Category Archives: Miscellaneous

New School Year Brings New Athletic Guidelines

The new school year is well on its way and youth athletics have begun, including for “about 1 million youth between the ages of 6 and 12 [who] play tackle [football].”  However, even though this number may seem high, youth athletic participation has continued its decade-long decline again this year.  Head trauma, specifically concussions, are the major worry.

In response, the CDC has authorized new guidelines on the diagnosis and treatment of concussions and other such mild traumatic brain injuries in children. Published in the medical journal JAMA Pediatrics, and referenced by other publications nationwide since, the guidelines encompass over 25 years of research and include, “19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (i.e., must, should, or may) based on confidence in the evidence.”

Noting the decline in participation and increased parental concern, many states and school districts have updated their guidelines on concussion protocol.  This year, New York State Education Department stated that, “Local boards of education are strongly advised to develop a written concussion management policy.”  In Scarsdale, NY, for example, the school district announced, “the establishment of a Concussion Management Team, training for the Team and appropriate staff, protocol for student evaluation and return to play or activity, accommodations if necessary in academic areas, and a set of procedures that outline the role and responsibilities of all concerned.”  The website of the Central Valley District, NY has a thorough webpage regarding concussion protocol, as “[the] School District recognizes that protecting students from head injuries is one of the most important ways of preventing a concussion.”  (A list of all the webpages dedicated to concussion protocol, and a list of all the concussion protocols that have been recently altered due to increased public concern, is too lengthy to individually recognize.)

* It should also be noted that even with all the negative media coverage and medical concern, many school districts, parents and some publications still see the benefits of organized athletics in a child’s physical and social development.

Minibus to Provide Relief and Research

Last week, President Trump signed into law a bipartisan minibus of “two critically important funding bills” for fiscal year 2019.  Specifically, the bills cover the financing of the Departments of Defense, the Labor, Health and Human Services and Education.  Included is a $2 billion budget increase for the NIH, which is 5.4 percent raise from the 2018 fiscal year.  The funding for the BRAIN Initiative, under the 21st Century Cures Act, is now set at $429.4 million.

New Jersey Congressman Bill Pascrell, Jr., co-chair of the Congressional Traumatic Brain Injury Task Force (along with Florida Congressman Thomas Rooney), released a statement, in which he notes that his funding requests related to brain injury had been met: “$125 million for the Psychological Health/Traumatic Brain Injury Congressionally-Directed Medical Research Program… as well as $6.75 million for the TBI Act programs.”  (Though the starting paragraphs of Pascrell’s press release follow party lines, the headline on his website expresses the broader view: Pascrell Highlights Budget Victories.)  Congressman Pascrell also cited the increase of brain injury research funding both for the military and the general population, which he championed.

As the Chairman of the House Appropriates Committee Congressman Rodney Frelinghuysen (NJ) remarked, “[This] legislation funds critical programs that will protect and save lives both now and in the future.”

McCain’s Posthumous Charitable Hopes

In 2002, Senator John McCain was instrumental in establishing the Arizona-based nonprofit Translational Genomics Research Institute (TGen),  “a one-of-a-kind genomics research institute.” Unfortunately, the research focus of this institute later became all too important for McCain, as his diagnosis of brain cancer was announced last year.  After losing this year-long battle with glioblastoma*, Senator McCain was laid to rest near the US Naval Academy in Annapolis, Maryland on Sunday, September 2, 2018.  However, his service to America has not ended.

A visit to the memorial webpage of the late Senator provides not only a history of the man and synopses of the moments of honor that have occurred since his death on August 25, 2018, but also gives the visitor an opportunity to donate to two nonprofits specifically selected by McCain: The McCain Institute Foundation and the Translational Genomics Research Institute (TGen).

*According to the NIH, glioblastoma is, “the most common and aggressive malignant brain tumor in adults.”  As previously reported on this site, symptoms of brain malignancy, a.k.a. brain cancer, include headaches, seizures, speech difficulty, weakness and double vision – symptoms that can also be found following a traumatic brain injury.  The question as to whether there is a link between brain injury and brain cancer has been “long-debated”, as was remarked on in a 1979 NIH report.  Today the NIH continues this investigation.  Two years ago, they reported, “Epidemiological studies are equivocal on the possible link between trauma and increased risk of malignant glioblastoma… We propose a putative pathogenesis model that connects post-traumatic inflammation, stem and progenitor cell transformation, and glioblastoma.”

Mitigation for Morality and Murder

In the modern world, our understanding of science changes rapidly.  Law, at large, does not change so rapidly.  What has changed, in the past 20 years, is that defense lawyers have begun, during the trial and/or sentencing phases of court, to use brain damage/injury as a mitigating factor for criminal acts.

Brain injury was first introduced as a defense in 1966 for Charles Whitman, the so-called Texas Tower Sniper.  (Whitman stabbed his mother and his wife, shot to death 16 people at the University of Texas at Austin and shot and injured 31 others.  An autopsy upon his death found a tumor in his brain.)  Since the start of this century, the exploration into the effects of brain injury on what some may see as moral quandaries for those with neurological deficits has broadened.  Generally, what has been found is that head injury, specifically a brain lesion, can hinder executive functioning, which governs the ability to plan ahead, think things through, manage impulse, etc.  However, this is basic knowledge that applies to all brain injury survivors; tests specifically related to the unique brains of those who commit criminal acts are inconsistent.

In 2015, the NIH published a report, Does TBI Lead to Criminality?.  Their conclusion states, “The results support a modest causal link between traumatic brain injury and criminality.”  Investigations have shown that while brain injury is not a sufficient defense for a criminal act, it may be a mitigating circumstance in the sentencing phase of a trial – treatment versus incarceration.

Since then, brain damage/injury has often been used as a defense, most recently earlier this month: a convicted murderer in Ohio said, during sentencing, “Not everyone is fortunate enough to have a caring family or outside guidance… I am proof [that] a young person – beaten and abused physically, emotionally, and mentally – becomes the abuser.”   Though the defendant now admits to the killing of five women, the testimony of one of two testifying doctors states that because Kirkland MAY have a brain injury, he should not receive the strictest punishment, the death penalty.

Perhaps, though, the “brain injury” defense will relatively soon become a thing of the past.  The above-mentioned NIH report further concludes, “Reducing the rate of TBI… might have benefits in terms of crime reduction.”  (Since this report was released, more defendants have used brain damage as a mitigating factor for criminal acts.)  According to a UK study, approximately 50 to 70% of the incarcerated population has a brain injury.  That percentage is thought to be in the same realm as those imprisoned in America.  Given these astonishing statistics and the continuing government-sponsored and private research on brain injury prevention and recovery, the NIH’s conclusion seems a definite possibility.

(See also Massachusetts General Hospital – Center for Law, Brain & Behavior, “an academic and professional resource for the education, research, and understanding of neuroscience and the law.”)

At Home Brain Care

Last week, the University of Arkansas for Medical Sciences received a three-year, $450,000 grant from the U.S. Department of Health and Human Services Administration for Community Living, in addition to the $75,000 annual gift they are receiving from the Arkansas Department of Health.  The federal grant is to be applied to the University’s Traumatic Brain Injury State Partnership Program State Funding Opportunity.  “Among the goals of the program… are incorporating telemedicine and other technologies into TBI services to survivors, raising awareness of clinical and educational services for survivors, caregivers and families…”  Telemedicine increases healthcare access for all, particularly those is rural areas and others that cannot easily visit medical facilities, such as those with tbi who need aid in transportation.

Although it may seem to be a relatively modern invention, forms of telemedicine have been in existence since man could verbally communicate.  The more modern view of telemedicine, involving both verbal and visual communication with the medic, was first seen in 1924 in, “an imaginative cover for the magazine Radio News foreshadowed telemedicine in its depiction of a ‘radio doctor’ linked to a patient not only by sound but also by a live picture.”  Though at the time, the ideas of television and telemedicine were merely fantasies, the first television transmission occurred only 3 years later.  Video communication between doctor and patient, however, is usually first dated to 1959.  1959 is also the year of the first neurologic examination through telemedicine, occurring at the University of Nebraska.  Five years later, means to treat patients with brain injury and neurological disorders were found, as, “they established a telemedicine link… to provide speech therapy, neurological examinations, diagnosis of difficult psychiatric cases, case consultations, research seminars, and education and training.”

The above paragraph primarily comes from information in a 1996 article that can be found on the site of the National Academy of Sciences.  In 1996, the government recognized that there was a vast need for telemedicine, since its envisionment to the present day.  With both new technology and increased forms of communication, telemedicine has gone far above what could have been imagined 22 years ago.  For example, a 71-page report penned by the Undersecretary of Defense to the House Chair of the Committee of Armed Services, states that, “the Department of Defense views telemedicine as an important set of tools to improve access to Psychological Health and TBI care services in both deployed and non-deployed settings.  In June 2018, the FDA approved the distribution of MindMotion GO, a type of mobile therapy that focuses on speech and task therapies.  As far as brain injury diagnosis, while CT scans and other such tests may need to occur at medical facilities, medical professionals are now using communication technology to diagnose another neurological disorder (autism) and to evaluate others (computerized concussion assessment).
 

Illegal Immigrants and Brain Injury

A hot topic in the past few decades, illegal immigration has now come to the forefront because of America’s current president and his border wall.  (For the past 10 years, the estimated number of illegal immigrants in America has stayed relatively stable at about 11 million.  During the presidencies of Bill Clinton and George W. Bush, it was steadily rising.)  As for brain injury and undocumented residents, there are many cause-and-effect questions that, when answered, are quite sobering.

To begin, what if the illegal immigrant is the culprit?  What if the illegal immigrant causes someone to have a brain injury, either intentionally or inadvertently?  First, the police or whomever is pursuing the case must find them.  Since illegal immigrants are largely undocumented, this can be a hard task.  For better or worse, depending on your political ideology, a number of states are now allowing an illegal immigrant to legally obtain a driver’s license and register their car.  In January 2015, for example, California signed into law AB60, which, “requires the [DMV] to issue an original driver’s license to an applicant who is unable to submit satisfactory proof of legal presence in the United States.”  New Jersey, with the support of Governor Phil Murphy, is now preparing for a similar bill, Assembly Bill No. 1738, to pass.  If this bill passes, it will make New Jersey the 13th state, plus the District of Columbia, to allow this.  (What the consequences are for an illegal immigrant who inflicts injury on another person, such as through a car accident and even if they are legally licensed, is unclear.  They are subject to criminal charges, but civil action may be more difficult.  As they are illegal, and many do not submit tax returns, which would show their yearly income, monetary consequences to cover such things as rehabilitation costs are not possible.)

More so, the government does not seem to account for the economic costs of brain injury:  For the victim, there will be a lose of future wages as, even if the victim is able to return to work, they will be away for a bit.  Additionally, when returning to work, a brain injured individual may have to pursue a career that is less cognitively and/or physically demanding and often less lucrative than their previous occupation.  For the Internal Revenue Service (IRS), this means less taxable dollars are earned.  Also, the brain injured individual may stay longer or indefinitely on Medicare and/or Medicaid.  The government then is required to help pay for their doctors’ visits, their medication, etc.

But, how about when the illegal immigrant is the victim?  No one wants to see a person, legal or not, suffer or even die due to lack of medical care.  All told, the government is financing about $18.5 billion a year for medical care to unauthorized immigrants.  Of this total, “federal taxpayers provided $11.2 billion in subsidized care to unauthorized immigrants in 2016.”  (“A relatively small number of undocumented immigrants, perhaps in the tens of thousands, obtain health insurance through private employers,” states a 2016 article.)  However, a page on the NIH website, written by an individual who had authored other pages on ethics, as it relates to illegal immigrants, notes that, “the Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries.”

There are local health clinics, hospital emergency rooms and free medical school clinics that must treat everyone, regardless of legality.*  Additionally, some doctors will treat undocumented immigrants, off the record.  Treatment for brain injury though, requires more than a brief trip to the doctor.  As an article from 2009, when illegal immigrants were treated differently by the government than now, is titled, “Struggling to find post-acute care for undocumented and uninsured immigrants.”  Should ethics trump legality, no pun intended?

*Another article recounts the story of an illegal man, without insurance, who suffered a stroke.  Though the hospital legally had to treat him, his care would be uncertain the second he stepped out of the hospital grounds.  Would receiving care for his stroke result in a “medical deportation”?  Ultimately, the hospital was able to find the man’s family in Mexico, but the trip to return him to his family cost $50,000 and was paid entirely by the government.

Note: The above post is not a personal comment on illegal immigration.

Magic Is An Illusion; Trauma Is Not

For me and many others, David Copperfield is the nation’s foremost illusionist/magician.  He even earned a spot on the Hollywood Walk of Fame in 1995.  From 1974 until last week, his magic has been just that; Copperfield could do what seemed impossible.

In 2013, an audience member was selected to participate in a trick called “Lucky 13”.  The trick required participants to enter a box which is then closed.  Miraculously, the participants would then appear at the back of the theater at the MGM Great Resort and Casino in Las Vegas.  (If you want to understand how the trick was performed, click here.)  The aforementioned audience member, Gavin Cox, had a slip-and-fall during the execution of the illusion and, “was taken to the hospital with a dislocated shoulder. After returning to Britain… he suffered chronic pain [and confusion] and a scan showed a lesion on his brain.”

Most simply described, a brain lesion is an injury or disease affecting the brain.  The cost of the two fusion surgeries, plus a diagnosed traumatic brain injury, has been more than $400,000 for the plaintiff.  (I have found no information regarding the non-surgical treatment Cox received for his tbi.)  Cox filed a multi-million dollar negligence lawsuit in 2014 to cover these medical costs and his pain-and-suffering.  In addition to Copperfield, MGM Grand, show producer Backstage Employment and Referral, and building firm Construction Management were named as defendants in this suit.

Given Copperfield’s popularity, this suit has gained a lot of press.  (I even found an article about it in Golf Digest.)  Two other past participants of the trick have since come forward claiming injury as a result of participating in this trick.    Despite this controversy, though, Copperfield is still performing, albeit without this illusion.

mTBI, Not So Mild for the Older Generation

Last month, Rep. Louise Slaughter (NY) fell, resulting in a trip to the hospital.  “The Congresswoman is tough as nails and she will bring that same spirit to the recovery,” said her Chief of Staff at the time.  A Google search of “Louise Slaughter brain trauma” results in many links, including one titled “Rep. Slaughter Announces Nearly $13 Million to Address Traumatic …”.  When clicking this link, however, one is directed to a now defunct personal webpage.  (A further search shows that Rep. Slaughter was a member of the Congressional Brain Injury Task Force, with particular attention paid to military weaponry.)

First elected to office in 1986, Slaughter was assuredly “tough as nails”, as she had to be, working in Congress and dealing with publications/broadcasters for so many years.  The first female chair of the House Rules Committee and the dean of the NY congressional delegation, Slaughter was planning on running for her 17th term.  “Louise was a trailblazer,” said Nancy Pelosi.  Unfortunately, the 88-year-old woman couldn’t recover from the intracranial hemorraging that resulted from the fall and passed away in mid-March.

Besides Rep. Slaughter, other politicians and others involved in politics have suffered such negative results from intracranial hemorraging.   Roger Ailes was a media consultant for President Richard Nixon, President Ronald Reagan, and President George H.W. Bush, as well as for Rudy Giuliani’s first mayoral campaign.  Most recently, he was CEO of Fox News until 2016 and served as a media consultant to Donald Trump’s presidential debates, before he passed away from intracranial hemorraging (subdural hematoma) in May 2017.  Additionally, one of the most respected past Presidents, Franklin Delano Roosevelt, died of intracranial hemorraging that was either caused by cancer or by high blood pressure.

Intracranial hemorraging is an all-encompassing diagnosis for bleeding within the skull that can be further categorized as an epidural hematoma, subdural hematoma, subarachnoid hemorrhage or intracerebral hemorrhage.  It is a form of mild traumatic brain injury (mTBI), that isn’t mild at all.  A concussion, for example, is a mTBI.

In 2012, the CDC reported that, “in the United States, the number of TBIs that occur each year among older adults, ages 65 years and older, is estimated at 237,844.”  Falls, as what happened to Rep. Slaughter, are the primary cause of TBI among the 65+ age range.  Additionally, it’s hard to assess how severe a brain injury is the older generation, because of other age-related issues.  Is a person’s memory loss due to a brain injury or simply a consequence of age?  The number of elderly Americans suffering a mTBI keeps rising, but the reason for this increase is unknown.  Perhaps it is because Americans are living longer?  Perhaps because Americans are living in their homes and generally staying active later in their lives?  Maybe it’s because new research and talk about such issues as sport-related injuries are being more broadly researched and discussed?

Rep. Smucker Joins Congressional Brain Injury Task Force

The Congressional Brain Injury Task Force states that its mission is, “to increase awareness of brain injury in the United States, supports research initiatives for rehabilitation and potential cures, and strives to address the effects such injuries have on families, children, education, and the workforce.”  This seems that it would be a unifying goal, going beyond political partisanship, and for that reason, most states have one or more Congressman serving on the Committee.  At the beginning of this year, Pennsylvania had 5 Congressmen serving as members.  Now, during Brain Injury Awareness Month and just after the Congressional Brain Injury Fair, Rep. Lloyd Smucker (PA-16) joined.  (Congressman Lou Barletta, who represents Carlisle, PA in the 11th district, where the Brain Injury Association of Pennsylvania is located, is not a member, though that does not mean that he does nothing to support those with tbi.)  At the moment, Smucker’s website does not mention his involvement with the task force and critics cite his support for and from the NRA as an indication of his disregard for American lives.  However, Smucker is a Congressional Republican, so his support for the NRA should be of no surprise.  He should not be told he cannot help brain injured Americans for that reason.   (More members may mean more ideas and more action from the Committee.)

(Above picture, originally published on March 29, 2018, is courtesy of the Facebook page of the Brain Injury Association of Pennsylvania.)

Caring for Man’s Best Friend

The benefits of dog ownership are well-known.  “Owning a dog can lift your mood or help you feel less stressed.”  For veterans and others with disabilities, the benefits of have a dog, specifically service dogs, go beyond this: dogs can serve by helping or even doing certain tasks that the handlers cannot do themselves.

However, what happens when the dog is the one with a brain injury?  Yes, dog’s skulls are harder than those of humans and surrounded by protective fluid, both of which make brain injuries less common in them.  (This is fortunate for animals who play/fight for fun, may bump into coffee tables as they chase after toys, etc.)  Canines though, can get brain injuries in the same ways that humans can: a car accident, a fall, etc.  The possible symptoms are also similar to those of humans:  bleeding from the nose or ears, coma, confusion, death, disorientation, facial weakness, lethargy, loss of consciousness, paralysis, pupil dilation, seizures, and stumbling.

Once these symptoms begin to occur what do you do?  For these members of the family, seeking medical help should be the next step.  Going to the local veterinarian is definitely the appropriate action, but there are also neuro-veterinarian specialists.  While this is a very limited profession, it’s not impossible to find.  It is fortuitous to an injured canine if their owner lives in Arizona, as they have access to this professional expertise.  (For example, Lucky, a dog found shot in the Arizona desert by border control officers earlier this year, was relatively fortunate that such help was available to him.)

One thing not to do is to abandon the dog.  This is what happened earlier this month to one dog in Sacramento, CA .  A woman, assuredly not the owner, found an injured dog on the streets and brought him to the Sacramento County Bradshaw Animal Shelter.  The dog, now named Thomas, has gone through multiple tests, yet the doctors still do not know what happened to him, just that it resulted in a severe brain injury.  “He is such a fighter… Baby Thomas wants everyone to know he is determined to heal, grow up and live a long, mischievous life!”  This and so many other examples show the need for Sacramento Counties non-profit T.E.A.M. – Teaching Everyone Animals Matter.  (As of March 16, the owner of Thomas has still not been found.  T.E.A.M. is now offering a $1,000 reward for information that leads to an arrest.)

(Most states have laws prohibiting animal cruelty.  For example, 3 weeks ago, a 27-year-old man was sentenced to 12 years in prison in Texas for abusing his boxer puppy.  Most of these states also have a law prohibiting animal abandonment.)