The rapid response of the Tucson, Arizona medical team saved the lives of a dozen people shot in a gunman’s rampage. Among the injured was U.S. Representative Gabrielle Giffords, who had been shot in the head. This week, neurologist Richard C. Senelick, M.D., gives us a peek into the challenges Representative Giffords will face as she recovers from such a severe brain injury (“What Will Gabrielle Giffords’ Recovery Look Like“).

According to the article, the bullet traveled through the left side of Rep. Giffords’ brain. But, her doctors also pointed out that:

…the damage is not done just by the bullet passing through the brain but also by the shock wave or “cavitation effect” that damages the brain tissue around the bullet track.

People with brain injuries can face numerous disabilities, some quite unexpected. There are three categories of potential problems:

1. Physical Impairments, including seizures, paralysis, loss of feeling, problems with speech or swallowing, and fatigue.
2. Cognitive Disturbances, or problems with thinking. These include difficulty with memory, attention, concentration, planning, judgment, learning new things, and communication.
3. Behavioral Disturbances, or personality changes. Common behavioral issues include irritability, depression, verbal or physical outbursts. Perhaps the most difficult to deal with is something called “inappropriate behavior,” which is like losing your social censor—the person does or says whatever comes to mind, without any thought of consequences.

This brief overview is just a slice of what Rep. Giffords will face. Her recovery will be long and unpredictable. After she leaves the acute care hospital, she’ll be transferred to a rehabilitation facility where she will learn to take back her life. As Dr. Senelick says:

… [it is] difficult to predict Representative Giffords’ future…. I am frequently gratified by the impressive recoveries that many patients make after extensive rehabilitation efforts.

Like the rest of the world, all of us at HensonFuerst Attorneys send our best wishes to all the Arizona shooting victims and their families, and condolences to the families of those who died. It was a senseless act that stunned the rational world. There are no words… only prayers.

To read the full article, click here: What Will Gabrielle Giffords’ Recovery Look Like, by Richard C. Senelick, M.D.

The initial trauma that causes brain injury is just the beginning of the health nightmare.

New research published in the November issue of The Journal of Nuclear Medicine used sophisticated imaging techniques to track how brain structures change over time after a traumatic brain injury (TBI). While the results of the research will help scientists and physicians develop better ways to treat people after brain trauma, the news was disheartening for anyone who has suffered TBI.

We know that TBI is a major cause of disability for children and young adults, often resulting in memory and attention problems, mood and behavioral issues, epilepsy, and difficulties in the areas of learning and decision making. According to a press release by SNM, an organization devoted to raising public awareness about the benefits of medical and molecular imaging, the researchers found that the brain changes physically and functionally for about 3 to 6 months after the initial injury. Specifically:

Widespread decreases in brain functioning were seen in specific brain regions, many of which are remote from the site of direct trauma and unaccompanied by signs of injury on the MRI. The hippocampus, a brain structure critical to memory and emotion, is the key area of these changes. This may have implications for the pathophysiology of some of the long-term neurological and psychiatric morbidity, seen following TBI, even when abnormalities are not obvious on structural MRI.

Basically, this means that after a brain injury, the part of the brain most involved with memory and emotion stops working as well as before the injury…even if that part of the brain was not injured in the original trauma.

Overall, the scientists hope that the results of this research can help in the development of new treatments that might be able to halt the progressive degradation of brain function. For the rest of us, the lesson is about the importance of medical treatment—just because you walk away from a head injury, it doesn’t mean that your brain hasn’t suffered damage. In fact, the full extent of your injury may not be known for months. Seek medical attention immediately after any head trauma that is more than a minor bump. It’s always better to be safe than sorry.

RESOURCES

The abstract and citation for the study mentioned above is available here: Journal of Nuclear Medicine

To read more about traumatic brain injury, or to learn about your legal options after personal injury, visit the HensonFuerst website. If you have questions, we have answers.

In a report by News 14 Carolina, tiny Colfax, North Carolina (located about halfway between Winston-Salem and Greensboro) is home to a special program that pairs horses with people who have suffered brain injury.

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)

Concussion is finally gaining respect as a serious injury. Doctors have begun calling it “mild traumatic brain injury,” which more fully and accurately defines what concussion really is. High schools and high school sports organizations have begun setting more stringent standards for evaluating a student athlete after a head injury–no matter how minor the injury may initially seem to be. And doctors are weighing in with guidelines for when the injured athlete can return to play.

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.

