SCI: It's Not Only About Finding Cure

May 8, 2012

When it comes to treating patients that have suffered a spinal cord injury, doctors are not only trying to find a cure, but trying to find ways of alleviating the pain that comes with the injury. For example, a recent study has discovered that the anticonvulsant drug pregabalin provides fast and continued relief from pain and pain-related sleep problems to patients that have suffered a spinal cord injury.

About two thirds of patients who suffer a spinal cord injury have chronic pain, while about 40% of spinal cord injuries have central neuropathic pain. That's where pregabalin comes in. Pregabalin is a 3-substitute analogue of gaba-amino butyric acid compound related to gabapentin, a medication used to treat, for example, neuropathic pain in diabetic patients after some painful surgeries.

Pregabalin is already being used in the United States for the treatment of fibromyalgia, postherpetic neuralgia, adjunctive therapy for adult patients with partial-onset seizures and like gabapentin, to treat neuropathic pain associated with diabetic peripheral neuropathy.

How Was The Study Performed?

Patients participating in this study were all adults who had either a complete or an incomplete injury at levels C2-T12. Most of the injuries in this group of patients were the result of trauma, including car accidents, truck accidents, motorcycle accidents and slip or trip and fall accidents. Some of the patients had spinal cord injuries caused by ischemia or by the removal of a benign spinal cord tumor. Most of them had been injured for years, a few for over a decade.

In addition to suffering from a spinal cord injury, participants in this study needed to have below-level central neuropathic pain throughout at least 3 months or the same level of pain on and off for at least 6 months.

According to doctors, the pain suffered by these patients (an average pain score of 6.6 on a 10-point scale and 2 levels below the level of injury) is the most difficult kind of neuropathic pain to treat in patients suffering this kind of injury. Participants were randomly assigned to receive placebo or pregabalin, with a total daily dose of pregabalin between 150 and 600 mg given daily divided in two doses. The double-blind study consisted of 4 weeks of titration, followed by a 12-week maintenance phase.

Impossible to Conduct Without Allowing Other Medications

Despite the risk of contamination, researchers had to allow participating patients to continue taking some of their other medications, including baclofen or benzodiazepines. They were also permitted to receive up to 4 grams of acetaminophen daily as pain medication. Thankfully, the most notable side effects were somnolence and dizziness. However, since patients were allowed to continue taking benzodiazepines, researches think these may have been the cause for the somnolence.

The study proved that Pregabalin caused a significant improvement in Duration Adjusted Average Change (DAAC) in pain, with a difference of 0.59 from placebo. Another significant improvement was how pregabalin patients achieved a 50% or greater reduction from baseline to endpoint in mean pain scores, compared with placebo.

Please note that all these treatments and medications are frequently needed over the lifetime of the patient and can be very expensive. Patients injured in an accident caused by someone else's negligence need a law firm that can help them recover the compensation they need to be able to afford these treatments and that is where we can help.

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Sinkhole Causes Insurer to Declare A Florida Home Total Loss

May 7, 2012

A massive sinkhole that opened in the backyard of a Florida home has made insurers declare the house a total loss.

Sinkholes occur when the ground caves in, often in karst terrains. These cave-ins happen because acidic water slowly dissolves underground cavities, making surface sediments collapse into underground caves in the limestone bedrock. Since most of Florida's terrains are karst, it is not unusual to hear about the formation of sinkholes.

Sinkhole Coverage Not Automatic

Although experts think that the sinkhole in question has stabilized, neighbors of the condemned house are worried, causing some to pack and leave. For example, Brian Dennis, who rents next door to the affected house, is moving out with his family. He told Chanel 13 News: "Our house hasn't been deemed unlivable, but it is way too close to the house".

Another neighbor, Kristin Jacobson, just moved to the house next door and spent all her savings in doing so, just to find herself without sinkhole coverage on her homeowners' insurance policy...

Maybe Ms. Jacobson does not have sinkhole coverage in her homeowner's insurance policy because of a common confusion between coverage for "catastrophic ground collapse" and coverage for "sinkhole damage". Thou they may seem one and the same to the lay person, in reality they are two different things under Florida Law:

Catastrophic ground cover collapse is defined by law as geological activity that results in the abrupt collapse and clearly visible depression of the ground cover, which in turn causes structural damage to buildings and their foundations to the point that the building is condemned by the government, as happened in this story.

A sinkhole, on the other hand, is defined as "a landform created by the subsidence of soil, sediment, or rock as underlying strata is dissolved by groundwater".

While insurance companies are obligated by law to include coverage for "catastrophic ground collapse" in their policies, they only have to include coverage for sinkhole related damage if the homeowner asks for it and pays an additional premium. Over the years we have found that many homeowners believe that this coverage is automatically included and therefore, do not ask for it. Please check our firm's internet portal for Sinkhole Damage Insurance Claims to familiarize yourself with the many ways we can help you avoid having to face a situation similar to the one Ms. Jacobson is in now.

