A new study has found that moderate exercise may help those who suffer from post-concussion syndrome (PCS), according to the National Post.
http://www.nationalpost.com/life/story.html?id=2628799
Those with PCS continue to suffer from the symptoms of traumatic brain injury (TBI), such as dizziness, headaches, insomnia and irritability. These PCS patients haven’t gotten much attention or focus, with the standard treatment for their condition just being rest.
But in a new study reported in the Clinical Journal of Sports Medicine, researchers had athletes with PCS work out on a treadmill, moderately. The goal was to create relief from PCS by working on the assumption that it is caused by an imbalanced flow of blood in the brain.
It’s known that rigorous exercise interferes with the flow of blood to the brain and can make concussion symptoms worse. So in the study, the patients with PCS were put on an exercise routine that ramped up slowly, and wasn’t very intense.
Researchers found that people in that group became better able to exercise after just a few weeks.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
The Bible of Mental Disorders – DSM-IV – May Undergo Controversial Revisions
The bible for diagnosing and treating mental illness, what The New York Times calls “the guidebook that largely determines where society draws the line between normal and not normal,” http://www.nytimes.com/2010/02/10/health/10psych.html?em
is undergoing some revisions that could have affect litigation and lawsuits.
The updating of the Diagnostic and Statistical Manual of Mental Disorders has been the subject of much lobbying by various advocacy groups. The proposed changes to the book, which physicians rely on to categorize their patients’ illness, were released Tuesday. http://www.dsm5.org/Pages/Default.aspx
Both The Times and AOL News noted that any changes in the this manual of mental ailments have “huge implications” — not just for psychiatrists but for the legal system, government programs and pharmaceutical companies – in terms of who is considered normal or who is considered disabled.
http://www.aolnews.com/nation/article/big-changes-proposed-for-diagnostic-and-statistical-manual-of-mental-disorders/19352107?icid=main|main|dl1|link3|http%3A%2F%2Fwww.aolnews.com%2Fnation%2Farticle%2Fbig-changes-proposed-for-diagnostic-and-statistical-manual-of-mental-disorders%2F19352107
One of the revisions that has some experts worried is a new “at risk” category for those who show early signs of illnesses like dementia. The fear is that this new label will stigmatize patients.
Another recommendation is the creation of a new childhood disorder, temper dysregulation disorder with dysphoria. It’s a new category for aggressive children who previously might have been misdiagnosed as having bipolar disorder, and then were given antipsychotic drugs that have serious side effects.
New proposed categories for the DSM include one for sex addiction, “hypersexuality,” defined as when “a great deal of time is consumed by sexual fantasies and urges; and in planning for and engaging in sexual behavior.”
And binge eating is a new suggested disorder, defined as at least one binge a week for three months, followed by guilt and mood swings.
Interesting that the news doesn’t focus on the bogus definition of Post Concussion Disorder in the Appendix’s of the DSM-IV. Through two revisions, the drafters of this “bible” have been unable to agree on what defines a concussion. The proposed definition still contains a requirement of a 5 minute loss of consciousness, a requirement that has uniformly been rejected by the American Academy of Neurologists, the CDC, the United States Armed Services and virtually every peer reviewed research article this century.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
is undergoing some revisions that could have affect litigation and lawsuits.
The updating of the Diagnostic and Statistical Manual of Mental Disorders has been the subject of much lobbying by various advocacy groups. The proposed changes to the book, which physicians rely on to categorize their patients’ illness, were released Tuesday. http://www.dsm5.org/Pages/Default.aspx
Both The Times and AOL News noted that any changes in the this manual of mental ailments have “huge implications” — not just for psychiatrists but for the legal system, government programs and pharmaceutical companies – in terms of who is considered normal or who is considered disabled.
http://www.aolnews.com/nation/article/big-changes-proposed-for-diagnostic-and-statistical-manual-of-mental-disorders/19352107?icid=main|main|dl1|link3|http%3A%2F%2Fwww.aolnews.com%2Fnation%2Farticle%2Fbig-changes-proposed-for-diagnostic-and-statistical-manual-of-mental-disorders%2F19352107
One of the revisions that has some experts worried is a new “at risk” category for those who show early signs of illnesses like dementia. The fear is that this new label will stigmatize patients.
Another recommendation is the creation of a new childhood disorder, temper dysregulation disorder with dysphoria. It’s a new category for aggressive children who previously might have been misdiagnosed as having bipolar disorder, and then were given antipsychotic drugs that have serious side effects.
New proposed categories for the DSM include one for sex addiction, “hypersexuality,” defined as when “a great deal of time is consumed by sexual fantasies and urges; and in planning for and engaging in sexual behavior.”
And binge eating is a new suggested disorder, defined as at least one binge a week for three months, followed by guilt and mood swings.
Interesting that the news doesn’t focus on the bogus definition of Post Concussion Disorder in the Appendix’s of the DSM-IV. Through two revisions, the drafters of this “bible” have been unable to agree on what defines a concussion. The proposed definition still contains a requirement of a 5 minute loss of consciousness, a requirement that has uniformly been rejected by the American Academy of Neurologists, the CDC, the United States Armed Services and virtually every peer reviewed research article this century.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Evolution in the Understanding of Concussion: Adrenaline Increases Memory and Masks Post Traumatic Amnesia
Our next lesson on the topic “The Evolution of Our Understanding of Concussion, otherwise Called Mild Traumatic Brain Injury,” is the role that adrenaline plays in masking the most reliable marker for brain injury, that of Post Traumatic Amnesia. The video on this topic is found at http://www.youtube.com/profile?user=braininjuryattorney#p/u/9/N0K2K-lqW18
When a concussed person does find his or her way to the Emergency Room, the first thing that typically gets asked is what do you remember of what happened. The second was did you get knocked out. Both questions are seriously flawed in methodology. Starting with the second, if you presume that someone who is knocked out will have amnesia of the event, how can you ask them what happened to them at a time they were amnestic? We would hope that most experienced ER doctors see the inherent conflict in relying on the answer to such a question from the concussed person.
The more subtle but more significant problem is assuming that because someone has memory of an event, that means they weren’t concussed in the event. This is simply not true and it ignores the well recognized principle that concussed individuals can have islands of memory during otherwise periods of significant amnesia. Amnesia is not a total loss of memory, it is a loss of any period of memory. The islands of memory a concussed person will most likely remember are those things where adrenaline played the greatest role, such as the accident itself. If you have ever been a car wreck that you do remember, especially a serious car wreck, it is something you will remember for the rest of your life. I have been in two serious wrecks and I remember exquisite details of what I was doing just before and in the hours after the wreck. One of those wrecks was in 1975 and the other in 1993. I even remember the date and hour of the 1993 wreck.
My brain remembers them best because they were most important to me. It also remembers them best because they were the most scary. What I don’t remember about the more serious of those accidents, is the ambulance ride. And I should because I was in pain and strapped to a board. In 1975 if I could walk and talk in an Emergency Room and didn’t have any broken bones, that was all they were concerned with. I was discharged home. No one ever asked me a single question about amnesia.
Our concern about concussions has improved dramatically since 1975 but the inquiry with respect to the most likely period of post traumatic amnesia, the period from 5 minutes post accident to 48 hours post accident, is still largely ignored. Since amnesia is the single most reliable symptom in the diagnosis of concussion, that needs to change.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
When a concussed person does find his or her way to the Emergency Room, the first thing that typically gets asked is what do you remember of what happened. The second was did you get knocked out. Both questions are seriously flawed in methodology. Starting with the second, if you presume that someone who is knocked out will have amnesia of the event, how can you ask them what happened to them at a time they were amnestic? We would hope that most experienced ER doctors see the inherent conflict in relying on the answer to such a question from the concussed person.
The more subtle but more significant problem is assuming that because someone has memory of an event, that means they weren’t concussed in the event. This is simply not true and it ignores the well recognized principle that concussed individuals can have islands of memory during otherwise periods of significant amnesia. Amnesia is not a total loss of memory, it is a loss of any period of memory. The islands of memory a concussed person will most likely remember are those things where adrenaline played the greatest role, such as the accident itself. If you have ever been a car wreck that you do remember, especially a serious car wreck, it is something you will remember for the rest of your life. I have been in two serious wrecks and I remember exquisite details of what I was doing just before and in the hours after the wreck. One of those wrecks was in 1975 and the other in 1993. I even remember the date and hour of the 1993 wreck.
My brain remembers them best because they were most important to me. It also remembers them best because they were the most scary. What I don’t remember about the more serious of those accidents, is the ambulance ride. And I should because I was in pain and strapped to a board. In 1975 if I could walk and talk in an Emergency Room and didn’t have any broken bones, that was all they were concerned with. I was discharged home. No one ever asked me a single question about amnesia.
