This is a story about athletes and concussions.

When you read that sentence, what picture popped into your mind:  250-pound football players… or 10-year-old girls with ponytails?  According to research published in The American Journal of Sports Medicine, the severity of symptoms after a concussion is–in part–dependent on the age and gender of the patient. Girls and young women suffer worse symptoms than men, and young people suffer more than older people.

The study tested young athletes for balance and verbal and visual memory. Researchers tracked the athletes for two years. In that time, about 300 of the athletes received a concussion and were tested again. Results showed that high school athletes performed worse for their age than college-aged athletes, and that female athletes with concussion had more symptoms and worse visual memory than male athletes with concussion. In addition, symptoms lasted longer in younger athletes than in older athletes.

According to an article in The New York Times:

The findings suggest that because of anatomical differences that make them more vulnerable, female athletes, and younger athletes in particular, may need to be managed more cautiously after a concussion, said Tracey Covassin, an associate professor of kinesiology at Michigan State University and the lead author of the report.

“Parents need to understand that if their daughter has a concussion, that they may potentially take longer to recover from that concussion than their son who is a football player,” she said.

Experts think that younger brains suffer greater damage from concussion because they haven’t fully developed…and because we tend to treat them as miniature adults when it comes to sports and expectations. According to Mark Hyman, author of “Until It Hurts: America’s Obsession With Youth Sports and How It Harms Our Kids” (Beacon Press, 2009):

“The brain and head of a small child are disproportionately large for the rest of the body,” he said. “The result is that their heads are not as steady on their shoulders. When they take a big hit in a football game or are slammed with an elbow in a soccer game, their brains move inside their skulls. That’s when concussions occur.”

RESOURCES

To read an abstract of the article in The American Journal of Sports Medicine, click here:  The role of age and sex in symptoms after concussion

To read the full article in The New York Times, click here:  Concussions May Be More Severe in Girls and Young Athletes

from The Observer

For Eastern Oregon University student and softball pitcher Holly Martin, February 25, 2010 was both the luckiest and unluckiest day of her life. On that day, she suffered a life-threatening, life-changing head injury. Given the reported lack of care she received after the injury, Holly was lucky to survive.

According to an article in an Oregon newspaper called The Observer, Holly Martin was pitching during practice from a distance of about 10 to 20 feet (significantly closer than the regulation distance of 40 feet). The batter, who was using a composite bat, struck the ball directly back to the pitcher, striking her in the head behind her right ear. A length of chain-link fence had been set up as protection, but it didn’t keep Martin safe.

So far, there were four mistakes made: The pitching distance was too short, the batter should not have been using a composite bat, the protective cage was inadequate, and the pitcher should have been required to wear a helmet.

But as far as we can discern from the article, those problems were compounded by the coach’s actions after the injury occurred.

Once hit, Martin fell to the ground, unconscious and bleeding from her ear. While other players urged coach Melissa Wheeler to call 9-1-1, she ignored them and called a trainer instead. According to the article:

Martin was transported on a golf cart to the training room. The suit alleges she was kept in the training room about two hours before Wheeler took her to the Grande Ronde Hospital in her personal car.

At the hospital, Martin was diagnosed with a longitudinal fracture of her right temporal bone. She was flown to Emmanuel Hospital in Portland for treatment.

That is hardly an appropriate reaction to a head injury. The injured Martin should have been transported by ambulance after a 9-1-1 call. This was a serious injury. According to the article, Martin suffers from permanent severe headaches, memory loss, inability to perform tasks requiring sustained attention, trouble with math and deductive reasoning, and more.

“She had all the signs of a head concussion but they kept her there for over two hours,” [Holly Martin's mother, Dawn Martin] said. “My whole point is, why wasn’t 9-1-1 called? It took them two hours to call me, and then another half hour to get them to take her to the hospital.”

The Martin family has filed a lawsuit to recover economic damages and other costs. Apparently, the University is fighting the lawsuit on a few grounds, including that the statute of limitations had passed.

That would be a shame. Holly Martin has been harmed enough.

To read the full story in The Observer, click here:  Softball player sues EOU over head injury

from Chicago Tribune

Junior Seau was a star. He was the kind of football hero that put butts on couches and raised Sunday TV ratings.

