Grand Rapids Personal Injury Lawyer - Head & Brain Injuries

Conceptualizing Brain Injury as a Chronic Disease

Timothy Smith — Thu, 17 Sep 2009 17:05:49 GMT

“Man is not a rational animal, he is a rationalizing animal.”---Robert A. Heinlein

As a species we naturally try to find patterns out of chaos. From the Biblical story of Adam’s attempts to name all the animals, to Plato’s ideal Forms, to the classification systems of modern biology and botany, one of the ways we attempt to control our surroundings is by classifying them. The upside to this of course has been the tremendous scientific progress of the past five centuries, made possible in large measure by the regularization of knowledge.

A downside to it is that often, when we encounter something new we attempt to fit it into existing categories. Or, when we learn something new about an existing idea, many of us prefer to leave it in its assigned category. Sometimes this leads to bitter quarrels; we begin to fight over the borders of categories while ignoring the new knowledge itself. Some examples of this sort of ludicrous controversy include arguments over whether Pluto is or is not a planet or disagreements over how to classify the platypus. In any event, there seems to be something reflexively contrary in human nature which leads us to resist any effort to move things from one conceptual pigeonhole to another.

One of the modern day bugbears concerns medicine. Namely, what constitutes a disease or sickness? Are the flu, cancer, and tuberculosis diseases? Almost everyone would agree that they are. How about alcoholism, depression, and attention-deficit-disorder? It is not difficult to find folks who do not believe that any of this last list are diseases. Much of the debate is merely semantic; is a condition acute or chronic? However, those semantics can have consequences. Much care of long-term disability has been pigeonholed as mere rehabilitation. This has led to decreases in research funding for many areas.

One of the more important medical areas that has lagged due to this sort of pigeonholing is the long-term care of traumatic brain injuries (TBI). Lay people tend to see brain injuries as an event rather than a process. Moreover, many assume that those with traumatic brain injuries either die almost immediately or recover. In reality, this condition can persist for years, with only gradual if any improvement. As trauma medicine advances, injuries that would have been fatal even a few years ago are now survivable. This trend will accelerate, and as it does we are likely to see increasing numbers of patients coping with significant long-term brain injuries.

It is with these facts in mind that the Brain Injury Association of America (BIAA) is attempting to change the way we think about traumatic brain injuries. Long-term brain injuries carry with them whole hosts of effects which carry over into every area of human health and have been little researched.

It is the position of the BIAA that only by ‘rebranding’ brain injuries can we escape the mental categories in which we have placed traumatic brain injuries. If this is so, and we can begin thinking of these injuries as something that we may someday be able to fix, then we can redirect our research efforts toward helping the millions of Americans living with TBI.

A very interesting approach, indeed.

Originally posted at InjuryBoard by Timothy Smith

A Guide to Selecting Legal Representation for Brain Injury Cases

Timothy Smith — Thu, 17 Sep 2009 16:55:34 GMT

With any injury resulting from the negligence of another person or company, victims may seek restitution for the damage caused. In many cases injuries are relatively minor, pain and suffering is short-term, and recovery is reasonably quick. In these cases, some of which are for relatively low stakes, it is important to select an experienced and skillful attorney. It only gets more important as the injuries become more severe and the chances of full recovery grow slimmer. Perhaps the most severe of the many long-term injuries is a traumatic brain injury, with its attendant need for medical, rehabilitation, and other health services not just for a few months or even years, but potentially for a lifetime. It was with these concerns in mind that the Brain Injury Association of America (BIAA) formed in 1980. The BIAA serves as a clearinghouse for information and support for the millions of Americans living with a traumatic brain injury.

Lay people sometimes have a tendency to see lawyers as a sort of multi-function tool. As though any lawyer has the training and skill to perform any needed task. In fact, the legal world is highly specialized, and just as one would not go to a dermatologist for open heart surgery, one should seek appropriate counsel for specialized legal tasks. Traumatic brain injuries often call for an attorney with a specialized legal skill-set. Some clients who have survived a brain injury need an attorney family law, estate planning, or even criminal law experience. With an eye toward these concerns, the BIAA has presented a brief guide to selecting appropriate counsel for brain injury survivors.

The questions suggested by the Brain Injury Association of America are excellent. these are questions that you or your family should be asking of your potential lawyer. Here is how my firm would answer these questions:

Who else in your practice would you involve in my case? What role(s) would these people have? Describe their background and expertise. On each case, depending upon your situation, you might have as many as 5 different attorneys working on your case - together- as a team. My background includes 17 years representing individuals with brain injuries. I also sit on the Board of Directors of the Brain Injury Association of Michigan. Other attorneys would include Page Graves - former professor of Michigan Auto No-Fault Law at the Detroit College of Law in Lansing; Brad Wierda - a 12 year veteran in the insurance defense industry who is now handling plaintiffs cases through my office; James Baker - a No-Fault specialist with this office; Robert Whims - a seasoned trial attorney with over 300 trials under his belt including a number of multi-million dollar verdicts; and Andrew Shotwell - our probate specialist when we have issues involving Guardianships and Conservatorships for our clients. There will also be 4 legal assistants and a paralegal assigned to your claim.
Who will be my primary contact with your practice? I am always the primary contact and you will be able to contact me by phone or email 24/7
Are you or your law firm able and willing to advance as much as $50,000 in the investigation, preparation and presentation of my case? The proper handling and workup of any claim involving a closed head injury is a very expensive undertaking. We only retain and work with the most skilled experts in the areas of neuropsychology, vocational assessments, economic valuations and other areas of expertise. This requires 10's of thousands of dollars. At Smith and Johnson, we have funded cases to the tune of over $100,000.00 to get the client the correct result. The proper funding of your lawsuit by this firm will not be a problem.

How much of your practice is devoted to personal injury? The great majority of my practice is devoted to personal injury. I handle some other litigation issues from time to time, but the main focus of my practice is personal injury.
Of your personal injury cases, how many are devoted to brain injury? I would estimate that approximately 25% of my current files involve a brain injury.
What results have you achieved? The attorneys here have excellent success in trying cases throughout Michigan including a record verdict in one Northern Michigan county. I was recently recognized by the ATLA as one of the top 100 Trial Attorneys in Michigan. I was listed as an "A-List" attorney by Traverse the Magazine. I received the highest rating [AV] one can receive from Martindale-Hubbell as a 34 year old. I was listed as a "Michigan Super Lawyer" by Super Lawyer magazine which only lists the top 5% in each state.
What have you worked on in the past six months? The last 6 months have included presenting a national webinar on "Endocrine System Dysfunction following TBI" to practicing attorneys throughout the country as well as reviewing and litigating TBI cases throughout Michigan.
What special training or education do you have specific to brain injury or benefits that people can get after brain injury. I can't point to any specific training per se other than representing individuals with closed head injuries and staying up to date on the medical literature by reading medical texts and journals. I do regularly provide training and education to other attorneys on how to properly handle cases involving a closed head injury. I am a frequent speaker through both the Michigan Trial Lawyers Association and trialsmith.com.
What is your involvement with legal associations, local, state or national brain injury associations or other organizations? I sit on the Board of Directors to the Brain Injury Association of Michigan. I'm a member of the Traumatic Brain Injury Litigation Section of the Association of Trial Lawyers of America. I sit on the legal advisory counsel to the Sara Jane Brain Foundation.
How do you stay up to date with personal injury law and brain injury issues? Through regular reviews and reading of new medical journals as well as active participation with the top brain injury attorneys in the country through the Traumatic Brain Injury Litigation Group
How did you first become involved in brain injury cases? In 1993 I was hired by an individual to represent him in a case involving a traumatic brain injury. I have been a passionate advocate for the survivors ever since.

Many of the issues in a matter involving a traumatic brain injury are similar to those in any other personal injury or wrongful death: seeking legal help immediately following an injury, identifying the correct defendant, and protecting your funds following any judgment. The BIAA piece provides brief advice on all these issues and also contains links to a directory of service providers dedicated to the three million Americans living with a traumatic brain injury. However, the seriousness of the injury and the fact that a plaintiff may only have one chance at recovery mean extra care should be taken during the selection process. In the wake of any severe injury, talking to a lawyer may be the last thing on your mind. Thinking about these issues before you are forced to deal with them may make things easier should you or your family ever be involved in a serious accident.