Our concern about concussions has improved dramatically since 1975 but the inquiry with respect to the most likely period of post traumatic amnesia, the period from 5 minutes post accident to 48 hours post accident, is still largely ignored. Since amnesia is the single most reliable symptom in the diagnosis of concussion, that needs to change.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Evolution in the Understanding of Concussion: Alternatively – Loss of Consciousness, Amnesia, Change in Mental State, Focal Neurological Deficits
This week I have been doing a series of blogs on “The Evolution of Our Understanding of Concussion, otherwise Called Mild Traumatic Brain Injury.” Today I continue to follow the topics of my YouTube videos on this theme. Today’s video is found here: http://www.youtube.com/profile?user=braininjuryattorney#p/u/14/uQuizURnxoQ
The subject of today’s video is call the four alternative acute events which dictate a concussion diagnosis. As discussed previously, the methodology of diagnosing a concussion changed markedly with the promulgation of American Congress of Rehabilitation Medicine’s (“ACRM”) definition of Mild Traumatic Brain Injury in 1992. See http://tbilaw.com/RehabDefinitionPage.php
The most significant aspect of the ACRM definition was establishing that a person did not have to be unconscious to have suffered a brain injury or concussion. (The terms mild traumatic brain injury (“MTBI”) and concussion are synonymous.) Under this definition a diagnosis of mild traumatic brain injury could be found if one of these four acute events of injury occurred:
1. any period of loss of consciousness;
2. any loss of memory for events immediately before or after the accident;
3. any alteration in mental state at the time of the accident (e.g, feeling dazed, disoriented or confused); and
4. focal neurological deficit(s) that may or may not be transient.
This changed the playing field for concussion diagnosis. It was a radical change, one that might have created continuing controversy, but as it was quickly followed by the American Academy of Neurology’s sport and concussion guidelines, with similar abandonment of the loss of consciousness standard, it has now become the gold standard for concussion diagnosis.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
The subject of today’s video is call the four alternative acute events which dictate a concussion diagnosis. As discussed previously, the methodology of diagnosing a concussion changed markedly with the promulgation of American Congress of Rehabilitation Medicine’s (“ACRM”) definition of Mild Traumatic Brain Injury in 1992. See http://tbilaw.com/RehabDefinitionPage.php
The most significant aspect of the ACRM definition was establishing that a person did not have to be unconscious to have suffered a brain injury or concussion. (The terms mild traumatic brain injury (“MTBI”) and concussion are synonymous.) Under this definition a diagnosis of mild traumatic brain injury could be found if one of these four acute events of injury occurred:
1. any period of loss of consciousness;
2. any loss of memory for events immediately before or after the accident;
3. any alteration in mental state at the time of the accident (e.g, feeling dazed, disoriented or confused); and
4. focal neurological deficit(s) that may or may not be transient.
This changed the playing field for concussion diagnosis. It was a radical change, one that might have created continuing controversy, but as it was quickly followed by the American Academy of Neurology’s sport and concussion guidelines, with similar abandonment of the loss of consciousness standard, it has now become the gold standard for concussion diagnosis.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
The Evolution of Our Understanding of Concussion: The Role of the Concussion and Sport Guidelines
Yesterday’s blog began a series of discussions about “The Evolution of Our Understanding of Concussion, otherwise Called Mild Traumatic Brain Injury.” Today I continue to follow the topics of my YouTube videos on this theme. Today’s video is found here: http://www.youtube.com/profile?user=braininjuryattorney#p/u/10/_kgiKz6WGSw
Today’s subset of this theme deals with the role that the various concussion and sport guidelines played in changing how the medical community and the public looked at concussion. The first set of those guidelines came out of an article written by James Kelly, M.D. in JAMA, the Journal of the American Medical Association: J.P. Kelly et al., Concussion in Sports, Guidelines for the Prevention of Catastrophic Outcome, 266 JAMA 2867, 2868 (1991). Kelly’s article was also really the first to warn of the danger of the “second impact syndrome”. It is concern about the second impact syndrome, where the second concussion leads to a catastrophic increase in intracranial pressure, that fueled much of the early development of these guidelines.
Among the important contributions of that first work on concussion and sport were the no-return to play if a concussion was symptomatic for more than 15 minutes and the requirement that a concussion that was symptomatic for more than 15 minutes would require serial evaluations until the symptoms had cleared. That first guideline, promulgated by the American Academy of Neurology required that symptoms would have to clear for a full seven days before the athlete was allowed to return to play.