Junior Seau died on May 2 of an apparent suicide. In echoes of the suicide of another former NFL great Dave Duerson, Seau killed himself with a shot to the chest, presumably because he wanted to preserve his brain so that experts could determine whether he was suffering from chronic traumatic encephalopathy (CTE). CTE is a form of progressive brain damage caused by multiple concussions. It can cause mood changes, memory difficulties, neurologic impairments, and dementia.

The tragedy of CTE—make that one of the many tragedies—is that the damage can be suffered when a person is young, strong, and seemingly quick to recover from any injury… but there is no way to diagnose CTE. The only way to tell the extent and progression of the injury is to examine the brain after death. Hence, one of the new preferred suicide methods for people who believe they have suffered enough brain injury to cause CTE is a gunshot to the chest, preserving the brain for autopsy.

According to an article on the Huffington Post:

After defensive back Andre Waters’ suicide in 2006, Dr. Benet Omalu of the Brain Injury Research Institute at West Virginia University told the New York Times that the 44-year-old “Waters’ brain tissue had degenerated into that of an 85-year-old man with similar characteristics to those of early-stage Alzheimer’s victims.”

When the Bengals’ troubled Chris Henry died, Dr. Omalu and his colleagues determined that the wide receiver suffered from the same chronic traumatic encephalopathy. He was 26 years old.

Seau was a former All-Pro linebacker who played for 19 seasons in the NFL, for the San Diego Chargers, New England Patriots, and Miami Dolphins. According to an article on Forbes.com, on the day Seau’s death was reported, NFL commissioner Roger Goodell handed out suspensions for the New Orleans Saints players involved in the team’s bounty program.

Have you heard about the bounty program? As we wrote in a previous blog, the New Orleans Saints had a bounty program, in which players were paid thousands of dollars for hard hits that knocked opponents out of games. Supposedly, players were paid $1000 for a “knockout hit,” and another $1000 if a player needed to be carried off the field. Those are just some of the tactics that have driven more than 1000 former NFL players to sue the league for their head trauma and potentially permanent disability.

How many more players and former players will have to commit suicide before the NFL puts more safety measures in place? Then again, maybe the hundreds of pending lawsuits against the NFL will be the deciding factors. Very often, safety and progress only come after an issue has been screened through the filter of the legal system:  Bad actors go to trial, good laws evolve.

Better a courtroom than an autopsy room any day.

RESOURCES

To read the HensonFuerst blog about the bounty program, click here: “Organized Savagery” in the NFL

To read the full article in Forbes.com, click here:  NFL’s Junior Seau Dies in Suspected Suicide

To read the full article on the Huffington Post, click here:   Junior Seau–Changing the NFL Forever

Ray Easterling, former player for the Atlanta Falcons, died Thursday at age 62 of an apparent self-inflicted gunshot wound. According to an article in The New York Times, Easterling was part of a group of former NFL players who sued the league, claiming that it had failed to treat players for concussions, and for attempting to conceal links between football concussions and long-term brain injuries.

An article on USAToday.com reported that the 61st concussion lawsuit was filed in federal court in Philadelphia by 28 former NFL players. In total, more than 1,260 players have filed concussion-related suits against the NFL. The suits blame that the players suffered long-term damage from concussions due to the league’s “carelessness, negligence, intentional misconduct, and concealment of information.”

As we wrote in previous blogs last year, multiple concussions can result in a brain disorder known as chronic traumatic encephalopathy, or CTE. This progressive, incurable condition leads to memory loss, depression, and dementia. Unfortunately, the only way to definitively diagnose CTE is after death, by autopsy. Boston University’s Center for the Study of Traumatic Encephalopathy has been researching the link between football and CTE. Of the brains of 15 former NFL players, 14 showed signs of CTE.

Concussion Safety

According to The New York Times, Easterling’s widow, Mary Ann Easterling, will continue to pursue the lawsuit on behalf of her husband, and she is urging the league to establish a fund for players with traumatic brain injuries related to their playing days.

“Half the time the player puts themselves back in the game, and they don’t know what kind of impact it has,” she said. “Somehow this has got to be stopped.”

Friends and Easterling’s attorney, Larry Coben, said that Easterling had not been himself for about the past six months. According to Coben:

“I could tell he was not on his game. He kept repeating himself and getting confused. It’s pretty tough, pretty tough.”

To read the full story in The New York Times, click here: Ray Easterling, of Atlanta’s Gris Blitz, Dies at 62

To read the full story on USAToday.com, click here:  Easterling’s death will impact concussion lawsuit

To learn more about the NFL lawsuits, click here:  NFLConcussionLitigation.com

To watch our video about concussion, click here:  Concussion Safety

After a head injury, patients face numerous physical and emotional challenges. During and even after hospitalization, there are many medical decisions that need to be made as part of treatment. But the very act of making decisions is a problem, according to research published in the April 11, 2012, issue of the medical journal Neurology.

According to an article in ScienceDaily, the severity of the injury directly corresponds to the amount of decision-making impairment. One month after the initial injury, patients with mild traumatic brain injury (TBI) showed little residual impairment, while those with more severe TBI had significant impairment. This impairment can affect patients’ health in ways that go beyond simple decision making.

“Immediately following injury and during the rehabilitation and recovery period, patients and their families must make ongoing and often complex medical decisions, including treatment of brain trauma and orthopedic injuries, choice of rehabilitation programming and treatment of neuropsychiatric problems,” said Daniel C. Marson, J.D., Ph.D., professor of Neurology, director of the UAB Division of Neuropsychology and senior author of the study.

This study suggests that doctors and caregivers need to be more aware of what patients are, and are not, capable of. Patients may not be able to give consent to medical procedures for months after the initial injury. It could be that caregivers need to take a more active role in medical decision making for a longer period of time than previously thought.

Unfortunately, there is no test to help us judge when a patient is capable of making decisions. Caregivers will need to rely on physicians and other experts to help them make proper decisions for their injured loved ones. This study points out another reason why TBI attorneys are valuable members of a treatment team for people with brain injury–attorneys have experience dealing with the long-term needs of patients, needs that include help for caregivers who may need to take control over their loved one’s lives for months or years after the patient leaves the hospital.

To read the full article in ScienceDaily, click here: Head Injuries Often Impair

To learn more about how an attorney can help in TBI cases, visit our dedicated TBI webpage:  www.lawmed.com/braininjury/

There are two new and wonderful resources about concussion. You know we write a lot about mild traumatic brain injury (MTBI), and it takes a lot to impress us, but these resources are truly special:  One is a physician-developed smart phone app designed to help coaches, parents, and athletes recognize and assess concussion; the other is a CDC info pamphlet about recognizing and treating concussion in children, including strategies for addressing concussion symptoms at school.

There’s an App for Concussion, Too!

When they say “There’s an App for That,” they’re not kidding…and that’s a good thing.

Concussion Recognition & Response gives real-time advice about recognizing and treating concussion. Menu items include “NEW INCIDENT,” which walks you through a series of assessment screens, including evaluative questions, such as “Was there likely a blow to the head or body, jerking the head?”, and did you observe vomiting, balance problems, or other specific (and listed) signs of concussion?

The app also provides a list of criteria to help you decide whether to treat a head injury as an emergency and call 911, questions to ask the child who experienced the head injury, and Frequently Asked Questions. Finally, the app tells you whether a concussion is likely, what led to that assessment, and what you should do about it. (Of course, there is a disclaimer at the first page of the app which states:  This application is not intended to replace seeking help from a trained medical professional. If the youth has lost consciousness, even briefly, call 911 immediately.  That makes sense—no app should ever replace common sense or rational concern when it comes to a child’s health.)

Should you need to seek medical attention for the child, the app provides a summary of all the information you input to share with a doctor…even by email.

“Concussion Recognition & Response” (CRR) is available on iTunes and Android Market. It works on smart phones, iPods, and tablets (such as the iPad). It was developed by two experts with ties to the University of North Carolina at Chapel Hill (UNC-CH), Jason Mihalik, Ph.D., an assistant professor of Exercise and Sports Science in UNC’s College of Arts and Sciences, and Gerard Gioia, Ph.D. (UNC ’84) of the George Washington University School of Medicine. This new app is so impressive that it has already been nominated for an Appy Award–and it is one of three finalists in the medical category. The app is priced at $3.99 for a limited time, and a portion of the proceeds of the sale go to support concussion research at the Children’s National Medical Center, and the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center.

According to developer Dr. Mihalik:

“We see as many as 60 percent of concussions go unreported or undiagnosed,” Mihalik said. “This app will really help to provide a systematic diagnostic approach to that injury, and we’re hopeful that it will capture more diagnoses of concussions so that kids can be managed properly.”

And despite the focus on sports, don’t think that the benefits of this app are only for young athletes. According to a press release by UNC:

“This is not just an application for kids that play sports,” said Karen Earp, as her 9 year-old daughter climbed on playground equipment behind her. “This is an application for anybody and everybody to use whether you play sports, whether you play on a playground, ride your bike or are just outside having fun.”

For more information about the CRR App, click here:  Concussion App publisher.  (You can find links to the Android Market and iTunes purchase pages here, too.) It is easy to get confused by the offerings on iTunes–there are at least four other concussion-related apps, but this is the best app of this type we have seen..by far. The full name is Concussion Recognition & Response: Coach & Parent Version. And the icon looks like this:

icon for CRR app

Information from the CDC to Read at Home

One of the biggest changes resulting from recent research is how young victims of concussion are treated at home and at school. Questions many parents have are:

• When can my child start playing sports again?
• What can I do to ease his or her symptoms?
• What can I expect in terms of emotional or behavioral changes, or ability to concentrate and do schoolwork?
• How can we deal with those changes?
• How long should symptoms last…and what should I do if they don’t seem to get better?
• How can I get the school involved in my child’s concussion treatment?
• What experts can we contact if the problem seems not to get better?

These questions are all answered in a fabulous new PDF document from the U.S. Centers for Disease Control and Prevention (CDC) titled Heads up to Schools: Know Your Concussion ABCs. Even though it is called “a fact sheet for school professionals,” parents will find it a valuable tool, as well.

You can download a free copy of this pamphlet here: http://www.cdc.gov/concussion/pdf/TBI_Returning_to_School-a.pdf

Thomas Henson Jr., managing partner of the catastrophic injury and complex litigation division of HensonFuerst Attorneys, spends much of his time focusing on cases involving traumatic brain injury, catastrophic personal injury, and spinal cord injury. He has personally represented hundreds of people—children and adults—with every type of brain injury, including concussion, coma, and brain bleeds. Henson is also a member of the Traumatic Brain Injury Litigation Group of the American Association for Justice.

BIANC Board Member

In recognition of his role as a passionate advocate for the causes of traumatic brain injury prevention and treatment, Henson was recently invited to serve on the Board of Directors of the Brain Injury Association of North Carolina (BIANC). In this new role, he will work with other BIANC board members to raise funds and raise awareness of the life-changing effects of brain injury.

Henson has been a sponsor and member of BIANC for several years and has led HensonFuerst’s cycling team in its annual participation in Ride for the Rock, a charity cycling event that benefits BIANC, named in honor of a cyclist who suffered brain injury during a cycling-related accident.

“I am pleased to find another opportunity to help victims of traumatic brain injuries and their families, and I am honored that I have been asked to serve in this capacity,” Henson said. “The consequences of brain injuries can be tragic and are often overwhelming for those affected. Traumatic brain injury victims need and deserve our help, and the BIANC members do everything they can to maximize the quality of life for these victims and their families.”

Speaker and Author

Henson has also recently completed work on a book chapter. The book—The Miracle Mind: Sonya’s Story—was designed to help people retrain their brains after stroke. Henson’s chapter is a perfect complement, focusing instead on brain injury due to trauma (instead of stroke), and discussing how lawyers are often a critical part of a successful treatment team.

The chapter was publicly introduced on February 24, 2012, at the BIANC conference called “Building Community from the Inside Out.” There, Henson spoke about how attorneys can benefit brain injury patients, including helping them seek compensation for their injuries, providing medical and rehabilitation resources, and planning for long-term financial needs.

“I am honored to have been part of such a special group of people who gathered to exchange information and resources about brain injury, its consequences, and successful techniques for managing some of those consequences,” Henson said.

Miracle Mind-TBI Chapter

Brain injury patients nationwide are lucky to have such a tireless and passionate advocate on their side.

Thomas Henson Jr. can be reached at HensonFuerst Attorneys at 1-800-4-LAWMED, or via their website at http://www.lawmed.com/.  If you have questions, HensonFuerst has answers.

Patrick & Sarah Jane Donohue

Patrick Donohue’s world is defined by two things: His daughter, Sarah Jane, and numbers.

