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Articles Tagged with traumatic brain injury

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accident sceneThe cyclist struck by a drunk and unlicensed driver in New York last Sunday is still in a coma. 55-year-old Nancy Pease was part of a group of 6,000 cyclists who were participating in the “NYC Century bike tour” organized by Transportation Alternatives. Nancy and a group of around 25 cyclists were waiting at a red light at 12th Ave and 39th Street in Borough Park, Brooklyn, when a minivan plowed into them. Several bicyclists were injured. Among them, Nancy who disappeared under the minivan as the driver literally drove over her.

The driver, 39-year-old Antonio Pina, was highly intoxicated. According to the police who arrested him he had a blood alcohol level of .287, three times the legal limit. Pina also told the police he didn’t have a driver’s license. He had been drinking margaritas and Coors light before driving his van. Witnesses saw him getting out of his parking space and crashing into another vehicle before accelerating and intentionally plowing into the group of cyclists. After he ran over the woman he got out of his car with bloodshot eyes and a disheveled appearance. As the police took him away he stuck his tongue out of his mouth looking crazy.

The FDNY had to remove Nancy Pease from under the van (see video below). Pease suffered serious physical injuries including a lacerated liver, abdominal bleeding and a traumatic brain injury. She had to undergo surgery and her spleen was removed. She is still in a coma according to the most recent news from the New York Post. A few other bicyclists also suffered injuries during the   accident.  They were treated for minor injuries at the scene of the accident and declined to go to the hospital.

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children at campConcussion is one of the most commonly sustained injuries by children and teenagers when they are at camp.  Therefore it is important that camps not only have specific requirements and guidelines to prevent traumatic brain injuries but also have a medical staff that is trained to recognize and treat concussions.

In regards to prevention, camps should always make sure that children wear proper helmets for activities involving motorized vehicles as well as activities such as skate boarding and skating.  Helmets also have to be mandatory when kids are involved in adventure activities such as climbing, spelunking or zip lining.  Children should also wear a helmet when bike riding as well as when horseback riding including pony riding.

Despite actively preventing concussions, accidents still happen and the camp medical team has to be ready.  The camp medical staff has to be able to recognize and evaluate a concussion sustained by a camp goer.  After  the camp clinician properly evaluates the young patient, he will have to communicate not only with the child but also with the parents to assure a proper recovery.

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 Electronic Health RecordThe Children’s Hospital of Philadelphia (CHOP)  released a study on Monday that looked at 14,527 traumatic brain injury-related primary care office visits for 7284 unique patients over a period of 4 years. They found out that after physicians used a concussion management tool provided to them through the Electronic Health Records (EHR) of their patients, they perform better diagnosis and treatment. 

82% of children suffering from concussion visit a primary care physician rather than a specialist to be treated. In the study, the researchers from the Children’s Hospital of Philadelphia (CHOP) found that many primary care physicians  then refer their young patients to specialists because they feel they are not properly equipped to manage Traumatic Brain Injury cases.

With the input of the primary care physicians, the researchers developed an electronic template guiding the physician through a step by step approach for diagnosis, treatment and follow-up of young patients suffering from concussion injuries. The electronic tool was integrated in the Electronic Health Record of the patient. The tool provided physicians with a “concussion Smartset” allowing them to document the evolution of the patient. Physicians were trained to used the tool at various seminars organized by CHOP researchers.

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young driverPeople who are driving after recovering from a concussion may be at higher risk of a car accident. A recent study lead by Julianne Schmidt, associate professor in the UGA College of Education’s department of kinesiology shows that despite being asymptomatic, people who recently suffered concussion may drive erratically. The study was recently published in the Journal of Neurotrauma.

During the study, Julianne Schmidt and her team compared the driving skills of 14 students who suffered concussion but were symptom free with the driving skills of 14 students who didn’t suffer from concussion. Participants were required to to complete a graded symptom checklist and a neuropsychological exam. Participants with concussion were asked to take a 20.5 km driving test within 48 hours of becoming asymptomatic. Healthy participants of the same age were required to complete the same driving test.

The study showed that participants who previously suffered concussion but were cleared of symptoms exhibited driving behavior similar to someone driving under the influence of alcohol.  The researchers compared the number of crashes between the two groups of students as well as the number of tickets, the number of lane excursion, the way they were driving in curves and their speed. They found out that concussed participants were not well controlling their vehicles especially when driving in the curves. They also swerved a lot more than healthy drivers putting themselves and other road users at a greater risk of accidents.

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child in strollerEvery year, thousands of infants and toddlers are diagnosed with traumatic brain injury or concussion after a stroller or carrier accident. A recent study by Erica Fowler, MPH, Christopher Kobe, MD, Kristin J. Roberts, MS, MPH, Christy L. Collins, PhD, Lara B. McKenzie, PhD, MA at the Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio analyzed strollers and carriers injuries from 1990 to 2010. The study was published in Academic Pediatrics.

The researchers found that over a period of 20 years, 360,937 children below 5 years old checked into the emergency room for an injury associated with a stroller or a carrier. The annual average of injuries was 17,187. However this average number didn’t mean much as the number of injuries significantly decreased over the years.

Most of the time, the injury was caused by a fall or a tip-over of the stroller or carrier.

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Flag footballAn increased number of parents have been worrying about their kids getting injured in contact sports after seeing the movie “Concussion” (see our previous blog). In a recent article Kristy Arbogast, Co-Scientific Director and Director of Engineering for the Center for Injury Research and Prevention at The Children’s Hospital of Philadelphia and a Research Associate Professor of Pediatrics at the University of Pennsylvania says many parents have asked questions about chronic traumatic encephalopathy (CTE). Parents want to know if kids who play contact sports are at risk to  develop CTE in the future. Kristy Arbohast who is a brain injury specialist, says that so far unfortunately there is no answer to this question. Some kids who played contact sports at high level (collegiate football or rugby) have developed symptoms of CTE but scientists still don’t know what predisposes a person to CTE.

Kristy Arbohast recommends that parents whose kids are interested in being involved in a contact sports make sure they are are proprely managed and coached. Parents should check that their child is playing in a league that requires coaches to be trained to recognize concussion signs. The coach should not only be trained in recognizing concussion signs but also have to respect the time that is needed to recover from a concussion. Recent research has shown that the best way to recover from a concussion is rest and then a progressive return to learning and playing activities.  Additionally parents should advocate for changes in rules to promote safety. Some rules can be changed so children are protected from injuries but still learn the skills for a specific sport. Flag football is a good example of how a child can still develop football skills while limiting personal injuries related to tackling players to the ground. Rules in hockey which prohibit body checking for youngsters have also help in reducing the number of head injuries in youth hockey.

The complete article can be read here

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will smithNFL players who suffer repetitive traumatic brain injury during their career have a high risk to develop Chronic Traumatic Encephalopathy (CTE).  CTE  is a progressive degenerative disease. Individuals affected by CTE often show symptoms of dementia such as loss of memory, confusion, depression and aggression.

Dr. Bennet Omalu, now the chief medical examiner, San Joaquin County in California, was one of the first doctors to detect CTE in NFL player’s brains.  Thirteen years ago as he was working at the Allegheny County Coroner’s Office in Pittsburgh he autopsied Mike Webster, a Hall of Fame center for the Steelers. Webster became so mentally ill that he ended up living in his pick up truck. During a dementia crisis, he pulled out his teeth and glued them back with superglue. He also shocked himself with a taser on a regular basis.

malu found that Webster’s brain was riddled with dark tangles of tau protein, which he explained had choked Webster from the inside out. He identified the condition as CTE and attribuDuring the autopsy, Dr Oted it to the estimated 70,000 hits to the head that Webster endured during his career. Dr Omalu then examined other players such as Terry Long, Justin Strezelczyk and Andre Waters and found they were afflicted by the same condition. When he showed the results of his research to the NFL they  publicly ridiculed him and intimidated him calling him a quack.

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cme-concussion-2015-std-canonicalEvery day students from elementary school to college are sustaining concussions during sport or playground activities.  A concussion is a type of traumatic brain injury that can affect the student’s cognitive, physical emotional and sleep functions.  Recent research has shown that knowledge of a concussion’s potential effects on a student and appropriate management of the return-to-school process is critical for helping students recover from a concussion.  Clinicians and school personnel who are  are involved in the management of care for students with concussion can attend a one day conference on this subject organized on May 9th by the Children Hospital of Philadelphia. Click here for more info and to register. For detailed information on Traumatic Brain Injury see the CDC related web page.

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Citi%20Bike.jpg73 year old Ronald Corvin is suing Citi Bike for the traumatic brain injury he suffered after a bicycle accident during which he fell from one of the Citi Bikes he was riding. The Citi Bike lawyer is arguing that the man should have worn an helmet. However Citi Bike stations in New York do not provide the option to rent helmets at their docking station. This option exists in Canada and in Australia where Alta, the Citi Bike operator, has installed helmet rental kiosks for their clients. Read more in the NY Daily News

It will be interesting to follow the evolution of this case as the Citi Bike program doesn’t have any insurance on their bikes. The cyclists using the share program are responsible for the damages incurred while they are using the bike. (read more here)

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NFL%20Brain%20Injury.jpgNew research from the Center for the Study of Traumatic Encephalopathy that looked at 36 male athletes diagnosed with Chronic Traumatic Encephalopathy (CTE) identified two distinct type of symptoms for the disease. A group of 22 athletes had behavioral and mood disorder developing at a younger age and the other group of 11 athletes had cognitive impairment developing at an older age. The study published in the Online edition of Neurology was led by Dr. Robert Stern, a Professor of Neurology and Neurosurgery at Boston University School of Medicine (BUSM), and Co- Director of the Center for the Study of Traumatic Encephalopathy.

Check the video below or go to “Game Changer” if you want to know more about CTE and the activity of the Center for the Study of Traumatic Encephalopathy.