Articles Posted in Brain, Spinal Cord and Nerve Injuries

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Whether a person has a “mild,” “moderate” or “severe” traumatic brain injury (TBI) is governed by the Glasgow Coma Scale. A score of 13-15 is a “mild” injury, a score of 9-12 is a “moderate” injury, and a score of 8 or less is a “severe” injury. 75% of brain injuries are considered “mild.” However, the consequences of a mild traumatic brain injury (MTBI) frequently are not mild and, in some instances, never go away.

Recently, a physician from New York University’s School of Medicine, reported that resting-state magnetic resonance imaging (an MRI) can be used to identify a mild TBI. Apparently, a resting-state MRI can identify increased thalamic resting-state networks (RSNs) and reduced symmetry. “We welcome additional radiological imaging to identify what really is a silent epidemic,” said Michael A. Bottar, a New York traumatic brain injury attorney. “Until recently, medicine said that you were fine if you did not fracture your skull, and had a normal CT and/or MRI. We know, from experience, that some people who experience a MTBI have no outward signs of injury. Even so, they are never the same.”

Some signs and symptoms of a MTBI include: transient confusion, disorientation, loss of consciousness or altered consciousness, memory dysfunction, headaches, dizziness, irritability, fatigue and poor concentration.

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“Approximately 1.7 million people sustain a traumatic brain injury every year,” said Anthony S. Bottar, of Bottar Leone, PLLC, a team of Syracuse personal injury attorneys representing individuals disabled by a concussion or post-concussion syndrome.

According to the CDC, 80% of people with a traumatic brain injury are treated and released by an emergency room. Concussions account for most of those TBIs (75%). “After a TBI, many people appear normal on the outside, yet some people never fully recover. And 3% of TBI victims die – as many as 50,000 people each year,” Bottar added.

Most TBIs are caused by falls, followed by car accidents, impacts/collisions (i.e., athletics), and assaults. With advancements in imaging technology, the medical community now acknowledges that a concussion, even a mild concussion, can harm the brain on a cellular level, with devastating consequences. In turn, a Concussion Bill has been introduced. It applies to all school age students, not just student athletes, and provides that “in the event that there is any doubt as to whether a pupil has sustained a concussion, it shall be presumed that he or she has been so injured until proven otherwise.” Pupils will be prohibited from participating in school athletic activity until they are concussion symptom-free for 24 hours. The Bill also requires that concussions be reported to the New York State Education Department

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The departments of Defense and Veterans Affairs recently announced that they are investing additional resources into research, prevention, early detection, outreach and treatment for concussions, post-concussion syndrome and traumatic brain injuries. The goal is to provide better care for service members and veterans suffering from a traumatic brain injury or coping with post-concussion sundrome.

According to Air Force Colonel (Dr.) Michael Jaffee, who recently spoke to the Senate Veterans’ Affairs Committee, said that the two departments will coordinate their efforts to better understand brain injuries through clinical trials and published research. One way the departments plan to better treat brain injuries is to implement mandatory concussion screenings for all service members who could have suffered a brain injury due to an accident or incident. Stated differently, everyone at risk for a concussion will be examined for signs of brain damage.

New efforts to diagnose and treat brain injuries will include a multi-disciplinary approach to treatment and, in conjunction with a bill recently signed by President Obama, will enable many service members to receive care at home. Inevitably, better military care will translate into better medical care for civilians, including those who suffer a brain injury in a car accident, or brain damage from a construction site fall.
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After a long winter, the sun is finally warming Central New York. Residents in Syracuse, Oneida, Oswego, Cortland, Ithaca, Auburn and Watertown will soon be spending much of their time outdoors, whether golfing, boating, biking, running, skateboarding, or rollerblading.

According to the Brain Injury Association of America, Syracuse-area residents and their children should remember to obey the rules of the road and wear a properly fitting helmet. A $20 helmet that fits properly and is worn properly can reduce the risk of brain injury and brain damage by nearly 90%. Choosing the right helmet and wearing it the right way are critical.

To avoid a traumatic brain injury or concussion, remember:

1. Helmet straps should form a “V” under the ears.
2. Chin straps should be connected and snugged. No more than one finger width of space should separate the strap from the chin.
3. Helmets should be worn on the forehead no more than two finger-widths from the eyebrows.
4. Helmets should not move side-to-side (laterally).
5. Helmets should match the sport. That is, a helmet designed for rollerblading should be worn for that sport, not for softball.
6. Helmets should be inspected for damage.
7. Helmets with cracks or other visible damage should not be worn.
8. Children should wear helmets whenever practicable. In the State of New York, all bicycle riders under age 14 must wear a helmet.
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The Syracuse chapter of the Brain Injury Association of New York State recently announced that it will hold its Fourth Annual Golf Classic on June 25, 2009, at Turning Stone. Cost to enter the tournament is $200 per player – proceeds to go to the Syracuse chapter of the Brain Injury Association.
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Defense medical examinations, also known as IMEs, performed by Central New York doctors working for insurance companies are were recently the subject of a statewide investigation conducted by the New York Times.

According to a New York Times review of workers’ compensation case files, medical records, and patient interviews, “independent medical examinations” and the reports that follow are are frequently conducted or prepared in a fashion that benefits insurers by minimizing injuries or by attributing injuries to some other cause or event. Unlike a visit to a treating physician, an IME physician may meet with an injured worker for less than ten minutes. During that ten minute period, the IME doctor may take an abbreviated history, skim medical records, perform a very limited physical examination and send the patient on his or her way without an ounce of compassion. After that examination, the majority of IME reports conclude that the patient is not injured or, if injured, is not disabled.

Many refer to Syracuse-area IME doctors as “Dr. No” or “Dr. Says-No,” because no matter how badly injured, certain doctors will consistently find no injury or no disability. The New York Times interviewed Dr. Alan Zimmerman, an orthopedic surgeon practicing in Queens, New York. According to Dr. Zimmerman, “[b]asically, if you haven’t murdered anyone and you have a medical license, you get certified.” Dr. Zimmerman added that its “clearly a nice was to semi-retire.” Dr. Zimmerman, 75, conducts orthopedic IMEs.

IME examinations are very profitable for doctors (some earning nearly $1,000,000 per year performing examinations and testifying in court), and were poorly regulated until 2001. In 2000, a Long Island doctor conducted five IMEs in a Long Island bar. Some examiners, of course, do furnish honest examinations.

A small study conducted a few years ago at the Central New York Occupational Health Clinical Center in Syracuse, New York, revealed that the clinic’s treating physicians and local independent medical examiners almost always disagreed on whether an injured worker was disabled.
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The New York State Department of Health recently approved a $3.3 million expansion of the St. Camillus Health and Rehabilitation Center (Syracuse, New York) in order to increase outpatient services available for brain injury patients, including those with brain damage and disability caused by a stroke, trauma, fall, or accident. The 12,000 square foot expansion will include a new entrance, exercise rooms, recreation facilities and rehabilitation counseling for brain injury patients. As part of the project, the day care facility will expand from 40 to 52 beds per day.

The brain injury rehabilitation program at St. Camillus is well established. The treatment team includes a case manager, dietitian, neuropsychologist, occupational therapist, physiatrist, physical therapist, recreation therapist, rehabilitation counselor, rehabilitation nurse, social worker, and speech/language pathologist.
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According to Dr. Elizabeth Murray, of the Golisano Children’s Hospital, soon coming to Syracuse, New York, children are safer in rear-facing car seats, even after they are old enough or large enough to ride in forward-facing car seats.

It was once thought that children should be turned-around or moved into a forward-facing car seat when they are 12 months old, or weigh more than twenty pounds. Recent studies suggest that children should stay in a rear-facing car seat for as long as possible. The American Academy of Pediatrics is on the verge of releasing new recommendations that would urge parents to keep children in rear-facing car seats until age two in order to prevent neck injuries, such as cervical fractures (i.e., a broken neck).

In order for a car seat to be effective in preventing injury, it must be installed properly. Remember that rear-facing car seats are installed tightly and are not placed in the front seat of a car with an active passenger air bag. Also make sure that car seat harnesses are at baby shoulder level, that a car set is installed at the correct angle, and that seatbelts are buckled correctly. Use the LATCH system were possible.
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At St. Joseph’s Hospital Health Center in Syracuse, New York, infants born with select brain injuries, which can be due to a labor and delivery complication or obstetrical malpractice, are now receiving cold therapy treatments.

Research suggests that cold therapy, which consists of placing a newborn baby on an icy cold blanket for 72 hours after birth, may reduce brain damage caused by a lack of oxygen or blood flow at birth, known as hypoxia, ischemia, or asphyxia. A lock of oxygen or blood flow can lead to brain damage, including cerebral palsy, mental retardation and other developmental problems.

Practically speaking, cold therapy slows metabolic activity in the brain which may prevent the second stage of injury due to oxygen deprivation – second stage injuries occur as blood and oxygen flow returns to portions of the baby’s brain deprived during delivery. Swelling is common during this time period, which the cold therapy is intended to reduce.

At St. Joe’s, the therapy was recently applied to two babies born following placental abruption, which is a life-threatening condition (for the mother and baby) where the placenta separates from the uterus. Crouse Hospital, which operates Syracuse, New York’s largest neonatal intensive care unit, has plans to introduce cold therapy during the Spring of 2009.
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In 1996, Cafe Plus Coffee Shop opened on 216 West Manlius Street in East Syracuse, New York. According to the Cafe Plus website, the store is run “by and for head-injured people.” In addition to coffee and bagels, Cafe Plus is a venue for much more than a caffeinated beverage, including activities such as cards, checkers, live music, movies, computers, creative writing, yoga, and motivation speakers.

Cafe Plus’ website is also an excellent resource for traumatic brain injury patients, as it includes links to many well-known authorities, including The Traumatic Brain Injury Survival Guide, the Brain Injury Resource Center, Upstate Medical Center Library, Brain Injury Information Network and the National Brain Injury Foundation.
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