When Sarah Jane was five days old, her baby nurse shook her violently, causing four broken ribs, two broken collarbones, and severe traumatic brain injury (TBI). That injury sparked the interest in numbers. According to an article in Utah’s Deseret News, some numbers that Mr. Donohue is obsessed with these days:

• 765,000:  The number of children and young adults sent to emergency rooms for brain injury in the United States each year.
• 80,000:  The number who go on to be hospitalized for TBI.
• 11,000:  The number who die of their TBI injuries.
• $10 million:  The amount spent on brain injury research. (He compares that to the $4 billion spent on AIDS/HIV research and $1 billion on autism research, which combined afflict fewer people each year than brain injury.)
• 10: The number of different treatment plans TBI patients are likely to get if they visit 10 different doctors.
• HR 2600:  The name/number of the bipartisan bill currently being considered in Congress also known as the Pediatric Acquired Brain Injury (PABI) Plan Act. This resolution would endorse a master treatment plan for brain injury, and create a network of 52 State Lead Centers of Excellence–one fore every state plus the District of Columbia and Puerto Rico.

Dr. Ricardo Komotar, a noted brain specialist at the University of Miami Hospital, many people with brain injury may not even know it, especially if the injury happens during sports.

“It’s important to understand that only 15 to 20 percent of all concussions involve loss of consciousness. The other 80 percent are largely unrecognized.”

That has long-term consequences, he says, including cumulative brain damage. “You can present with early Alzheimer’s, Parkinson’s, dementia. We’re seeing it more and more, the hits in sports more violent.”

The dementia-related disorders are the biggest issues facing adults who suffer brain injury, even minor brain injuries like concussion…especially after multiple concussions. But for children, the biggest challenges of brain injury are getting appropriate assistance in the school system, and helping them make the transition to adulthood. Experts say that about 90 percent of children in juvenile detention have brain injuries, making it not just a personal health problem but a public health and social crisis.

Concussion may be a dirty word

Mild traumatic brain injury (MTBI) is better known by its more common name:  concussion. But TBI activists and many physicians would rather we call call it just plain brain injury. Why? Because, according to Mr. Donohue, there’s a tendency to disregard injuries classified as mild TBI. “Imagine someone saying you have mild cancer,” he says.

MTBI may not cause the kinds of dramatic and devastating disabilities seen in patients with more severe brain injury, these mild injuries still require medical attention and coordinated treatment plans. Especially children, the youngest victims. And we all deserve to know that scientific and medical research is progressing, and it would be nice if there were sufficient funding that we have hope that someday TBI might become a treatable disorder, as opposed to a permanent disability.

To read the full article in the Deseret News, click here:  TBI crisis as evidence mounts

from 9News.com

Dylan Hearn probably has a great future ahead of him; he is wise beyond is meager years. The 7-year-old Colorado boy has a personal crusade to made sure that everyone takes concussion seriously.

And he knows what he is talking about:  He suffered two concussions in the past six months. The first was playing football, and the second happened when he ran into the dishwasher at his home (he was chasing his brother.) The injuries put him out of commission for about a month, including his favorite activities—no TV, no video games, no reading.

According to an article on 9News.com, Dylan says:

“It hurts,” said Dylan. “A lot of sick and dizzy. Sometimes, you have blackouts.”

Now, Dylan’s concussions are changing the way people around him view head injuries. For example, his baseball coach, Jeff Pigati, says that the determination of injury used to be totally in the hands of players. If they said they were feeling well enough to play, they played. But kids and athletes being what they are, they typically jumped back into the game sooner than they probably should have.  That’s what killed another boy, 15-year-old Jake Snakenberg:

Snakenberg died in September 2004 after sustaining a serious concussion in a football game. Doctors believe it was his second concussion in a week and he died of Second Impact Syndrome. Just before the game, he told everyone he was fine.

That’s why there is now a law in place called the Jake Snakenberg Act. It requires all coaches, like Pigati, to undergo concussion training to look for signs of possible brain injury.
Dylan and Alex Hearn [Dylan's mother] applaud the new measures.

[If you would like to see the online training program for coaches, click here:  CDC HeadsUp]

Now, coach Pigati watches kids for head injury and tell-tale symptoms, and he’s happy to do so. Like most coaches, Pigati takes the health of his players very seriously. He applauds the Colorado law requiring coaches to undergo concussion training.

And Dylan? He likes the law, too. Why?

“Because it’s safe,” said Dylan.

From the mouths of babes.

To read the full story on 9News.com, click here:  7-year-old applauds new concussion rules

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