“Nearly 30,000 veterans have suffered some kind of traumatic brain injury in the wars in Afghanistan and Iraq – an estimated 2,000 of them severe enough to put warriors into comas or leave them with severe disabilities. Yet eight years into the wars, testimony before Congress shows veterans still suffer yawning gaps in coverage for what has become the conflicts’ signature wound.”   (News & Observer, 5/23/2010)

“…part of Pittman’s brain has gone dormant, and on most days, he can’t think straight. He leaves the room and forgets what he was searching for. He gets migraines so piercing that his right eye wanders. Anger comes easily, inspiring rages that sometimes have his wife terrified for herself and the couple’s 3-year-old daughter.”

The herbal medication Ginko biloba (sometimes called G. biloba, or even just “Ginkgo”) is commonly sold as a memory-boosting supplement. Now, a study published in the Journal of Natural Products reports that using Ginkgo may increase the risk of seizures in people with epilepsy, and Ginkgo could reduce the effectiveness of anti-seizure drugs. (see full story here: ScienceDaily)

Why am I writing about this here? Well… many people with traumatic brain injury (TBI) suffer from memory problems…and some of them will also need to take anti-seizure medications for an extended time. This study shows that it is potentially dangerous to use Ginkgo herbal treatments while taking the medications.

About TBI and seizures:

Between 5% and 10% of people with traumatic brain injury (TBI) have seizures as a result of their head injury. The risk is greatest among those with more severe head trauma. The seizures can start immediately, or may not become apparent for days, weeks, or even months. According to the Brain Injury Resource Foundation, seizures are so common that the drug Dilantin (phenytoin) is often given to head trauma patients for 7 days after the incident as a preventive measure.

If a patient has a seizure within the first week, they are advised to stay on the anti-seizure medication for at least one year. Some people with TBI end up with persistent seizures, and may therefore be on medication indefinitely. (for more information, click here)

As always, check with your doctor before taking any additional over-the-counter drug, supplement, or herbal remedy. Some chemicals have powerful interactions–even those you can buy without a a prescription!

[side note: Randomized studies, such as these published in the Journal of the American Medical Association, or JAMA, have shown that the belief that Ginkgo improves memory is pretty much false---it doesn't improve memory, nor does it prevent cognitive decline as we age. FYI.]

A research company has received a grant of almost $ 9 million to study the effects of brain injuries of deployed servicemen.  One reason is because the symptoms of a concussion may not be obvious, while things such as slower reaction time and memory impairments may persist.  Similar to the high school proposal for testing of athletes who have suffered a head injury, this commitment by the military exhibits an understanding that the effects of head injury can be very subtle, and return to any kind of active duty/sport should be approached with extreme caution in any circumstance.  For the full article regarding the military study, please click on the following link:

http://www.defenseindustrydaily.com/89M-to-Eyak-for-Brain-Injury-Testing-for-Deploying-US-Troops-05592/

Chronic seizures caused by traumatic head injuries may result from chemicals released by the brain’s immune system attempting to repair the injured site, according to a study led by the University of Colorado at Boulder.  Studies like this are exciting because they give hope to further treatments for underlying conditions caused by traumatic brain injuries.  I marvel at the ability of my clients who have suffered brain injuries to cope with the myriad of different complexes that occur after such an event.  Whereas a broken leg is a broken leg and the victim of that has a definable limit on the rehabilitation process, brain injuries have so many clinical outcomes, including cognitive deficits, physical deficits, seizures, memory and organizational problems, that I am constantly amazed at how families and victims of brain injury cope with all of the different problems.  I like to keep up with the latest studies on brain injury treatment so that I can keep my clients and their families informed of the cutting edge of the TBI rehabilitative process.  To view the entire article surrounding this new study, please click HERE:

I have several friends who have had multiple deployments to Iraq.  This concerns me for obvious reasons, but one of which is the severity of the wounds being suffered by our troops.  The incidence of brain injury for our soldiers is increasing at ever faster rates, given the types of weapons being used by the enemy.   A 2008 study by the think tank RAND estimates that 19 percent of soldiers in Iraq and Afghanistan experience possible traumatic brain injury.  Many of these injuries are more subtle than the direct blast wound to the head, since we know that simple concussions can result in serious long term consequences for a soldier, such as memory and cognitive deficits.   More concerning is the possible lack of self-reporting done by soldiers in the field, who may think of brain injury as a “psychological wound”   and therefore not want to suffer the perceived stigma of not being able to return to battle.    We do know that immediate treatment is absolutely critical to properly manage an injury to the brain, and therefore we must encourage reporting of concussive symptoms so that treatment can be rendered.  For more discussion of this topic, please click HERE: