling Eagle Raises Concerns

The average cyclist crashes about every 4,500 miles. Kids? Seems like at least once a week. Wearing a helmet has been shown to prevent up to 75% of cyclists’ head injuries… and are required by law in the state of North Carolina for all cyclists under age 16.*

Here’s what you need to know about choosing and wearing a bicycle helmet.

WHAT TO LOOK FOR IN A HELMET

• Helmets must meet the U.S. Consumer Product Safety Commission standard. Look for one of the following stickers: CPSC sticker, or ASTM’s F1447 sticker, or Snell’s B-95 sticker. (CPSC and ASTM standards are identical; Snell’s is even tougher, but you’ll rarely see these.)
• Choose color with visibility in mind: white is still best, next in line come other bright colors that are easily seen by drivers.
• Choose a helmet that is totally smooth, with no points that can snag. A good helmet is designed to protect your head in case the worst possible event occurs: if you are hit by a car. It needs to be smooth to “glide” along pavement (instead of catching in a way that bends your neck), and to prevent any protrusion from catching under the bumper of a car.
• If you ride a mountain bike, look for models that offer protection from trailside hazards.
• If you have unusual needs–or if you simply want help with your helmet choice–ask for help at a specialized cycling store, which will have a wider range of products and the expertise to help. For example, there are helmets to fit unusually large heads…padding to fit unusually small heads…helmets with “ponytail ports” for people with long hair…helmets with no large top vents for people with sparse or no hair.

WHAT TO AVOID

Avoid anything that prevents you from wearing a helmet properly, or which violates the definition of a “good helmet” listed above. In particular:

• AVOID dark colors
• AVOID extreme aero shapes, which provide a convenient “lever” for knocking the helmet aside in a fall
• AVOID squared-off, ridged, ribbed, or spiked shapes
• AVOID helmets without a standards sticker on the inside
• AVOID helmets with thin straps (more likely to break)
• AVOID helmets that don’t allow good visibility
• AVOID helmets that don’t fit properly
• AVOID helmets with strap adjustments that are too complicated for comfortable, everyday use

WHEN TO REPLACE A HELMET

• For sure, if the last time you bought a helmet was before 1999, the last time the U.S. government updated safety standards.
• Replacement recommended every 5 years, but can go longer if you don’t ride often.
• For sure, if the helmet has a crack or dent.
• Recommended after any crash–some damage may not be visible.
• If your helmet shows bubbling or other signs of heat damage

HOW TO WEAR A HELMET

For a video on how to do a helmet fit test, click here: Helmet Fit Test Video

For an illustration of the right and wrong ways to wear a helmet, click here: “Do you know the right way to wear a helmet?” or here: “Easy Steps to Properly Fit a Bicycle Helmet”

• A helmet is properly worn level on the head–not tilted forward or backward.
• The helmet should sit low on the forehead, one or two finger-widths above the eyebrows.
• The strap should be fit snugly–not loose, not too tight for comfort.
• Once on the head, try to move it with your hands. The helmet shouldn’t move more than an inch in any direction no matter how hard you try.

SPECIAL INFORMATION ABOUT HELMETS FOR KIDS

• Every child who rides alone or on the back of an adult’s bike needs a helmet. However, until a child reaches age 1 year, the neck muscles aren’t strong enough to support a helmet. If you have questions about riding with a toddler, talk with your child’s pediatrician about the best protection.
• Replace a helmet as often as you need to assure a good, safe fit. Consider a helmet at least as important as shoes.
• Some child helmets have several foam inserts of different thicknesses. These can be changed out to accommodate a growing head. (And the different thicknesses do NOT affect the protection offered by the helmet.)
• Teach your child that bike helmet is for biking or skating with in-line skates only. Skateboarding requires a different helmet.
• VERY IMPORTANT WARNING: A child SHOULD NOT wear a bike helmet on the playground. Children have died due to crush or strangulation when the helmet got caught on climbing equipment. For more information about this topic, click here: “Wear Bike Helmets On Bicycles – Not On Playgrounds”

HOW TO GET YOUR CHILD TO WEAR A HELMET

• Start by being a good role model: Wear a helmet yourself while riding!
• Make wearing a helmet a requirement right from the first day your child starts riding a 2-wheeler. If you make it an important rite of passage, it will feel more like something to be proud of. (Do you remember the day your training wheels were finally taken off? That kind of pride.)
• Explain why wearing a helmet is important.
• Talk with the parents of your child’s friends to let them know that you require your child to wear a helmet…and that you would like their help in applying that rule. This is a great opportunity to ask if they also require their children to wear helmets–kids are more likely to wear helmets if their friends also do.
• Point out cyclists wearing helmets as you’re driving, or if you watch bike races on television.

FAMOUS LAST WORDS…

From actual people who crashed:

• “I didn’t think I needed a helmet–I was only going about a mile.”
• “I don’t know what happened. The brakes locked on a turn and I flipped over the front wheel.”
• “I wasn’t expecting that rock to be there.”

* While your child’s brain depends on a helmet, don’t forget that your child depends on you and your healthy brain. The HensonFuerst traumatic brain injury team has seen too many people suffer permanent, catastrophic brain damage from bicycle accidents.

INFORMATION SOURCES:

Bicycle Helmet Safety Institute

U.S. Consumer Product Safety Commission

SafeKids USA

Insurance Institute for Highway Safety: Helmet Laws by State

ASTM International: Standards Worldwide

REI: How to Choose a Bicycle Helmet

National Highway Traffic Safety Administration

Wikipedia: Bicycle Helmet

Although there are no hard data linking metal bats to an increase in injuries, there are plenty of anecdotes. Plus, bat manufacturers are quick to try to sell metal bats based on superior performance, but seem to back off when it comes to injury. They say that “exit speeds” off metal bats are only about 6 mph greater than those for wooden bats. On the other hand, metal bats have a “trampoline effect,” which causes the bat to compress and bounce back when hitting a baseball, causing a faster hit. (Wood bats don’t compress as much because they’re not hollow.)

States are creating rules about the use of metal bats in grammar and high school sports. The latest is in California.

According to an article in today’s San Francisco Chronicle:

Assemblyman Jared Huffman will abandon a bill that would have temporarily banned metal baseball bats in school sports, after striking a deal with California high school sports officials that may lead to mandatory protective headgear for pitchers and other players.

New safety standards set by the California Interscholastic Federation (CIF) will ensure that non-wooden bats perform more like wooden bats, and that the bats cannot be tampered with to enhance their performance.

Most importantly, the CIF agreed to encourage infielders and coaches to wear protective headgear, and this may become mandatory within two years. In addition, the federation pledged to lobby its national leadership organization to set protective headgear standards.

HensonFuerst supports any measure that helps protect young athletes. Especially if the brain is protected. It bears repeating: Injured bones heal… injured brains are injured for life. Protective headgear may seem extreme, but there’s a whole generation of adults who grew up before bicycle helmets were required… now, wearing a helmet is second nature. This is a good idea, and we encourage federal safety standards for bats and head protection.

To read the full San Francisco Chronicle article: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/08/11/MNV51ESKG6.DTL#ixzz0wQNLi5I2

To read the original blog: http://www.lawmed.com/brain-injury/tbi-lawyer/more-injuries-from-metal-baseball-bats/

They’ve each had a son on the verge of dying after being struck on the head by a batted ball and suffering a skull fracture that required emergency surgery. Gunnar Sandberg, 16, was in a coma for three weeks; Cole Schlesner, 15, spent four days in a coma and remained in a hospital for another six weeks.

[The families] both want to see improved safety measures in the youth game — Sandberg a return to wood-only bats, Schlesner the use of helmets by pitchers…. (from USA Today article)

Basically, they are for any change that will make the game safer for kids. Who can blame them? No one expects that a high school baseball game could end in a catastrophic, life-changing injury.

Although there are no hard data linking metal bats to an increase in injuries, there are plenty of anecdotes. Plus, bat manufacturers are quick to try to sell metal bats based on superior performance, but seem to back off when it comes to injury. They say that “exit speeds” off metal bats are only about 6 mph greater than those for wooden bats. On the other hand, those concerned with safety argue that:

• Metal bats have a “trampoline effect,” the result of the bat compressing and bouncing back when hit by a baseball. Wood bats don’t compress as much because they’re not hollow.
• Some metal-bat barrels are as much as half-an-inch wider in diameter than wood, increasing the size of their “sweet spot.”
• Metal bats are lighter and have more of their weight on the handle, which makes them easier to swing faster.
• In unregulated travel-team tournaments, such as the one where [Cole Schlesner] got hurt, there are no restrictions on bat performance. Before the 2001 season, the National Federation of State High School Associations required high schoolers swing bats in which the differential in weight (in ounces) and length (in inches) is no greater than 3. The previous standard allowed a differential of 5, meaning players could swing bats (such as the popular 34-inch, 29-ounce model) that provided ample plate coverage without sacrificing bat speed. (from USA Today article)

Cole Schlesner’s life was forever changed. he was taken to hospital by helicopter, had surgery to remove part of his skull, and spent time in a coma.

“When he awoke from his coma, he could not talk or walk and his right side was paralyzed. Despite up to nine hours a week of outpatient rehabilitation, he has difficulty walking and lacks full use of his right side. His cognitive development has improved to where he can function in school with some accommodations, but recently he has lost the ability to articulate some syllables and words. His father estimates the cost of his care so far at between $750,000 and $1 million, with 80% to 90% covered by insurance.” (USA Today)

Next Steps

North Dakota has banned metal bats, but other states are considering similar measures. A few individual baseball leagues have made the switch to wooden bats, but not many. There are some research studies being conducted–one at the bioengineering lab at Brown University–to objectively examine whether metal bats are significantly different from wooden bats in terms of their ability to cause catastrophic injuries.

These studies may not fully answer the questions though: researcher Dan Russell, associate professor of applied physics at Kettering University, admits that some of his work has been funded by bat manufacturers. There will, no doubt, be cause for skepticism if his studies show that metal bats are no more dangerous than wooden bats.

In the long run, money may end up helping to change safety regulations. When a larger percentage of metal bat profits have to go to pay the costs of injured children, the manufacturers may decide to take safety seriously. (Last year, manufacturer Hillerich & Bradsby was order by a Montana court to pay $850,000 to the family of a teen player killed by a line drive off a metal bat.)

Meanwhile, we like the advice of Cole Schlesner’s father, who “advocates youth pitchers using helmets, as his three other sons do now.” (USA TODAY)

USA Today article: “As Injuries Mount, Debate Over Metal Baseball Bats Continues”

A study of nearly 200 Vietnam vets found that 13% of those with penetrating head wounds developed epilepsy more than 14 years later. A few veterans had new seizures that popped up 35 years after the initial injury.

The results of the Vietnam Head Injury Study, published in the journal Neurology, confirmed that epilepsy is common after injuries that pierced the brain, such as from bullets or shrapnel. But why it takes so long for some vets to develop seizures remains a mystery.

According to an article in the Los Angeles Times:

“There are all sorts of things that can contribute to a [late-onset] seizure, including sleep deprivation, excessive drinking and other kinds of illnesses,” Grafman said. [study coauthor Jordan Grafman, chief of the Cognitive Neuroscience Section of the National Institute of Neurological Disorders and Stroke]

The study showed that soldiers who retained pieces of metal in their brains were at heightened risk for seizures, as were those with larger brain lesions (these also predicted a higher frequency of seizures).

This is a great piece of information, and we believe it probably is applicable to other penetrating head injuries, such as from a car wreck or assault. We’ve always known that the brain is a delicate and mysterious organ, and this study shows that the true effects of wounds don’t always show up immediately. Long-term follow-up is important for everyone with a serious brain injury.

“You can have an injury and get better, but with time, people don’t always do as well as they should,” said Dr. Gerald Grant, associate professor of neurosurgery at Duke University in Durham, N.C., and a former Air Force neurosurgeon. “It shows us that this is a chronic disease.” [also from the LA Times article]

Not all injuries heal with time. Brain injury is not like breaking a bone… it’s more like dropping a computer on the floor. There’s a chance that the wiring will remain intact, but you won’t necessarily see the actual damage until you run the machine for awhile.

We can’t say this often enough: Every head injury holds the potential to cause brain injury. And now we can add that brain injury holds the potential for lifelong problems, including seizures, cognitive deficits, and memory issues.

To read more about the effects of traumatic brain injury, see the HensonFuerst TBI web page.

The non-profit Horsepower Therapeutic Learning Center calls on different aspects of horsemanship to develop athleticism, memory, balance, and speech among people who lost some of that function.

“There’s three different stations,” said Jan Clifford, executive director and founder of Horsepower, Inc. “They’re working on the farrier, who provides the footwear for the horses. They have a riding segment where they actually ride the horses and work on balance and speech. Then they have a section where they go in and work on memory and recall, working on different things that horses and equestrian activities do.” (from the News14 story)

The news piece tells the story of Brandy Gilliam who was hit by a car 11 years ago. She spent 3 months in a coma, and another year in the hospital. She has participated in the Horsepower program for three years, and has experienced significant improvements in her posture, walking, and speaking abilities.

This amazing program provides help to more than 250 people every year. There is no cost to the participants, thanks to a grant from the Winston-Salem Foundation.

To read or watch the full news story, click here: News14 Carolina.

To read more about Horsepower, visit their website here: www.horsepower.org

For more information about the Winston-Salem Foundation, click here: Winston-Salem Foundation

And if you have legal questions about traumatic brain injury, visit our website here: HensonFuerst Law (www.lawmed.com)

Weeks of vacation and sultry weather make outdoor sports more popular, and whenever people get active, there are bound to be injuries. This week, the American Association of Neurological Surgeons (AANS) issued a reminder to enjoy summertime sports safely.

Over a one-year period from 2008 to 2009, the numbers of head injuries rose for nearly every sport (the single exception: Trampoline!). Heading the list (pun intended) are bicycling, water sports, baseball and softball. Cyclists suffered the most head injuries–more than 85,000 were reported in a single year, up from about 71,000. And the number water-related head injuries more than doubled, from 11,200 to than 28,700.

“By taking a minute or two to use your head, you can help prevent potentially life-altering and tragic consequences,” Dr. Gail Rosseau, a Chicago-area neurosurgeon and AANS spokeswoman, said in an association news release.

Surprising and Preventable Causes

When it comes to cycling, the AANS reports that at least part of the blame for the increase in injuries comes from–get this: use of cell phones! “Sidetracked cycling” is is as dangerous as “distracted driving.”

The AANS offers the following safety recommendations:

• To prevent biking accidents, the organization encourages riders to use helmets, obey traffic signals, avoid uneven surfaces, wear bright colors and reflectors at night, and avoid cell phone use.
• To increase water safety, AANS advocates for adult supervision of young children, careful diving in conjunction with accurate water-depth information, keeping gates locked around backyard pools, avoiding alcohol consumption during water-related activities, following posted instructions at public places, and enforcing a strict ban on potentially dangerous rough play.

And don’t forget that using cell phones while supervising young children around swimming pools could also be dangerous. If attention is needed, give attention. Of course, if you’re a glass-is-half-full kind of person, you could take the AANS report as a license to turn off the cell phone and enjoy your time outdoors. Summer, sports, and safety–that’s having it all!

This week, a press release from C.S. Mott Children’s Hospital (part of the University of Michigan Health System) reports on a recent poll, and talks about the next step in recognizing concussions: parents.

According to the article, two-thirds of parents of young athletes worry that their children will get a concussion while playing school sports, but 50% don’t know if their children’s school has a concussion policy. One-third of parents are unaware of the dangers of repeated concussions, which can include permanent brain injury, early dementia, or even death.

Experts believe that a young athlete who suffers a concussion should not return to play for at least two weeks, and some brain injury specialists believe that injured players should sit on the sidelines for three full months to give the brain a chance to heal.

It can be difficult to diagnose a potential concussion on the field. Contrary to popular belief, most concussions do not result in a loss of consciousness…and symptoms may not occur for several hours after the injury. Young athletes may not recognize that they are hurt, or they may be afraid to mention symptoms for fear of losing playing time or of disappointing a coach or a parent.

What parents should know

Parent involvement in guarding against repeat concussions is critical.  Any time you suspect that your child has received a head injury, watch for these common signs and symptoms of concussion:

• confusion
• loss of memory (amnesia)
• headache
• dizziness
• a sensation of the world spinning (vertigo)
• imbalance
• lack of awareness of surroundings
• nausea and vomiting

If these symptoms appear after a head injury, consult a medical professional promptly for a full evaluation. Don’t allow a coach to pressure your child into playing before he or she has recovered. When in doubt, talk with a doctor.

For more information, click here:   “Concussion in Sports” from the Centers for Disease Control and Prevention (CDC)

To read the full C.S. Mott Children’s Hospital press release, click here: “Parents Ill-Prepared to Reduce Kids’ Concussions Risks”

If you have legal questions about concussion and brain injury, go to the HensonFuerst dedicated Brain Injury page. At HensonFuerst, if you have questions, we have answers.

The sport?  Cheerleading.  And compounding the tragedy of injury is the fact that only 20-25 states list high school cheerleading as a sport… the NCAA doesn’t recognize cheering as a championship sport… and unless the number has changed since December 2009, only 3 colleges consider cheering a sport–none in North Carolina. (Statistics from Journal of Athletic Training 2009)

Call a Sport a Sport.

While “recognition” might seem like a minor point, it has major ramifications for safety.  A “sport,” performed competitively and for entertainment, requires strict guidelines to ensure the safety of athletes. In 1980, when cheering was still primarily about leading the crowd in cheers, there were fewer than 5,000 emergency room visits. Today, cheering involves highly skilled gymnastics (as well as being tossed in the air and trusting that someone will be there to catch you).

Without the sanction of being a sport, cheerleaders often have to practice in areas that make injuries more likely, such as an asphalt parking lot or a team member’s backyard.  A “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.

Gimme an A-C-T-I-O-N.

One of cheering biggest and most vocal supporters is 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). The group’s 26th annual report devotes a special section to cheerleading injuries, which describes the current state of cheering as a sport, details specific catastrophic injuries and how they occurred, and suggests sample guidelines that could help prevent cheerleading injuries. As quoted from the report (available here):

“Is cheerleading an activity that leads the spectators in cheers or is it a sport? If the answer is to entertain the crowd and to be in competition with other cheerleading squads, then there must be safety guidelines initiated. The authors of this research question why it is called cheerleading, when competitive cheer has nothing to do with leading the crowds at athletic events in cheering for the athletic teams on the playing field. Following are a list of sample guidelines that may help prevent cheerleading injuries:

1. Cheerleaders should have medical examinations before they are allowed to participate. Included would be a complete medical history.
2. Cheerleaders should be trained by a qualified coach with training in gymnastics and partner stunting. This person should also be trained in the proper methods for spotting and other safety factors.
3. Cheerleaders should be exposed to proper conditioning programs and trained in proper spotting techniques.
4. Cheerleaders should receive proper training before attempting gymnastic and partner type stunts and should not attempt stunts they are not capable of completing. A qualification system demonstrating mastery of stunts is recommended.
5. Coaches should supervise all practice sessions in a safe facility.
6. Mini-trampolines and flips or falls off of pyramids and shoulders should be prohibited.
7. Pyramids over two high should not be performed. Two high pyramids should not be performed without mats and other safety precautions.
8. If it is not possible to have a physician or certified athletic trainer at games and practice sessions, emergency procedures must be provided. The emergency procedure should be in writing and available to all staff and athletes.
9. There should be continued research concerning safety in cheerleading.
10. When a cheerleader has experienced or shown signs of head trauma (loss of consciousness, visual disturbances, headache, inability to walk correctly, obvious disorientation, memory loss) she/he should receive immediate medical attention and should not be allowed to practice or cheer without permission from a physician.
11. Cheerleading coaches should have some type of safety certification. The American Association of Cheerleading Coaches and Advisors offers this certification.
12. The NFHS should make cheerleading a sport, which will place cheerleading under the same restrictions and safety rules as all other high school sports. The NCAA should follow this same recommendation.”

HensonFuerst commends the research and activist efforts of Dr. Mueller and his team. We represent the interests of far too many children and young adults whose lives have been shattered due to head trauma or other catastrophic injury. There are few things in life as heartbreaking as broken potential. We agree that it is time to let recognition and regulations catch up to this fast-moving, physically demanding sport. Yes, sport. Let’s at least make an effort to stop the hemorrhage of young, enthusiastic lives.

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.

(Related and interesting articles can be found here: Flying without a net: Cheer injuries on rise. MSNBC and Cheerleading is leading cause of catastrophic injury in young women, ScienceDaily.)