The entire country is learning more about head injury and PTSD as a result of the war in Iraq. Recent reports document that fully one-third of returning vets suffer from one or both of these serious problems.
In Estate of Buckner v. City of Lansing the "gang of four" on the Supreme Court recently reversed a decision allowing the family of two young girls to sue the City for plowing snow over the sidewalk and forcing the girls out into the road on their walk home. One girl was killed and the other suffered a catastrophic head injury when they were struck by a motorist. The majority--composed of four activist Republicans-- held that the City's duty to maintain sidewalks and reasonably safe roads does not include a duty to avoid blocking the sidewalk with snow.
This week the New England Journal of Medicine released the results of a large study examining head injuries and post traumatic stress in Iraq veterans. According to the Journal's numbers, one of six combat troopers returning from Iraq reported suffering a concussion during his or her tour. The numbers also showed that the fact of suffering even a mild concussion put the troopers at higher risk for suffering post-traumatic stress syndrome.
Continue reading "Concussion and post-traumatic stress in returning Iraq veterans" »
The rights of accident victims struck a new low in Michigan with the Court of Appeals' unpublished November 15, 2007, decision in Jones v. Jones, et al. The Court upheld the Trial Court's dismissal of an auto negligence claim relying on the Kreiner Supreme Court decision requiring a "serious injury" to have "life-altering" consequences. Under the no fault act, an injured person can only sue the at-fault driver if the injured person has a threshold injury (i.e., death, permanent serious disfigurement or a "serious impairment of a bodily function). In 2005, the Engler majority on the Michigan Supreme Court reinterpreted "serious impairment" to require a "life-altering" impact.
Controlled by this interpretation, the Court of Appeals in Jones held that the injured victim didn't have a "serious" injury, DESPITE THE FACT THAT SHE SUFFERED A FRACTURED BONE IN HER LEG THAT REQUIRED SURGERY AND INSERTION OF A ROD AND SCREWS TO MEND. The woman required in-home health care for "several months" after discharge from the hospital, had to use a wheelchair or walker when she left home during that period, and required assistance with her activities of daily living. She claimed she was left with a permanent limp and the need to use a cane for support. She was unable to stand for extended periods or to walk any significant distance.
The Court relied heavily on the fact that Ms. Jones had not worked for three years prior to this injury and that "minor problems with walking or standing" are not "serious". It noted that her physician had neither diagnosed the limp nor prescribed the cane and that she could perform most household tasks. Her life was "not so different" from before the injury and therefore did not meet the Kreiner standard of a "serious" injury. We wonder if the Justices who redefined "serious" to exclude an injury of this nature would still argue it was not "serious" if it was inflicted on one of them or their family. We seriously doubt it.
Injuries to NFL football players have kept the issue of concussion and closed head injury in the public eye. Because of the recent retirement of the Kansas City Chiefs' quarterback (and past retirements of well-known players such as Steve Young), the public has become better educated about the potential long-term effect of multiple concussions. It is estimated that more than ten percent of all high school football players suffer a concussion each season. As the size and speed of the game increase, the rate of head injury also increases.
Studies have shown that while many high schools attempt to refurbish helmets regularly, this process is haphazard and often does not include the padding in helmets. In a recently documented case, a high school athlete suffered permanent deficits after sustaining a hard blow in a helmet that turned out to be more than twenty years old with the original padding. Surveys have shown that this is not uncommon, and while football helmets are designed for multiple impacts (unlike bike helmets, for example) they do not have an unlimited life.
A former Harvard quarterback has developed a new helmet that may revolutionize football helmet safety. The so-called Xenith helmet has passed several testing requirements alrady and may be marketable at a reasonable price (initially $350.00). One safety expert, Dr. Robert Cantu calls the helmet "the greatest advance in helmet design in at least 30 years." Probably not all players would be assigned this helmet initially, however, it would be available for young men who have already suffered one concussion. A company called SportSoft now maerkets tracking stickers to help equipment managers to better monitor each helmet's age and history. Other companies (Simbex and Schutt) are also marketing specialized helmets that may improve safety, and for $1,000.00 Riddel sells a helmet that would help safety personnel to identify players who should not return to a game after a severe impact.
On August 1, 2007, the journal Nature published a new report documenting the case of a 38 year-old man who was awakened from a barely-conscious state through electronic brain stimulation. The man had suffered a depressed skull fracture and severe brain injury in an armed robbery and beating, and had not regained full consciousness in more than five years (the NYT reported more than five years, NPR reported 8 years). The man's recovery has not been complete, but he can now converse with his mother over simple issues; previously, he had remained in a virtual sleep-state.
The recovery was achieved by means of a deep brain stimulator implanted in the thalamus at a site that controls sleep and waking states. Researchers were quick to point out that this procedure was not helpful when attempted with Terri Schiavo and that the patient must have evidence of some brain function for it to work. This patient was minimally responsive over the years and testing showed that certain language and intellectual functions of his brain remained intact. The procedure was performed at the Cleveland Clinic. A neurologist at Cornell reported the results, along with the Clinic physicians. They note that the patient shows clear, objective improvement in function during the 12 hours per day when the implant is activated, and that he regresses in function when it is off. While he has thus far been unable to develop new memory, he is once again an individual--even if his functional capacity is incomplete.
The University of North Carolina recently published a study involving more than 2500 retired NFL football players. The study confirmed that players who suffered concussions during their career are far more likely to exhibit clinical depression years later. The study directly contradicts the claims by the NFL that concussions don't result in long-term medical consequences, but corroborates the findings of medical studies showing that even "mild" head injuries can have a long-term impact.
The study documented that NFL players who reported no history of concussion reported a depression rate similar to the population at large. The likelihood of depression increased with an increase in the number of concussions suffered. Players who reported suffering three mild head injuries exhibited a twenty percent likelihood of exhibiting clinical depression, compared to a reported rate well under ten percent in the "normal" population.
While the NFL criticized the study for relying upon a survey format, it was professionally peer-reviewed prior to publication and independent experts found that it was likely to be reliable. The authors and the NFL are currently investigating whether a history of concussions increases the likelihood of cognitive impairment and early-onset Alzheimers or dementia.
Previous medical studies have documented the serious long-term consequences which may flow from "mild" closed head injuries in civilian populations. High profile examples from the NFL were cited by both sides of this debate to support or contradict these claims. A neuropathologist claimed that repeated concussions probably contributed to the November 2006 suicide of Philadelphia Eagles linebacker Andre Waters, and New England Patriots linebacker Ted Johnson's neurologist linked his depression and cognitive decline to on-field concussions.
Studies performed outside the NFL have also documented a higher-than-expected fatality rate among head injury survivors, which experts attribute to a combination of impulsiveness, impaired judgment and depression.
It seems apparent that victims of even mild closed head injuries should be examined and watched carefully for head injury sequelae, particularly including clinical depression.