It is unknown at this point if the owner of the property directly affected by the sinkhole had the requisite coverage in his homeowner insurance policy. However, he has already announced he plans to sell. Engineers estimate that it will take about a month to make the house habitable again, as they need to place hydraulically driven underpinning steel rods into the bedrock and then bolt them into the foundation in order to stabilize the house, before they fill in the hole.

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Failure To Use Turn Signals Leads To Accidents

May 3, 2012

In many ways, South Florida cities cannot compare to New York City, London or Paris. All these places have charms that make them special and famous: history, museums, theater, opera and other memorable attractions we lack. I'm not saying that our cities are lesser places, just different. We have charm those larger metropolis lack: weather, spectacular beaches, and our own very special melting pot of cultures that makes both our night life, as well as our daily existence a privileged one.

Too Many Drivers or Too Many Bad Drivers?

More to the point of this article, one thing that those cities have and ours lack is an efficient public transportation system. As a result, there are more of us on the road than there should be. As much money as we spend on road improvement and construction, our road capacity always seems to be trying to catch up to the demand. Yet, the worst part is not how many people call South Florida home, but how many of them seem to have no clue about the "rules of the road". At times it feels like South Florida has some of the worst drivers in the Western hemisphere driving around in our cities.

Turn Signals?

A recent study, the first of its kind, points to 2 million motor vehicle accidents each year just because too many of us do not use our cars' turn indicator signals as often as we should. By the way, that is more that twice the 950,000 accidents linked to other distractions, like texting or talking on the phone while driving.

Be it because of laziness, poor training, lack of courtesy or a combination of them all, the fact is that drivers forget to use their turn indicator signals (or to turn them off) 48 percent of the time when changing lanes. They also fail, around 25 percent of the time, to use the indicators when making a turn. It works out to about 2 billion times a day that drivers fail to use their signals or 750 billion times a year.

Electronic Solution?

In this study, researchers are proposing that car manufacturers equip vehicles with something they call a "Smart Turn Signal". Basically, the new device would automatically shut off a turn indicator signal by timing out after a set delay or by detecting when a vehicle has finished changing lanes. Obviously, it would replace today's mechanical trip mechanism, which cancels a turn indicator signal after we have made the turn.

Another Electronic Solution?

On the other hand, the nation's top automotive safety regulator, the National Highway Traffic Safety Administration, is working with auto manufacturers researching the viability of vehicle-to-vehicle communications systems. Such technologies could alert surrounding drivers about another that is about to run a red light or send a warning to all nearby vehicles that there's an icy patch of pavement ahead. Similarly, it could alert a driver that the car in the next lane seems to be about to change into his or her lane and cut them off. These technologies could help prevent most collisions, from rear-end crashes to intersection collisions and if viable, their implementation could be mandated by the NHTSA. Also, if these technologies end up being as effective as expected, they would help drive insurance rates down considerably and reduce injuries and fatalities.

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Age of Stem Cells May Be Important For Regenerative Medicine

May 1, 2012

In past posts we have talked about different efforts undertaken by scientists to find cures for traumatic spinal cord injuries. Some researchers are trying to use stem cells to help regenerate the damaged spinal cord tissue. To accomplish their goal, these scientists use so called "signal proteins" to induce the stem cells into grouping together at the site of the injured tissue and to stick there for the duration of the regenerative process. Yet, the body absorbs these "signal proteins" too fast for the regenerative process to be concluded. This has made scientists create devices that act as a "scaffold" that helps hold these stem cells in place for the duration of the process and are then absorbed by the body.

Perhaps given the inherent difficulties of all regenerative remedies, some scientists have decided to completely bypass the spinal cord and come up with a neuroprosthesis that combines a brain-computer interface (BCI) directly wired into about 100 neurons in the motor cortex of the patient's brain with a functional electrical stimulation (FES) device that's wired into the muscles of the patient's arm. Should the patient choose, for example, to move his hand, the cluster of 100 neurons activates and generates a stream of data that is sent to the brain-computer interface. The BCI then reads and analyzes the data and selects which muscles (and with what degree of force) the patient is trying to move. This data is then sent wirelessly to the FES, which makes the necessary muscles move.

Younger Stem Cells Might Be Better

I believe we must do all we can to help those suffering from a spinal cord injury and I also believe all options are worth exploring. Yet, those who believe that doing away with part of our original equipment is not a good idea, may want to consider that newer stem cells seem to be better than old ones. According to healthnewsdigest.com, researchers studying stem cell use in transplant medicine have found that newborn stem cells transplanted from cord blood had younger acting blood cells compared those transplanted from other sources of stem cells like bone marrow.