Originally posted at InjuryBoard by Timothy Smith

Great New York Times Article Regarding the Power of the Brain to Heal Itself

Timothy Smith — Tue, 11 Aug 2009 16:24:56 GMT

The Science of Identity

For all that scientists have studied it, the brain remains the most complex and mysterious human organ — and, now, the focus of billions of dollars’ worth of research to penetrate its secrets.

This article from the New York Times takes an interesting look at an age old question. Some philosophers refered to it as the "Mind-Body conundrum". The problem, at it's most simple level is, "how can some thing tangible, organic and objective [the brain] produce something intangible, inorganic and subjective [the mind]?".

This article probes this issue from a different angle as it asks, "How and where does our sense of 'self' come from"?

A small group of brain scientists is now investigating misidentification syndromes, as the delusions are called, for clues to one of the most confounding problems in brain science: identity. How and where does the brain maintain the “self”?

What researchers are finding is that there is no single “identity spot” in the brain. Instead, the brain uses several different neural regions, working closely together, to sustain and update the identities of self and others. Learning what makes identity, researchers say, will help doctors understand how some people preserve their identities in the face of creeping dementia, and how others, battling injuries like Adam’s, are sometimes able to reconstitute one.

Ultimately, what researchers are looking into, specifically in the field of neuro-biology, is an understanding of what it means to be human. Recently, researchers have begun utilizing very advanced neuro-imaging of the brain as it processes information related to personal identity. What they have noticed is that certain areas of the brain are particularly active during these process, in particular, the cortical midline structures - the areas which "run like an apple core from the frontal lobes near the forehead through the center of the brain".

What this tells us is that when we have injury to these frontal lobes [which is very common in auto accidents], often times, our ability to be aware of not only "who" we are but "who" the people around are, is diminished.

Ultimately, damage to this frontal lobe area affects our ability to not only understand who we are, but what is an is not appropriate, from a behavioral standpoint, as we related to the world around us.

Most importantly, what experts are discovering is that the brain is "plastic" and it can heal itself. But, how exactly does it do this?

Essentially, the damaged sections of the brain can re-route electronic signals around the damaged parts to achieve the same result. But, scientists and researchers are telling us that for the brain to learn how to re-route these signals, to circumvent the damaged sections of our brain, we need to be actively engaging TBI survivors through communication, problem solving and helping them meet different social expectations.

For people recovering from a severe brain injury, several recent experiments suggest that there is some promise in hitting it hard with what it has lost, contact with its familiar, social environment. In one 2005 brain imaging study, neuroscientists in New York found that the sound of a loved one’s voice activated widely distributed circuits in the brains of two severely brain-injured patients who were only occasionally able to respond to commands. Last year, a team of Spanish neuroscientists duplicated the finding.

For those InjuryBoard readers that are dealing with this issue, click through to the NY Times article here. It's definitely worth the read.

Originally posted at InjuryBoard by Timothy Smith

PDA 4 Memory Project Using Technology to Assist Brain Injury Survivrs

Timothy Smith — Fri, 07 Aug 2009 16:02:53 GMT

I recieved a nice email from Michelle Wild this week. Michelle is a professor at Coastline Community College in California. For the last 22 years she has been a professor at Coastline's Acquired Brain Injury Program and was recently nominated for the U.S. Professor of the year because of her work at CCC.

Michelle was kind enough to fill me in on a new program at Coastal involving the use of smartphones and PDA's to assist the brain injured as memory or cognitive prosthetic devices. The proper use of these tech devices help the survivor make the cognitive connection to overcome acquired deficits in:

Professor Wild reports that:

Unlike a typical memory workbook or PDA manual, which many users find frustrating and technical, our training material is much more than a reference source; it is consciously structured to be a learning tool for adults with ABI.

This program of study provides a broad range of benefits. It benefits those living with a brain injury by presenting information in easy to follow steps, by offering training videos that can be watched, paused and reviewed whenever necessary, by focusing on day-to-day activities where you would use your smartphone/PDA to compensate for memory deficiencies, by integrating review and reference of cognitive skills throughout the learning process and by basing the program design on feedback from individuals living with brain injuries.

