Articles Posted in Concussion

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Personal Injury accidents can have life altering effects on the person who is injured. Sometimes, the problems that the person suffers exceed the physical injuries that have occurred. When a person goes from being active and unimpaired one day to infirmed the next, it is impossible for the person to not have some depression about the change in life circumstances. In some of these cases, the injured person becomes so depressed by the changes in his or her life circumstances that they lose the will to live. In these cases, New York law has stipulated that if the person filing a wrongful death suit must be able to show that there is a causal link between the person’s suicide and the injury that they received at work.

One case that involved this type of wrongful death action involved a man who was injured twice at work. He was injured 14 years before his death and then again five years before his death. In 1945, the decedent was an usher at a movie theatre when a fight broke out in the men’s room. He attempted to break up the fight and was pushed into a marble wall, and suffered a brain injury. He was diagnosed with a cerebral concussion as a result of the accident and eleven days later a workers’ compensation doctor announced that he was fully recovered. His wife claims that although he went back to work. Her husband suffered from headaches blackouts, and fainting spells following this accident.

The second accident occurred in 1959 in Nassau, when he suffered a debilitating back injury while at work. The back injury changed his lifestyle and caused him to plummet into a state of deep depression. His wife stated that it was this deep depression that led him to take his own life. The workers compensation board disagreed. They contend that this man was suffering from many issues that affected his mental stability long before he took his own life. They contend that he was suffering from mental illness before he had his first work place injury in 1945.

The workers compensation board attorneys state that it was his life story that pointed to their contention that his work place injury had nothing to do with his suicide. They testified that his birth was the result of the rape of his mother who was crippled. She could not stand the sight of him after his birth and gave him up for adoption. He was raised in foster care and had medical problems from birth. He suffered from painful rickets as a small child because of his poor nutrition. He had surgery in 1940 for a polyp in his right ear. Four years later he was hospitalized because of a severe bout of renal colic. He remained in the hospital for a month. The year before his first industrial accident, he voluntarily admitted himself into the Queens General Mental Hygiene Clinic for anxiety and back pain. He told the medical personnel at that time that he had fallen off of a stoop three years before. He told them that as a result of the fall, he would get panicky and have black outs. He told them that he would have occasions of blindness that would occur about twice a day and that he suffered from headaches every day. He also told them that he had strange dreams and nightmares. The board maintained that while the causes of suicide are many, this man was headed in that direction long before his first industrial accident.

The court in Suffolk did not agree. They reviewed all of the associated evidence and determined that while this man clearly had other issues to deal with, the change in life circumstances that occurred following his back injury were dramatic. The depression that resulted was well documented and the Supreme Court ruled that the death was associated to the personal injury.
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According to the research provided in a study released last week, the Army could reduce the chances of a soldier suffering from brain injury simply by having them wear a helmet one size larger and containing slightly thicker padding.

The study in Long Island found that as little as a Enlarge Closen eighth of an inch more cushion could decrease impact force on the skull by up to 24% – a substantial difference when determining whether or not brain trauma is on the menu.

Brain injury is a common occurrence on the battlefield of Afghanistan, and the Army is looking to verify the findings and then to move toward issuing larger helmets with the extra padding. Concussions are common among troops knocked about inside armored vehicles or flung to the ground while on foot patrols.

The results of the research and development are very encouraging. The work warrants field testing on a limited and experimental basis, starting with a brigade of soldiers. For a widespread policy and wardrobe change, more research and validation of the findings are necessary.

During the summer of 2010 alone, battlefield doctors diagnosed more than 300 service members per month with concussions and mild traumatic brain injuries (TBI). A smaller number of service members were diagnosed with more moderate or severe head wounds.
A New York Brain Injury Law Specialist says the effectiveness and economic brilliance of the study is that it offers an answer that is drawn from equipment the Army already has. “This is what appears to be an off-the-shelf solution.”

Helmets currently weigh about 5½ pounds. Upgrading to one size larger would add about 4 ounces of weight to the headgear. The study found that adding padding beyond an eighth of an inch provided only slightly better protection, and since they are concerned and unwilling to create helmets that are too large or heavy for soldiers to maneuver in, they are working with the idea of the 1/8 inch padding.

Although this discovery by Bronx scientists improves protection against a blow to the head, soldiers still need a bulletproof helmet and one that will resist blast waves. Only then will the brains of soldiers be completely protected from TBIs on the battlefield.
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The state of West Virginia is seeking a federal Medicaid waiver so it can offer a program that will help people with traumatic brain injuries (TBI) remain in their homes, rather than forcing them into nursing homes or other facilities.

Earlier last month, the West Virginia state Supreme Court upheld a County Circuit Court ruling that issued a requirement that the Department of Health and Human Resources had to seek the waiver from the federal entity and that they had to get funding for the program.

A DHHR spokesman told a Lawyer that the program will begin when the federal Centers for Medicare and Medicaid Services approves the waiver. Though the agency can’t pinpoint when the waiver will be approved, they did say it plans to provide services to 75 people in the first year, 100 in the second year, and 125 at the third year of the program.

The estimated program costs will be $2 million a year. The State Legislature has already appropriated $800,000 for necessary services such as physical therapy and home health visits.

Back in 2009, a judge ordered the DHHR to seek the waiver and secure funding, but the state appealed, stating that the circuit court had overstepped its bounds. The State Supreme Court called that claim “devoid of merit” and recently rejected the DHHR’s appeal.

The spokesman said Thursday that the waiver application was submitted while state officials awaited the appeal ruling. This speeds up the process since the waiting part has already begun.

Advocates of the program in Staten Island and Suffolk have long complained that West Virginia fails to offer adequate brain injury care. Such inadequate care can cause depression, personality changes, and loss of coordination and memory.

A man whose 39-year-old son suffered a brain injury as a child at the hands of a drunk driver gives others a glimpse into the life of TBI patient. “They can’t plan a meal, they can’t balance a checkbook, and they can’t go to the store on their own.”

Once the waiting is over, this program can help many residents of the state receive the care they probably would not have gotten otherwise.
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U.S. service members injured in the line of duty have long been eligible to receive the Purple Heart Medal. This has held true for the signature wounds of the current wars, including mild traumatic brain injuries and concussions.

Recently, the criterion for awarding the medal was refined. “More clarity now exists for how medical criteria for the award are applied,” Defense Department officials reported.

“The criteria for the Purple Heart award state that the injury must have been caused by enemy action or in action against the enemy and has to be of a degree requiring treatment by a medical officer.”

The DOD still allows for the award of a Purple Heart when a service member was not treated by a Westchester medical officer, as long as a medical officer can certify that the member’s injury would have required treatment by a medical officer had such an officer been available.

This additional criterion is important because it can still be a very difficult task to determine when a mild traumatic brain injury or a concussive injury occurs if it does not result in a loss of consciousness. Many injuries are severe enough to require treatment by a medical officer, but they are not diagnosed.

Many advances are being made to ensure proper diagnoses in the field, but may still yet be months or years away from implementation, a source based in Manhattan tells us. Officials with the DOD said that as the science of traumatic brain injuries becomes better understood, guidance for award of the medal will evolve.

A Lawyer praises the efforts of the military for their acknowledgement of the sacrifices of the members of the U.S. Armed Forces’.

Receiving a Purple Heart is a high honor given to those who have sacrificed in the line of duty. By taking steps to refine the requirements for the award, the DOD is ensuring that the award maintains its distinctiveness. And by listing the requirements, everyone who sees the Medal will know that a valorous deed was committed by the wearer.
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In 1960, a Nassau man was found dead by his own hand. He left behind a suicide note that stated that he could not stand the pain of his injuries any longer. This man had suffered from a back injury on his job that left him in constant pain and unable to function as he had before he was injured. His wife filed a wrongful death suit against the Workmen’s Compensation Board. Her contention is that her husband suffered from two debilitating industrial accidents. One of the work related accidents that he suffered occurred in 1945. He was working for a theatre as an usher when he attempted to break up a fight in the men’s room. His head was slammed against the marble wall of the men’s room and he suffered from a brain injuryas a result. Following this injury, the man was plagued by headaches, blackouts, and incidents of blindness. His wife stated that he would have moments of blindness that would last a few seconds at least once or twice each day. These incidents were followed by excruciating headaches. She stated that following the second injury, it was too much for him to handle. She proposes that there was a direct causal link between her husband’s industrial accidents and his suicide.

New York law states that where the symptoms of an injury that occurs on the job continue until the suicide of that person, a direct causal relationship may be inferred. That means that death benefits are awarded if the injury results naturally in disease and the disease is the cause of death. The courts have ruled that if the injury causes insanity and the insanity cause the suicide, it is the proximate cause of the death. However, if the insanity is not a result of the injury, but rather from some other cause such as melancholy or discouragement, then the injury is not considered to be the proximate cause of death.

The Worker’s Compensation Board contends that the brain injury was not the proximate cause of the decedent committing suicide. They contend that the decedent had a long history of mental illness dating back to early childhood. They produced evidence that he had committed himself to a mental institution before his first injury. His complaint at that time was severe anxiety and headaches accompanied with bouts of blindness. They stated that following this incident and only one year before his death, he checked himself into the hospital for renal colic and was in treatment for one month. They brought forth evidence of the decedent’s many medical issues and even ventured into his relationship with his mother. His mother was crippled at an early age. She was raped and the result of the rape was the decedent. He grew up in foster care. The Worker’s Compensation Board contends that the decedent had numerous health and psychiatric problems his entire life and that it was these problems and not his back injury that caused him to take his own life.

The wife disagreed and presented the case to the courts. The courts examined the injuries, reports, and contentions associated with this case. The trial court at first determined that there was no causal link between his injury and his death. The wife appealed this decision to the Supreme Court. The Supreme Court ruled that based on the suicide note claiming that the injury caused his suicide, and the devastating effects that the back injury had on his life, there was reason to believe that the suicide was the result of the injury at least in part. There is little doubt that this man dealt with depression in his life circumstances, but the court determined that there was a causal link between his suicide and his injury.
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It isn’t necessary to go into the entire pathology of primary brain damage here. Suffice it to say that it is important to use primary brain damage to understand the initial level of consciousness of a patient and any neurological problems that might immediately be apparent, doctors in The Bronx and Brooklyn have determined.

Any changes that occur in the first few moments after injury should be understood whenever possible, so they can be treated as soon as possible. The damage caused directly the impact could very well be aggravated by secondary brain damage, resulting in effects ranging from concussion to coma and death, sources have learned. For example, a object that penetrates the skull will obviously cause direct damage, but it may also cause some loss of function or impairment. Any further loss of consciousness or brain function would be caused by secondary brain damage.

Experimental research has shown swelling occurs at the site of the injury within 15 minutes of traumatic brain injury. As hours pass, the injury can continue to worsen, due to misalignment of parts of the brain. Pressure inside the skull can increase, subjecting the brain to forces that will make matters even worse. Doctors have determined the first few minutes after head injury are vital. It takes trained medical professionals who know what to do with head injury to prevent what may seem like a straightforward medical problem from becoming something far worse, something that might cause lifelong impairment or even death.

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War, while terrible, can often bring many innovations, such as new medical concepts, according to sources. A committee of British clinical neurosurgeons in World War II sought to develop a standardized terminology for states of impaired consciousnessand published a glossary of their work. This committee included several preeminent neurosurgeons and others were quick to adopt their terminology. The original publication did not have a graded scale of levels of consciousness, but the glossary was used to help build such a scale. Eventually, the Glasgow Coma Scale was created in 1974.

The GCS has been used for decades and has become a widely-accepted way of measuring consciousness, studies have learned. There are some who do not like some of the details of this scale, however, and the way it is used has changed since its first implementation. Differing levels of stimulus and response were experimented with in an effort o create a universal scale that most physicians could agree upon.