The reason this serial evaluation requirement is so significant is that it is not the symptoms that an individual has on the day of that determines the severity of concussion, but how symptomatic they are at 24 hours, 48 hours, 72 hours.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Today’s subset of this theme deals with the role that the various concussion and sport guidelines played in changing how the medical community and the public looked at concussion. The first set of those guidelines came out of an article written by James Kelly, M.D. in JAMA, the Journal of the American Medical Association: J.P. Kelly et al., Concussion in Sports, Guidelines for the Prevention of Catastrophic Outcome, 266 JAMA 2867, 2868 (1991). Kelly’s article was also really the first to warn of the danger of the “second impact syndrome”. It is concern about the second impact syndrome, where the second concussion leads to a catastrophic increase in intracranial pressure, that fueled much of the early development of these guidelines.
Among the important contributions of that first work on concussion and sport were the no-return to play if a concussion was symptomatic for more than 15 minutes and the requirement that a concussion that was symptomatic for more than 15 minutes would require serial evaluations until the symptoms had cleared. That first guideline, promulgated by the American Academy of Neurology required that symptoms would have to clear for a full seven days before the athlete was allowed to return to play.
The reason this serial evaluation requirement is so significant is that it is not the symptoms that an individual has on the day of that determines the severity of concussion, but how symptomatic they are at 24 hours, 48 hours, 72 hours.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
The Evolution of Our Understanding of Concussion, otherwise Called Mild Traumatic Brain Injury
I have been blogging over the holidays about concussions because once again they have been in the news. As discussed on this blog, Texas Tech coach Mike Leach was fired because of his forced isolation of wide receiver Adam James after he was diagnosed with a concussion. See also my comment on a related issue on one of my Brain Injury Lawyer Blog: http://www.waiting.com/blog/
With these stories bringing concussion back in the headlines, it seems appropriate to spend the next several blogs discussing the evolution of how our medical community has viewed concussion. Prior to about 1990, there was almost universal ignorance in the medical community about concussion. Most textbooks and learned treatises which neurologists, emergency room doctors and medical students relied on, simply had it wrong. Among the most significant mistakes was the belief that an individual had to be unconscious to have suffered a brain injury. That significantly began to change with the publication of a definition of mild traumatic brain injury in 1992 by the American Congress of Rehabilitation Medicine. (Definition of Mild Traumatic Brain Injury, Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. J Head Trauma Rehabil 1993:8(3):86-87)
That definition is found at http://tbilaw.com/RehabDefinitionPage.php
To understand where we need to go with continuing improvement in the diagnosis of brain injury, I think it is important that we understand where we have come from. Thus, I created a series of lectures on this topic, found on my YouTube page http://www.youtube.com/profile?user=braininjuryattorney#p/u. The first of those lectures can be found at:
http://www.youtube.com/profile?user=braininjuryattorney#p/u/13/x2EKaVHpVd0
In this series of blogs, I will discuss the topics of each of those videos.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
With these stories bringing concussion back in the headlines, it seems appropriate to spend the next several blogs discussing the evolution of how our medical community has viewed concussion. Prior to about 1990, there was almost universal ignorance in the medical community about concussion. Most textbooks and learned treatises which neurologists, emergency room doctors and medical students relied on, simply had it wrong. Among the most significant mistakes was the belief that an individual had to be unconscious to have suffered a brain injury. That significantly began to change with the publication of a definition of mild traumatic brain injury in 1992 by the American Congress of Rehabilitation Medicine. (Definition of Mild Traumatic Brain Injury, Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. J Head Trauma Rehabil 1993:8(3):86-87)
That definition is found at http://tbilaw.com/RehabDefinitionPage.php
To understand where we need to go with continuing improvement in the diagnosis of brain injury, I think it is important that we understand where we have come from. Thus, I created a series of lectures on this topic, found on my YouTube page http://www.youtube.com/profile?user=braininjuryattorney#p/u. The first of those lectures can be found at:
http://www.youtube.com/profile?user=braininjuryattorney#p/u/13/x2EKaVHpVd0
In this series of blogs, I will discuss the topics of each of those videos.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
http://subtlebraininjury.com
http://car-accident-rain.com
http://tbilaw.com
http://waiting.com
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney