10 Myths of Brain Injuries - Myth 9

November 30, 2007 on 1:04 pm | In Uncategorized | Comments Off

Myth 9: Mild TBI is not permanent.

Over and over again defense doctors testify that everyone who sustains a mild traumatic brain injury gets better; that mild traumatic brain injury is not a permanent condition. This simply is untrue.

Dr. Alexander has pointed out that at one year after injury, 10 percent to 15 percent of mild TBI patients have not recovered. Many are more symptomatic than even immediately after the injury. Some have had persistence of one particularly troubling symptom –usually headache, neck pain or dizziness. Most have persistence and even worsening of the entire symptom complex. Both groups are at high risk of permanent symptomatic persistent post-concussive syndrome.

Work to date shows that mild brain injury results in measurable deficits in speed of information, processing, attention and memory in the immediate post-injury period. Recovery from these deficits is the rule occurring over a variable period ranging from four to 12 weeks. For small group, recovery may occur much more slowly or remain incomplete.

As Silver and McAlister explain, a good recovery is not universal. They note that although the long-term prognosis is favorable for the majority of patients with a mild TBI, it is well recognized that there can be significant short-term behavioral, somatic and cognitive sequelae. Furthermore, a significant minority of patients develops a chronic, often-debilitating constellation of signs and symptoms known as the chronic post-concussive syndrome.

You can read my other posts on the 10 myths of traumatic brain injuries here.

Presentation to the National Academy of Neuropsychology

November 29, 2007 on 1:36 pm | In Brain Injury News | Comments Off

As a follow up to my previous post at the National Academy of Neuropsychology’s (NAN) 27th Annual Conference in Scottsdale, AZ, below is a link to an MP3 of my presentation.  The topic of the presentation was “Neuropsychology in the Courtroom.”

My presentation was designed to give neuropsychologists an understanding of the admissibility of neuropsychological testimony at trial through a retrospective look at neuropsychological testimony and admissibility in the past and my observations of where neuropsychology was headed in the future.

You can listen to the presentation in its entirety here. (42 MB)

Urge Congress to Retain Funding Levels for TBI Programs

November 27, 2007 on 1:02 pm | In Brain Injury News | Comments Off

On November 15, the House of Representatives failed to override President Bush's veto of the Fiscal Year 2008 Labor-HHS-Education appropriations bill, which contains important funding for TBI programs.

Despite a great deal of advocacy by many individuals and organizations, the House came up two votes short (277-141) of the necessary two-thirds majority needed to override the president’s veto.

The bill provides $9.455 million for the Health Resources and Services Administration [HRSA] Federal TBI program, over the total $8.910 million allocated last year.  Likewise, the bill includes $5.960 million in funding for Centers for Disease Control and Prevention [CDC] TBI programs, an increase from approximately $5.3 million last year.  Also of key importance, the bill includes $900,000 in additional funding for the TBI Model Systems of Care program in order to prevent this important research program from being downsized.

When Congress reconvenes in December after a two-week Thanksgiving Recess, it is expected that Democratic leaders will pursue a compromise multi-bill “omnibus” appropriations package that would split the difference between the White House and Congressional budget proposals.

Such an omnibus bill is expected to include a cut of $3.5 billion in funding from the recently passed Labor-HHS-Education appropriations bill.

There is a way for you to help. You can contact your Representative and Senators and urge them to retain the current funding levels for your TBI programs. These programs include the CDC and HRSA TBI programs, as well as the important stopgap funding for the TBI Model Systems of Care Program.  For the greatest impact, please call your Representative and Senators, in addition to sending an email.  The Capitol switchboard number is 202-224-3121 -- just ask to be connected to your Representative and Senators.

A Response to Joe Reed - The Controversy Over Fixed and Flexible Test Batteries

November 26, 2007 on 1:18 pm | In Brain Injury News | Comments Off
At my recent NAN presentation at the 27th Annual NAN Conference, my presentation was interrupted by Dr. Joseph Reed while I was discussing a quote found in a paper which he wrote regarding a Federal Court decision entitled “Chapple v. Ganger”.
 
During my presentation, I was discussing a Federal Court case entitled Chapple v. Ganger, 851 F. Supp. 1481 (E.D. Wash 1994).  That case involved a catastrophic motor vehicle crash which killed Peggy A. Chapple and severely injured her 10-year old son.  The defendant conceded liability, and the parties waived their right to a trial by jury and agreed to have the Court decide it by an abbreviated bench trial.  The parties agreed that damages would be based upon a review of deposition testimony submitted by the parties, their experts and witnesses.  The parties further agreed that the decision of the Court would be final, binding and nonappealable.
 
Christopher Chapple, the 10-year old child, through his guardian sued the defendant seeking both economic and non-economic damages for the losses he suffered as a result of the injuries he sustained in the crash.  One of the issues in this contested bench trial is whether or not Christopher had sustained a permanent traumatic brain injury.  Plaintiff retained Dr. Catherine Mateer who performed certain tests to determine if Christopher had a permanent cognitive deficit.  In contrast to plaintiff’s evidence, defendant asserted that the child did not have a permanent brain injury.  In support of this argument, defendant offered the testimony of Dr. Ralph M. Reitan.  Dr. Reitan reviewed Christopher’s history, his raw test scores administered and various records.  Dr. Reitan rejected Dr. Mateer’s assessment as it was not what he described as a “neuropsychological” examination but instead, “was the kind of ability and cognitive testing that might be used to assess a normal child.”  Dr. Reitan attacked the methodology utilized by Dr. Mateer.
 
The trial court rendered an award to Christopher.  However, the court specifically found that in its opinion, Christopher had not sustained a permanent brain injury.
 
After this decision, Dr. Joseph Reed, published an article stating that for the first time, the court applied the Daubert standard to the use of the fixed (standardized) versus flexible ( non-(standardized) neuropsycholological test batteries in federal court.
 
In my presentation, I pointed out that this statement by Dr. Reed was inaccurate and that Dr. Reitan and others had utilized this article to promote the use of the fixed battery over the flexible test battery.  During my presentation, Dr. Reed interrupted me to argue that his statement was correct.  I am thus following up on my blog to set the record straight.
 
As I indicated, there were a number of “Daubert” challenges to the admissibility of expert testimony as it pertained to Christopher’s injuries.
 
In the case, there were Daubert challenges.  However, those challenges were made by plaintiff’s counsel to exclude portions of Dr. Lynch’s testimony, a medical physician and consultant in neurosurgery and neurology.  The court stated, “Having reviewed Dr. Lynch’s opinion under the Daubert criteria, the court accepts Dr. Lynch’s testimony.”  There was also a Daubert challenge to defendant’s vocational expert, Dr. Moisan.  Plaintiff challenged the admissibility of Dr. Moisan, arguing it does not meet the Daubert standard as that testimony relates to Dr. Moisan’s opinion that Christopher would enter the job market in the mining field.  The court agreed that this was Dr. Moisan’s personal opinion and unsupported by any scientific analysis. (Footnote 15).
 
The Court found, based on the evidence, a lack of medical evidence as to long-term prognosis, and therefore was  unable to conclude that Christopher had permanent organic brain damage.  However, nowhere in the opinion did the Court strike the testimony of Dr. Mateer as not meeting the Daubert standard.  Furthermore, nowhere did the Court find that the Halstead-Reitan neuropsychological battery (fixed battery) met the Daubert standard while the flexible test battery did not. 
 
 Hopefully, this will put to rest the artificial controversy stirred up by Dr. Reed during my presentation.

Stern Addresses California Brain Injury Association

November 21, 2007 on 1:15 pm | In Brain Injury News | Comments Off
From Phoenix, I flew to California to speak at the California Brain Injury Association’s Medical Legal Conference held at the Silverado Resort in Napa, CA.  The conference was designed for attorneys, medical professionals and survivors of traumatic brain injury.  My invited topic was the Selection and Use of Experts in the Traumatic Brain Injury case.
 
Always a well-attended conference, moneys raised were donated to the California Brain Injury Association to help those with acquired traumatic brain injury.  As always, I was happy to participate and look forward to speaking there again in the future.
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