Criteria such as sensitivity to pain, reflexes, and eye motion were all taken into account. Eventually, it came to be understood that all patients with a GCS score of 7 or less were comatose, while many with a score of 8 could also be called comatose, with the maximum score being 15, at fully unimpaired consciousness. doctors in The Bronx and Brooklyn have learned the final value of the GCS is in early evaluation of the primary effects of a head impact, and it helps to track the progress of an injury in order to treat any complications that might arise.

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Physically, the only real difference between the head being still or in motion when struck, is frame of reference. The real difference, doctors have learned, is that does not lie in if the head is in motion or not, but in such factors as the velocity of impact and the characteristics of the object that strike the head.

So, a high-speed crash will have a greater impact velocity than a low-speed crash – in most cases. In reality, researchers have learned, such details as the type of crash can be very significant. A high speed rollover can be relatively harmless, compared to collision with another vehicle or a fixed object, even if the speed is much lower. Even in crashes that seem very similar, it isn’t uncommon for one person to receive a major head injury, where another did not receive an impact to the head at all.

A major factor in head injury is the striking object itself. Given that the object does not pierce the skull as a bullet would, the important characteristics of the struck or striking object is how stiff it is and its general surface area. Doctors in Staten Island and Suffolk County.

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The way surgeons deal with shrapnel or bone fragments in the brain has changed since the days of Korea or Vietnam, doctors tell sources. It was once the standard to remove every last fragment of bone or any other foreign body, so the brain would have a lower risk of infection and there would be less chance of developing post-traumatic epilepsy. Studies in Westchester County of Vietnam War patients has shown that removal of all fragments is not actually necessary, though objects that cause gross contamination should still be removed.

Closure of the scalp and replacement of the dura are absolutely vital to prevent, or at least reduce the chance of, CSF leakage and meningitis. A soldier who seems to have good neurological status, with only small fragments in the brain may be able to be treated locally to prevent leakage. One with a more extensive injury will have to undergo a large decompressive creniectomy and removal of the fragments.

Another source of head injury from an explosive blast can result from being bodily thrown by the explosion. The soldier’s head could strike some other object, causing tertiary blast injury. This can cause injuries in a number of places in the patient’s skull. There is also the risk of infection in cases such as these, often from bacteria that are drug-resistant. A number of dangerous injuries can result from such trauma, New York City doctors know. It can be very important to repair such injuries as facial fractures quickly.

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Researchers recently found that soldiers who wear military helmets one size larger and with thicker pads, have reduced the severity of blunt and ballistic impact traumatic brain injury (TBI).
The one-year study funded by the U.S. Army and the Joint IED Defeat Organization (JIEDDO) was aimed at comparing the effectiveness of various military and football helmet pads.
The particular research facility used was chosen via a review committee. The committee concluded that the LLNL research lab had the best set of skills, and their previous experience working on blast-induced TBI would prove valuable.

A Queens doctor specified that five different types of pad systems were studied. Those currently and previously used by the Army, two used in NFL helmets, and one used in other protective sports equipment were examined.

The two Army systems consist of bilayer (hard-soft) foam pads within a water-resistant airtight wrapper. One of the NFL systems consists of a thin foam pad and a hollow air-filled cylinder that buckles under load, and the other is a bilayer foam pad surrounded by a covering with air-relief channels that connect to adjacent pads in the helmet. The fifth pad consists of uniformly dense foam.

A combination of experiments and computational simulations were used to study the response of the various protective systems when pitted against battlefield-relevant impacts. The information gathered helped researchers gain an understanding of how each of the helmet pads provide protection against impact.

A researcher who read the report relates in simple terms what the scientific findings were. “For each of the pads, experiments were conducted so the research team could characterize the properties of each of the components within the helmet system. They also observed the response of the complete pad system. The tests were given in a range of impact velocities to ensure accurate answers.

After the testing in Nassau, computational simulations examined how those various parameters affect the system’s general response to impacts. The materials of the foam, pad thickness, pad area, trapped air, etc. were some of the parameters tested.

Drop tests with the actual materials were done to confirm the results of the simulations.
As a result of the teams exhaustive testing and simulation, they were able to recommend the use of a larger size helmet and thicker foam to reduce TBIs in the field.
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