The program benefits Professionals by providing them with a structured curriculum that can be used during therapy sessions, by complimenting exisiting cognitive therapy, by integrating cognitive remediation strategies while teaching how to use a PDA/Smartphone, and by providing structured homework assignments which include training videos.

For caregivers, the benfits are invaluable. The program will teach them about cognitive skills impacted by the injury and will explain how a memory prosthetic device can help. In turn, the use of the PDA/Smartphone by the injured party will free up the caregiver's time as it promotes autonomy, follow through on appointments and tasks, and increases the self-esteem of the injured person.

Some quotes from attendees to this program:

"My husband has a brain injury and he has both short-term and long-term memory problems. The Pharos device has helped him immensely with reminders of appointments. I also have the Pharos device and it has become very helpful in my keeping appointment schedules."

"First off, WOW! Tons of good stuff here by way of the level of detail, organization, comprehensiveness of the skills training across both the workbook and video clips."

"Improving my life organization and decreasing piles and piles of paper was my goal. I found my solution with this hands-on, easy-to-follow PDA training."

"The Pocket PC has been a transformative tool in my life. It has strengthened my ability to be independent, efficient, and productive. It has given me hope and a concrete vehicle with which to create a new fulfilling and fruitful future for myself."

My review of the course leads me to believe this is a great tool for individuals with brain injuries, doctors and therapists who treat these folks and their familial caregivers that are helping them 24/7.

Originally posted at InjuryBoard by Timothy Smith

Free Center for Disease Control Tool Kit on Concussion for High School Coaches

Timothy Smith — Wed, 05 Aug 2009 18:00:12 GMT

My oldest daughter plays tennis on the local high school tennis team. Although, her chances of getting concussed while trading baseline shots with an opponent is pretty low, there are other sports in high school where the chances of "getting your bell rung" are pretty high.

It is critical that the coaches who are supervising our children during these extracurricular activities have an understanding of concussions and what to do when a student/athlete suffers one.

I've already sent this link to area coaches, but I'm hoping that readers of this column take the time to forward this link to their area schools to make sure that our children's coaches can identify the problem and take steps to make sure that our children enjoy a fun filled and safe athletic experience while in school.

If you have children that are playing sports, have them and the rest of the family watch this video because if the trainers and coaches don't recognize the problem, maybe the family will.

http://www.youtube.com/watch?v=yIqZDbk3M40

Originally posted at InjuryBoard by Timothy Smith

Cognitive Rehabilitation Services for our Wounded Veterans.

Timothy Smith — Wed, 05 Aug 2009 15:57:25 GMT

I'm pleased to see that the invisible injuries suffered by our veterans as a result of concussive injuries sustained during their duty are starting to be recognized as a serious medical situation requiring the attention of our government. Statistically speaking, proper care of this disease [traumatic brain injury] can cost 10's of thousands of dollars, sometimes even hundreds of thousands of dollars.

To provide our returning veterans with these therapy services under TRICARE is an important step to their recovery and hopeful return as a productive member of our society. Without these benefits, families of wounded veterans will be helpless to cure or accommodate the disease of acquired brain injury.

Here is a brief press release from the National Brain Injury Association:

FY10 National Defense Authorization Act (S. 1390)

On Thursday, July 23, 2009, the Senate passed its version of the FY10 National Defense Authorization Act. During debate, Senator John McCain for Senator Graham offered an amendment that authorizes the Secretary of Defense to carry out a pilot program for providing cognitive rehabilitation therapy services under TRICARE. Both BIAA and the Wounded Warrior Project have worked tirelessly to advocate for the inclusion of this amendment. To view the amendment, click on the link below:

http://www.biausa.org/elements/policy/2009/ndaa_cognitive%20_rehabilitation_amendment_2009.pdf

The amendment requires the Department of Defense to consult the Department of Veterans Affairs, The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and relevant national organizations with experience in treating traumatic brain injury. It also requires the Secretary of Defense to submit a report to congress evaluating the effectiveness of the program and making recommendations of the appropriateness of including cognitive rehabilitation as a benefit under the TRICARE program.

In response to the adoption by unanimous consent of this amendment into S. 1390, a representative from the Congressional Budget Office reached out to BIAA to ask advice regarding the cost and duration of cognitive rehabilitation therapy in order to formulate a cost estimate for the pilot program. BIAA authored the following comments in response:

http://www.biausa.org/elements/policy/2009/cbo_request_july_09_cog_rehab.pdf

Currently, the Senate is gearing up for a conference with the House to agree on final language. The informal process began this week even though house conferees have yet to be named. With hope that finalization will happen in early September, be on the lookout for BIAA action alerts to urge congress to retain this important amendment as part of the final package.

In conclusion, BIAA is thrilled to have the opportunity to work on this important inclusion in S. 1390 and believes that this is a much needed step forward in providing access to brain injury care for returning service members.

I hope that by December, I will be urging each and everyone of my InjuryBoard readers to contact your representatives once this important package comes to a final vote. Proper medical and therapeutic care is the least we can do for our men and women who put their lives on the line for this great country of ours.

Originally posted at InjuryBoard by Timothy Smith

Timothy Smith accepts position on the National Advisory Board to the Sara Jane Brain Project

Timothy Smith — Mon, 06 Jul 2009 13:56:15 GMT

Odd name, huh? The Sara Jane Brain Project. But what is odd in name is absolutely breathtaking in what the project is trying to accomplish as it works to create a model system for children suffering from all types of Pediatric Acquired Brain Injuries.

"A model system of what"?, you might ask. Well, that is best explained by the website www.thebrainproject.org

Thank you for visiting The Sarah Jane Brain Project. As you may know, Sarah Jane Donohue is my three-year old daughter who was shaken by her baby nurse when she was only five days old and suffers from Pediatric Traumatic Brain Injury - PTBI (Click on the angel to read her story). PTBI includes all brain injuries caused by trauma including falls, motor vehicle (MV) accidents, being struck by an object, violence/assault, sports incidents, gunshot wounds, and non-MV bicycle accidents.

PTBI is the leading cause of death and disability for children and young adults from birth through 25 years of age in the United States. Over 5,000 deaths occur annually due to PTBI, over 17,000 annually suffer from permanent disability due to PTBI, and over 1,000,000 are hospitalized each year due to PTBI. In addition, since most brains aren't fully developed until age 25, many of the Military Veterans returning from Iraq and Afghanistan with TBI are actually considered PTBI. Pediatric Acquired Brain Injuries (PABI) include all traumatic causes plus brain injuries caused by brain tumors, strokes, meningitis, insufficient oxygen, poisoning, ischemia and substance abuse.

The Mission of The Sarah Jane Brain Project is to create a model system for children suffering from all Pediatric Acquired Brain Injuries.

We have four Phases of The Sarah Jane Brain Project. Phase 1 uses open source principles for the first time in medical history making all of Sarah Jane's medical records available online without any restrictions. Phase 2 will bring in more families into our open source initiative and develop The National Advisory Board of The Sarah Jane Brain Foundation. Phase 3 will create a Pediatric Acquired Brain Injury Plan designed to outline the model system for children suffering from PABI. Phase 4 will be implementing the PABI Plan and the model system.

Thank you in advance for being part of The Sarah Jane Brain Project and please share this site with others you think would be interested.

Patrick B. Donohue, Esq.
Father of Sarah Jane Donohue

The vision of Mr. Donohue is stunning and the help and assistance that this project will provide to medical care practitioners across the country is immeasurable. Mr. Donohue is working arm and arm with the project's National Advisory Board that as of right now, is comprised of some of the top brain injury medical practitioners, therapists, counselors and attorneys in addition to a number of family members who have directly dealt with this serious injury to their own child.

Why did Mr. Donohue start this project? It's best to let him explain it in his own words:

Why did I create The Sarah Jane Brain Project?

As a father of a child suffering from Pediatric Traumatic Brain Injury (PTBI), I have spent countless hours searching the internet and speaking with her Development Team (doctors, therapists and other professionals) trying to improve the development of my daughter, Sarah Jane.

Whereas, there are a countless number of wonderful and informative prevention sites for Shaken Baby Syndrome and advocacy sites for Traumatic Brain Injury and other Pediatric Acquired Brain Injuries (PABI), there isn't a central resource for research, rehabilitation and development for PABI. Many of the issues families and children face are the same whether the brain injury was caused by a car accident, an assault or by a tumor.

In addition, it has become clear no one person or organization has all the answers to the questions we face as parents with children suffering from PABI. After speaking with Sarah Jane's Development Team, the coordination and dissemination of Sarah Jane's medical and therapy records and data in an orderly manner only helps them to help her. Her Development Team is constantly looking for additional ways to improve Sarah Jane's progress by speaking with colleagues, reading literature, and collaborating with other parents. But they all admit there is considerable amount still needed to be learned about the human brain.

Using the computer industry as an example, the field of neuroscience is like the computer industry in the 1970s: you have a diverse group of very smart people working independent of one another throughout the United States and world without knowing what the others are working on making significant strides behind closed-doors. Fast-forward 30 years and many of the breakthroughs in the computer industry are utilizing the principle of open source. Open source is a set of principles and practices that promote free and open access to the design and production of goods and knowledge. Its well known use is through the creation of the Linux computer operating system which professionals make corrections and fix problems or commonly used with the Wikipedia online free encyclopedia that is free and allows for any user to make additions or corrections.

The National Institute of Mental Health launched The Human Brain Project in 1993 to develop and support the new science of neuroinformatics. From this initiative, it is obvious what needed to be done. That's why we created the Sarah Jane Brain Project - which is a data portal for professionals and families dealing with PABI around the world and a vehicle to create the PABI Plan establishing a model system for PABI.

Smith and Johnson is excited to be working with it's contacts in the Michigan medical community to set up and structure this model plan here in Michigan. This will help ease the initial burden that so many families suffer from when a child suffers a PABI.

Smith and Johnson is not only excited about this new partnership with the Sara Jane Brain Project, but also with the ability that we now have to bring this information right to our readers here at InjuryBoard as soon as it's released by the project. Stay tuned!

Originally posted at InjuryBoard by Timothy Smith

Endocrine System Dysfunction Following Brain Injury

Timothy Smith — Thu, 15 Jan 2009 14:14:26 GMT

SeminarWeb has asked me to speak again on this emerging issue in the area of traumatic brain injury. I presented this issue to a national group of attorneys in early 2008 and have been asked to present again as there has been continued medical research in the area including 4 or 5 peer reviewed articles based on studies performed both here in the United States and abroad.

I will present updated medical information linking hypothalamic-pituitary dysfunction to closed head injury. To date, scientific data confirms that anywhere from 30-50% of those that sustain a traumatic brain injury also sustain some type of injury to their pituitary gland which then causes endocrine system dysfunction. In fact, one study, by Lieberman et. al. looked at 70 cases, ages 18-58 years old with Glasgow Coma Scores of 3-15 and found that 68.5% of the group also had pituitary damage.

Of even greater interest was the documented fact that severity of injury and Glasgow Coma Score had nothing to do with the prevalence of pituitary dysfunction. In many instances, minor head injury or mild closed head injury with a GCS score of 15 revealed damage to the endocrine system. Further, in the May 2005 issue of Brain Injury, it was documented that growth hormone deficiency [a side effect of pituitary damage] occurs in 15-20% of adult patients following traumatic brain injury, regardless of injury severity. This demonstrates that pituitary hormone deficiencies are a major and relatively common complication of closed head injury.

Further, the symptoms arising from injury to the pituitary are strikingly similar to the post-concussional syndrome which arises out of trauma to the brain. These symptoms of endocrine dysfunction [in particular growth hormone deficiency] include:

1. Memory impairment

2. Concentration impairment

3. Decreased IQ

4. Fatigue

5. Anxiety

6. Depression

7. Social Isolation, and

8. Decreased sex drive

If you have sustained a closed head or traumatic brain injury and are suffering from any of the above symptoms, you should have your treating physician refer you to a competent endocrinologist for a complete assessment of your endocrine system. If your physicians are treating you for post-concussion syndrome and what you actually have is an injury to your pituitary gland, the treatment isn't getting to the root of your problem.

If you are an attorney or simply interested in learning more about this evolving area of closed head injury, go here to sign up for the seminar to be held via webinar on January 21 2009 at 3pm.

Originally posted at InjuryBoard by Timothy Smith