Similarly, researchers focused in regenerative medicine are using mesenchymal stem cells (MSCs), which have the ability to regenerate tissue that connects bone, cartilage and tendon. The youngest MSC we can possibly collect, cord tissue-derived MSCs, have shown to have unique characteristics that make them specially suited for regenerative cellular therapies like those considered for spinal cord injuries. These younger cells are known to divide more quickly and more extensively than adult-derived cells, ensuring higher proliferation rates.

For decades now, the stem cells of millions of people have been stored in biobanks in case they are needed in the future. In fact, tens of thousands of patients have needed their stored cells for cancer treatments or other regenerative therapies. Over the years, researchers have noted that stem cells collected from younger and healthier donors are more effective in regenerative medicine than stem cells taken from donors that are older or not as healthy. Research seems to prove this to be true for both hematopoietic and mesenchymal stem cells, which indicates that it is better to collect and preserve newborn stem cells from the umbilical cord and cord blood for potential future use.

Of course, all of these treatments are expensive. However, if you are a victim suffering from a spinal cord injury caused by another's negligence, maybe we can be of assistance.

Continue reading "Age of Stem Cells May Be Important For Regenerative Medicine" »

Brain/Computer Interface to Bypass Spinal Cord

April 24, 2012

The central nervous system is formed by the brain and the spinal cord. As we all know, the brain is the organ that generates ideas and processes information. Among many different functions, the brain controls the motor function of the body. In other words, if we want to walk, the brain generates a command ordering the legs to walk. Similarly, if we want to grab a glass of water with the left hand, the brain generates a command to the left hand to grab the glass of water and so on...

These "commands" are generated in the form of neural or electrical signals and are transmitted through the spinal cord to the rest of the body. But transmitting the motor information generated by the brain is not the spinal cord's only function. The spinal cord is also a conduit of sensory information from the rest of the body to the brain (like when we touch a hot surface with a hand and the heat sensation travels from the hand through the spinal cord to the brain) as well as a center where some reflexes are coordinated.

For the purpose of this post, we will concentrate on the spinal cord's motor information transmitting function. Traumas to the spinal cord may result in the cord being crushed, bent or even severed. Patients that suffer spinal cord injuries have to deal with different degrees of paralysis. For example, much like the transmission of internet service at your home, the brain (your modem/router) receives and transmits signals through the spinal cord (the wiring in your house) to your hands and legs (computer). If any part of the wiring is damaged (crushed or severed) the internet signal (neural or electrical signals) transmitted by the modem/router (brain) will not reach the computers (arms, legs, etc.).

Unless the wiring is repaired...

Some researchers are studying the use of stem cells to help regenerate the damaged spinal cord tissue (wiring). For the process to work, the stem cells have to be correctly aligned and delivered to the injured area. Moreover, the cells have to be induced into "grouping" and "sticking" together around the injured area until they have completed the regenerative process. This is accomplished by using "signal proteins". However, since "signal proteins" are typically absorbed by the body before the regenerative process is completed, researchers have had to create man-made nano filaments that form a sort of "scaffold" that keeps the cells together long enough for full regeneration to take place. Once the stem cells have done their regenerative job, the body absorbs the nano filaments and no traces of the process are left behind.

Other companies have created similar devices: InVivo Therapeutics Holdings Corp., has created a biocompatible polymer-based scaffolding device that also helps group and keep together the stem cells for the duration of the regenerative process.

Or, Unless The Spinal Cord Is Bypassed Altogether

Now scientists have come up with the idea of bypassing the spinal cord entirely. Think of it as having a wireless modem/router (brain) and a wireless computer (arms and legs) at home: no need to use the wiring inside your walls (spinal cord)...Researchers at Northwestern University in Chicago have managed exactly that: the bypassing of the spinal cord using a brain-computer interface.

Scientists have created a neuroprosthesis that combines a brain-computer interface (BCI) that is wired directly into approximately 100 neurons in the motor cortex of the patient's brain with a functional electrical stimulation (FES) device that's wired into the muscles of the patient's arm. For example, if the patient chooses to move his hand, the cluster of 100 neurons activates and generates a stream of data that is sent to the brain-computer interface. The BCI then reads and analyzes the data and selects which muscles (and with what degree of force) the patient is trying to move. This data is then wirelessly sent to the FES device, which makes the right muscles move.

It is important to note that Functional Electrical Stimulation (FES) devices have been in use for years. However, those previously tested devices have had pre-programmed basic movements (like a command to open a hand or lift a leg) that are triggered by small muscle movements in non-paralyzed muscles. As opposed to these older devices, the BCI does not respond to "second-hand" signals, but to a normal array of neural signals generated by those 100 neurons in the cerebral cortex.

Of course, this Brain-Computer Interface has only been tried in primates and we are a long way from human trials. Yet, it is exciting to know that such science fiction like technology is not only possible, but is already being tried. Maybe the idea of having a computer chip in our brain that wirelessly interfaces with our other electronic devices is not that farfetched. Perhaps answering the phone in the relatively near future will be a matter of blinking one's right eye...

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Some Hormones May Help Reduce Brain Swelling in TBI Patients

April 23, 2012

In past blogs I've talked about what happens to the brain when it suffers an injury. For example, my last post on the subject was about how brain cells at the site of impact die and release toxic substances that cause the death of more cells if left untreated. In that post I talked about how scientists have devised a way of using the negative pressure generated by a microcomputer controlled vacuum pump to extract those deadly chemicals.

Estrogen Hormones Can Help Too

In an effort to help reduce the swelling of the brain after an injury, scientists at the University of Texas Southwestern Medical Center in Dallas have discovered that estrone, one of three naturally occurring estrogen hormones in the human body, has important anti-inflammatory and antioxidant characteristics.

Dr. Joshua Gatson, Assistant Professor of Surgery at the University of Texas headed the research that proved the anti-inflammatory and anti-oxidant qualities of estrone after the occurrence of a traumatic brain injury. The study was conducted on male rats comparing 0.5 mg of estrone with a placebo administered within 30 minutes of the brain injury. The results showed that the estrogen hormone is involved in promoting cell survival.

The toxic substances released by the dead cells around the area of the injury cause the brain to swell. As the brain swells within the confines of the skull, the veins and arteries that bring oxygen to the head are constricted, causing oxygen deprivation that kills more cells. If doctors allow the cycle to continue repeating itself and become a vicious circle, the patient's recovery is put in jeopardy. Using the micro-computer controlled vacuum pump to extract the toxic substances released by the dead cells and the estrone to fight the swelling of the brain may help avoid the deadly deprivation of oxygen characteristic of these cases.

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New Treatment To Help Traumatic Brain Injury Patients

April 18, 2012

A technology that has proven effective preventing cell death is being successfully tested to help with the recovery of patients suffering traumatic brain injuries. According to scienceblog.com, a microcomputer vacuum pump is being used to help prevent further cell damage by toxic substances released around the injured area.

Vacuum Pump The Brain?

When the brain suffers an injury due to trauma, the damaged cells around the area where the impact happened die. These dead cells release toxic chemicals that make the brain swell, something that then restricts blood flow and oxygen level. Since our body (and all of its organs) depends on a healthy supply of oxygen for survival, this restriction of oxygen causes further cellular death and decay that affects brain function. Unless something is done to stop this cycle from repeating itself, patients' recovery is compromised.

Consequently, scientists from Wake Forest Baptist Medical Center realized that if they wanted to help their patients recover, the harmful substances released into the body by the decaying cells had to be removed. That is how they came up with the idea of using the negative pressure generated by a microcomputer vacuum pump to remove the toxic fluids released by these damaged cells to help expedite their patients' recovery.

Study Funded By The Department of Defense

Not surprisingly, the $1.5 million study that allowed for the development of this new technology was funded by the Department of Defense. Together with Post Traumatic Stress Disorder (PTSD), traumatic brain injuries have been dubbed the "hallmark injuries" of our soldiers in Afghanistan and Iraq. Soldiers often suffer these injuries when insurgents explode their IEDs (Improvised Explosive Devices) by the side of the road as our troop convoys pass by. The bomb's shock wave travels through the skull and makes the brain bounce back and forth inside it, causing extensive injuries. The process is repeated as the body impacts parts of the vehicle in which the soldier is traveling (roof, dashboard, side columns) or outside objects like other vehicles, walls or the road, when the soldier is expelled from the vehicle. Unfortunately, something very similar happens everyday to ordinary people in all kinds of motor vehicle accidents (i.e., car accidents, motorcycle accidents, accidents with large commercial trucks like tractor-trailers or eighteen-wheelers). And this is where we can help.

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FDA Meets With Company Developing Treatments For Spinal Cord Injuries

April 17, 2012

The Food and Drug Administration held a meeting with InVivo Therapeutics Holdings Corp., a company currently developing advanced technologies for the treatment of patients suffering from spinal cord injuries. According to marketwatch.com, InVivo has developed a biocompatible polymer-based scaffolding device. This device is expected to provide support to a damaged spinal cord and spare tissue from scarring, as well as improve a person's recovery and prognosis after a traumatic SCI.

Why Meeting With The FDA?

The purpose of InVivo's meeting with the FDA was to obtain an Investigational Device Exemption. This will allow InVivo to use their device in a clinical study in order to collect safety and effectiveness data which it will need to support approval by the FDA to use the device in the market.

Stem Cells, Progenitor Cells And Treatment of Spinal Cord Injuries

I'm sure that most of you have heard about the ongoing debate over the use of stem cells by medical experts trying to find cures for the many different illnesses that affect modern society. I'm also sure that almost everyone has heard of someone prostrated in bed or confined to a wheelchair after suffering a severe traumatic spinal cord injury. Even if you have not met or heard of someone personally, you are probably familiar with the late actor Christopher Reeve and the courageous battle he fought to help find a cure from the moment a horse riding accident left him paralyzed. The plight of these victims moves scientists to try and find a cure. However, what can stem cells do for SCI patients?

Both stem cells and progenitor cells are biological cells capable of dividing themselves into diverse specialized cell types and also capable of multiplying to produce more cells similar to them. Mammals have two broad kinds of stem cells: embryonic stem cells and adult stem cells. Both kinds of cells act as a repair system in adult bodies, helping replenish damaged tissue in a process similar to the healing of a flesh wound.

Scientists hope that stem cells will help regenerate tissue damaged as a result of spinal cord injuries. The problem is that while coagulation forms a scab that allows for the skin to grow and eventually cover the injury, the regenerative process with stem cells inside the body is a bit more complex...

First, to expedite the regenerative process, the stem cells have to be delivered in a specific direction to target the damaged parts of the injured organ - in this case the spinal cord. This "special delivery" is accomplished by using "protein cells" which induce the cells to group at the damaged area.

Second, since protein cells are typically absorbed by the body before the full regenerative process is done, scientists need to find a way to keep those cells in place. That is where InVivo's biocompatible polymer-based scaffolding device comes in. It helps support the spine and, at the same time, helps attach the "protein cells" (and therefore, hold the stem cells) to the injured area while the regenerative process is accomplished. Much like the scab in the flesh wound healing example, InVivo's biocompatible polymer-based scaffolding will help "stop the bleeding" of protein cells (and stem cells) while the wound heals.

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Exoskeleton to Help Spinal Cord Injury Victims Walk Again

April 12, 2012

Science is helping some spinal cord injury victims to walk again with a new device that attaches to the body like a backpack.

According to 9news.com, the EKSO exoskeleton has been called a "wearable" robot. In reality, it is a device that resembles a slim backpack with leg and feet extensions. The backpack contains the batteries and also serves as back support, while the extensions attach the electrodes that send electrical signals to the legs and feet. This signal helps prompt victims with spinal cord injuries and people with weak lower extremities to stand up and walk. The device is only being used within a hospital environment during this trial period. At $125,000.00 apiece, most victims cannot afford it. However, its creators hope that future generations of EKSO will be cheaper, as well as more compact, enabling it to be used outside the hospital setting.

Although the exoskeleton is not a cure, Candy Tefertiller, the director of physical therapy at Craig Hospital (who is also the physical therapist working most closely with the wearable robot), says that they hope it will someday give patients a choice between a wheelchair or walking using the EKSO exoskeleton.

Types of Spinal Cord Injuries

The vertebral column is formed by thirty-three vertebrae that go from the base of the skull to the tailbone. The spinal cord is encased within those vertebrae. Trauma to the spinal cord may result in an injury the cord itself or in indirect damage to the surrounding bones, tissues, or blood vessels. Direct trauma occurs when the cord is cut, pulled, pressed sideways or compressed. These types of injuries occur when the head, neck, or back are twisted abnormally. Please note that about 30% of spinal cord injuries suffered by quadriplegic patients are traumas to the cervical spine, which is encased in seven vertebrae located in the neck area.

Typically, these injuries occur as a result of motor vehicle accidents, falls, sports injuries (like when a diver dives head first into water that is too shallow or a football player tackles an opponent while leading with his head), industrial accidents and other causes.

Medical professionals classify traumatic spinal cord injury into five categories:

  1. Cases in category "A" have suffered a "complete" spinal cord injury. In other words, the victim has no motor or sensory function preserved in the sacral segments S4-S5.
  2. Those in category "B" have suffered the first spinal cord injury classified as "incomplete". In these cases the victim has sensory perception, but no motor function below the neurological level, including the sacral segments S4-S5. This is usually a temporary phase. Victims that recover any motor function below the neurological level, become a motor incomplete (i.e. either a category "C" or "D", as explained below).
  3. A patient in category "C" is also one with an "incomplete" spinal cord injury. In these cases, motor function is preserved below the neurological level and more than half of the key muscles below that level having a muscle grade of less than 3. That indicates active movement with full range of motion against gravity.
  4. A category "D" also indicates an "incomplete" spinal cord injury, but the motor function in these cases is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of 3 or more.
  5. Category "E" indicates that the patient has "normal" motor and sensory scores. Please note that the reason for this category is that a person may suffer a spinal cord injury and have neurological deficits while having completely normal motor and sensory scores.

Continue reading "Exoskeleton to Help Spinal Cord Injury Victims Walk Again" »

Treating Traumatic Brain Injuries With Oxygen Seems To Help

April 11, 2012

Scientists believe that a new drug free treatment for patients with traumatic brain injuries may help accelerate their recovery time. According to firstcoastnews.com, doctors are placing injured soldiers in hyperbaric oxygen chambers. These are the same type of chambers used by deep sea divers to avoid getting decompression sickness (DCS; also known as divers' disease or the bends) which is a condition that occurs when dissolved gases come out of their solution and become bubbles inside the human body upon decompression.

TBI patients undergo treatment in the oxygen rich environment of the chamber for 40 sessions, one hour each time. The pressure inside the tanks is similar to that experienced by a diver 17 feet under water.

Typical Type of Injury

Traumatic Brain Injuries are one of the two most common types of injuries suffered by soldiers coming back from the wars in Afghanistan and Iraq. Together with Post Traumatic Stress Disorder (PTSD), they have been dubbed the "hallmark injuries" of our returning wounded warriors. Given how often enemy insurgents resort to placing Improvised Explosive Devices (IEDs) by the side of roads and detonating them as our troops' convoys go by, it is not surprising that traumatic brain injuries are so common. When an explosion occurs, the shock wave moves through the victim's skull and throws the brain back and forth against the walls of the skull, causing grave injuries. The process is repeated as the victim hits a wall, a vehicle, the road or any other object against which he gets thrown.

Something very similar occurs to athletes and car accident victims. For example, it is not uncommon for the brain of a football player to suffer the same "bouncing" effect after their head hits the ground or makes contact with another player even thou they are wearing helmets. Car victims experience the same trauma as they get thrown head first against the dashboard, the roof of the car or even through the windshield. This is why it is so important to always buckle up.

Some Not So Visible Effects of Traumatic Brain Injuries

Some traumatic brain injuries are obvious; some people are unable to walk, talk or function as the victim used to before the injury; some people become bedridden for life. Others, however, are not as obvious: cognitive problems, attention problems, loss of recent memories, not knowing what's going on and behavior or temperamental problems are just a few examples.

Such was the case of William Cook, a 22 year-old soldier injured when he stepped on a mine while on his tour of duty in Iraq. He lost his left leg and suffered other injuries. Yet, while he could learn to walk again with the use of a prosthesis, he still didn't feel quite well. He would have unexplainable mood swings, ranging from anger to sadness, and were always accompanied by extreme headaches. Luckily, a friend told him to go see Dr. Stephen Xemakis, a retired Army Brigadier General and psychiatrist who prescribed the hyperbaric chamber treatment.

Cook has already undergone most of the 40 sessions of treatment in the hyperbaric chamber and claims that he finally feels like himself again. Moreover, researchers have found that most patients start feeling better after only 20 sessions. An unbelievable 100 hundred percent of patients claim to feel better after receiving the full treatment. Dr. Xenakis says that he believes that the oxygen has a direct effect on both the neurons and on the small blood vessels in the brain. The treatment, however, is not cheap. Each session costs $250.00 and they are not covered by insurance companies.

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Will The New PIP Law Drive Car Insurance Rates Down?

April 10, 2012

In one word: maybe...According to the Tampa Bay Times, HB119 (as the measure was known while it made its way from the legislature to the Governor's office) may initially have the opposite effect...

What Is The Purpose Of Personal Injury Protection (PIP)?

A bit of history first: Florida's legislature created PIP to make sure that people in this state at least had a $10,000.00 cushion to pay for the emergency treatment they may need after a motor vehicle accident. Because the majority of people in car accidents sustain minor injuries, PIP would theoretically help drivers involved in these accidents get back on their feet.

However, some unscrupulous chiropractors and providers of other medical services have made it a habit to plunder the $10,000.00 from PIP policies by frequently administering to accident victims treatments that are usually found to be unnecessary over the course of several visits. In essence, after an accident victim is "seen" at these providers' offices, there is no money left for the treatment they really need: MRIs, therapy, hospitalization, orthopedics, even surgery.

Given this situation, the legislature decided to revise the law and came up with the new rules contained in HB119.

Limitation on Benefits

The most important change intended by HB119 is to bar some providers of medical services (i.e., massage therapists and acupuncturists) from charging accident victims under PIP. Similarly, the new rules limit the access that other providers (i.e., chiropractors and physical therapists) have to PIP funds. Under the HB119, chiropractors and physical therapists will only be able to charge for $2,500.00 of the $10,000.00 available under each PIP policy. However, this limitation is removed if a doctor, a dentist, a physician's assistant or a nurse practitioner determines that the patient has a medical emergency. This provision is prompting a Tampa based company to offer the services of doctors and even osteopathic physicians to chiropractors' offices. These medical professionals can be "hired" just to prepare the paperwork required for declaring the emergency medical conditions necessary to gain access to the rest of the funds...

No Definition Of Medical Emergency

Moreover, both proponents and opponents have already identified another legal "loophole" that may tie up the courts for some time: HB119 fails to define what constitutes a medical emergency. Some fear that this omission may prompt insurance companies to simply deny coverage by naming most injuries non-medical emergencies. If that happens, it will likely prompt much more litigation and end up clogging the courts.

So, Will It Drive Insurance Rates Down?

Under HB119, insurance companies are required to reduce personal injury protection premiums at least 10 percent by October 1st of this year and 25 percent by the year 2014. Theoretically, the less money insurance companies have to pay out under PIP policies (by not allowing chiropractors to exhaust the $10,000.00), the fewer premiums they should charge for these policies. However, as mentioned before, it remains to be seen whether any money will be saved under the new rules. In fact, if more litigation ensues as a result of the omissions discussed above, premiums may go up, not down...

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Loophole in New Florida PIP Law Already Being Exploited

April 5, 2012

In past posts I have talked about the new Personal Injury Protection (PIP) law currently working its way from the Florida legislature to the governor's desk for signature. According to cnbc.com, there is already a Tampa based company trying to circumvent the spirit of the law by exploiting one of the loopholes we discussed in previous posts.

Doctors For Hire

Florida drivers must carry $10,000.00 in Personal Injury Protection to help pay their medical bills and lost wages when they get injured in an automobile accident. The purpose of the law is laudable: most accidents cause only mild injuries and everyone should at least be prepared to bear the cost of these minor injuries.

The problem, however, is that some chiropractors and some doctors have centered their practices on exhausting those $10,000.00 with treatments that have often proven useless. This situation has made Florida legislators come up with a new set of rules known as HB 119 until they are signed into law by Governor Rick Scott, a strong supporter. HB119 limits chiropractors' access to only $2,500.00 of the $10,000.00 coverage, unless (and here comes the loophole being exploited) a physician, a dentist, a physician's assistant or even a nurse practitioner determines that the patient has a medical emergency.

As a result of this loophole, there is a company in Tampa offering to send medical doctors or osteopathic physicians to chiropractor's offices so that they can document the "medical emergency" necessary for those chiropractors to be eligible to bill insurance for the remaining $7,500.00 of the personal injury protection coverage.

Don't allow these chiropractors to plunder your insurance policy and deprive you of the money you need for real medical treatment. Any of our many excellent South Florida hospitals can provide you with the treatment your injuries need and they all accept payments from car insurance policies.

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Car Accidents Are Leading Cause for TBIs Among Teenagers

April 3, 2012

A study of traumatic brain injuries in teenagers recently released by the Children's Hospital of Philadelphia points to automobile crashes as the leading cause for head trauma among youths. For many years, car crashes have been the leading cause of death for teenagers, killing almost five times as many youngsters between the ages of 15 and 19 years as cancer or poisoning.

The Children's Hospital of Philadelphia looked at the data from accidents in which more than 55,000 teenagers and their passengers resulted injured during 2009 and 2010. The study found that about 30 percent of these teen drivers suffered head injuries such as concussions, contusions and skull fractures. A concussion is an injury to the head that may cause the victim to lose awareness or alertness anywhere from a few minutes to a few hours after the traumatic event. On the other hand, a contusion is a bruise to the brain that causes bleeding and swelling inside of the brain around the area where the head was struck.

A skull fracture is a break in the skull bone. There are four different kinds of skull fractures and their severity varies depending on the type:

  1. Linear skull fractures, which consist of a break in the bone without it moving from its place and account for about 70 percent of skull fractures. In these cases the patients are usually kept under observation at the hospital for a brief period and allowed to continue with their normal daily activities in a few days, without a need for surgery.
  2. Depressed skull fractures are those where a part of the skull is actually sunken in from the trauma, which is why it typically requires surgery to correct the deformity.
  3. Diastatic skull fractures are the fractures that occur along the suture lines or areas between the bones in the head that fuse when a child grows.
  4. Basilar skull fractures are the worst kinds of skull fracture because they consist of a break at the base of the skull. Typically, victims suffering this type of fracture have bruises around their eyes and a bruise behind their ear. Also, a tear to part of the covering of the brain might have occurred, causing the victim to drain a clear fluid through the nose or ears. These cases require close attention in the hospital.

A Common Brain Injury: Bruising

Whiplash, a very common injury in motor vehicle accidents, can cause a bruise to the brain and damage the internal tissue and blood vessels by making the brain bounce back and forth inside the skull.

This is also a very common way for soldiers to suffer head injuries. Throughout the years, Afghani and Iraqi rebels have resorted to IEDs or Improvised Explosive Devices as a preferred mode of attacking our troops. When a bomb explodes, the shockwave passes through the skull and "throws" the brain against the walls of the skull making it, as stated above, bounce back and forth. The process is called coup-countercoup and is repeated as the victim's body hits a wall, a vehicle or the pavement. The bruise caused by the trauma at the site of impact is called a coup lesion, while the trauma at the opposite side is called a countercoup lesion. The injury caused by these impacts may consist of a tearing of the internal lining, as well as tearing to tissues and blood vessels that may in turn cause internal bleeding, bruising or swelling of the brain.

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Regenerative Medicine May Help Victims of Car Accidents

March 29, 2012

Regenerative medicine is a new field of medicine that tries to develop technology based on a combination of chemistry, biology and engineering methods. The technology is commonly referred to as "nano technology".

Nano Technology to Help Car Accident Victims

According to sciencedaily.com, this new treatment could be used to cure people that have suffered catastrophic injuries in accidents by regenerating tissue and organs damaged through injury. Apparently, this new "cure" resembles microscopic uncooked spaghetti in the form of "noodle gels" and other invisible man-made filaments. The regenerated tissue could include nerves severed in car or truck accidents.

As discussed in previous posts, the degradation of the spinal cord and the damage to tissue surrounding the injured area are part of the problems that doctors face when trying to help with the recovery of SCI patients. The regeneration of damaged nerves depends on the delivery of stem cells in a specific direction to target the damaged parts of the injured organ. These "noodle gels", created by Professor Samuel I. Stupp, Ph.D. and his team from Northwestern University, have proven effective in correctly aligning the stem cells necessary for the regeneration of damaged tissue.

The delivery of the stem cells necessary for the regeneration of damaged nerves is accomplished by using "signal proteins" that induce the cells to "group" at the damaged area. However, for the whole regenerative process to occur, the cells have to "stick around" the injured area before the "signal proteins" that bring and bind these cells together are absorbed by the body. If the signal proteins are absorbed too quickly, the cells will not have enough time to repair the damage.

Consequently, Professor Stupp's team developed a nano-filament formed by small bits of proteins that glue themselves together spontaneously. This "scaffold" could help attach the "signal proteins" (and therefore, the stem cells) to the injured area for the duration of the regenerative process. The nano-filament scaffold eventually breaks down and is absorbed by the body, leaving behind only the regenerated tissue.

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Deadly Day For Car Accident Victims in South Florida

March 28, 2012

According to miamiherald.com, ten people died from car accidents in South Florida beginning late Saturday evening through Sunday night. The result is the worst death toll in recent memory in South Florida from car accidents for a period of 24 hours.

Six of these victims died in accidents throughout Miami Dade County, while four people (including an unborn child) died in crashes within Broward County.

Head-On Collision

One of these tragic accidents occurred on the Gratigny Expressway in Northwest Miami Dade County where four people died in a head-on collision. According to the Florida Highway Patrol, a driver might have driven his car the wrong way onto the expressway ramp at Northwest 57th Avenue around 5 a.m. on Sunday morning. The two vehicles involved in the crash, a car and an SUV, caught fire after crashing, subsequently trapping all four occupants.

Hit and Run Accident on Turnpike

Two people were killed while changing a tire when a car went onto the shoulder of the Florida Turnpike and struck them both. One of the victims was a good samaritan who had stopped to help the other victim. It was reported that after the accident the driver fled the scene.

Pregnant Woman Victim Of Freak Car Accident

Broward County also saw an unusual number of deaths caused by car crashes. A woman who was seven months pregnant and on vacation from Boston was crushed to death when a car crashed into the area around a poolside cabana behind the Riverside Hotel off Las Olas Boulevard. According to witnesses, the woman and the unborn baby's father had just separated to use the poolside restrooms when the vehicle crashed into the area she was standing. The driver of the vehicle was taken to Broward General Medical Center with serious injuries.

A 5 year-old girl died when she was run over by a van while riding her tricycle in front of her trailer house. Similarly, an elderly woman drove over and killed a parishioner that had just attended mass on Sunday morning at St. Ambrose Catholic Church in Deerfield Beach. Finally, a 14 year-old boy was killed while riding his skateboard in Tamarac.

We would like to take this opportunity to convey our firm's sympathy to the families and friends of the deceased. The irreparable loss of their loved ones makes our community a lesser place. Our thoughts are with them in this time of sorrow.

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