Earlier this year, we posted an article on coping with the emotional difficulties that typically follow traumatic brain injuries, which occur when one sustains a violent blow to the head or body that causes damage to the brain. Emotional issues, such as depression, anxiety, and irritability can occur not only because the part of the brain controlling emotions and behavior may have been affected, but also because a sufferer of a traumatic brain injury may simply be frustrated with the changes she has experienced post-injury in her cognitive skills. Traumatic brain injury patients typically experience cognitive issues with attention and concentration, memory, language and speech, and problem-solving. While some of these issues will improve with time, patients do not need to feel reduced to waiting on recovery; they may help facilitate it by taking some simple steps to improve their cognitive functions.
After discussing in more detail the potential causes and symptoms of reflex sympathetic dystrophy (RSD), here, we turn to the treatment and diagnosis of the condition.
At present, no single diagnostic test for RSD exists. Physicians will often refer to contextual clues such as the patient's medical history and common signs and symptoms. According to the Mayo Clinic, however, physicians consider certain procedures to be particularly helpful in seeking clues to diagnose RSD.
Throughout the year, we have posted several entries about reflex sympathetic dystrophy (RSD) through the narrative of Kathy, a woman featured on "The Doctors" TV show who lives with a severe form of RSD. Today, we want to explain RSD more in detail--its causes, its symptoms, and its treatments.
Earlier this year, a blog entry on activities, exercises and toys for children with cerebral palsy mentioned the concept of "play therapy," a concept in which children will play with toys and activities and, in the process, develop their mental and physical abilities. Play therapy is considered crucial to the growth of children with cerebral palsy. It is easy to see why; children are prone to want to play, and in the process, they can learn more about themselves and the world around them.
Earlier this year, an article was posted with general introductory information about cerebral palsy, a group of disorders resulting from injury to the developing brain of a fetus that affects motor skills and posture. This article follows up by providing information on how to detect cerebral palsy in a child based on the child's age.
According to the American Pregnancy Association, cerebral palsy is typically not diagnosed in children until they have reached about two or three years old. However, indicators can occur as early as when the child is younger than six months old. While no single diagnostic test for cerebral palsy exists, vigilance regarding the growing child's milestones and whether the child reaches them at the appropriate times, along with the help of the child's doctor, can aid in the diagnosis of cerebral palsy.
Traumatic brain injuries (TBI) can occur when one sustains a violent blow to the head or body that will cause damage to the brain, or if an object pierces the skull to enter the brain tissue. Millions of people in the United States sustain brain injuries every year, and approximately half of these injuries, according to the National Institutes of Health, occur from motor vehicle accidents. While TBI symptoms can range from mild to severe, it is important that someone who has suffered from a head injury seeks medical aid in order to diagnose the severity of the injury.
Methods of diagnosis and treatment can vary based on the severity of the injury. Patients suffering from mild to moderate head injuries might receive x-rays of the skull and neck to check for fractures or any spinal instability. Moderate to severe cases, however, require a computed tomography (CT) scan and possibly magnetic resonance imaging (MRI). CT scans are the most common method of diagnosing, as they easily reveal conditions caused by blood and swelling around the brain. MRI tends to follow CT scans if necessary and possible in order to further determine the extent of the injury and the kind of treatment required. In recent years, CT scans and MRI have undergone technological advancements that have increased physicians' capabilities in diagnosing and treating head injuries.
Life after sustaining an injury can be tough in any situation. However, it may seem especially daunting when the injury in question is a traumatic brain injury, an injury that occurs when one sustains a violent blow to the head or body that causes damage to the brain. The brain is a resilient organ, and it is certainly possible to recover well from a traumatic brain injury. However, due to the brain's role as the central command for the body, adjustment after the injury can be more difficult than, say, adjustment after recovering from a broken leg. This can be exacerbated upon revisiting high-pressure or high-stress situations, such as returning to work or even just being around friends and family.
When a person sustains a traumatic brain injury, she not only suffers physical damage and may exhibit difficulty with daily physical activities, such as walking or feeding herself, but she also suffers cognitive disabilities as well. A sufferer of traumatic brain injury commonly experiences issues with attention, concentration, speech, memory and problem-solving after injury.
In raising a child with cerebral palsy, a condition in which the areas of the brain that control movement are damaged either during pregnancy or birth, a parent may struggle finding activities that suit the needs of her child. Because cerebral palsy can impair a child's muscles, movement, balance, and posture, it is essential that physical activities, and perhaps even toys, of children with cerebral palsy must be tailored to their needs.
Cerebral palsy is a neurological disorder that affects one's motor skills and limits movement and posture. The condition occurs typically due to injury to an infant's brain during pregnancy or childbirth, and although the brain abnormality does not progress over time, cerebral palsy currently has no cure. According to the Centers for Disease Control (CDC), cerebral palsy is the most common motor disability among children. Living with cerebral palsy or caring for a child with cerebral palsy can be challenging--but the more knowledge one has about the condition, the better equipped she is to manage it. This article provides a brief, basic introduction to cerebral palsy in its various forms.
Cerebral palsy does not present itself in a singular fashion--in other words, its symptoms will vary depending on the person, both in severity and in manifestation. One person afflicted with cerebral palsy, for instance, may have difficulty walking on his or her own, while another may have some difficulty with posture. According to the CDC, intellectual disabilities, seizures, problems with hearing, vision, or speech, and joint problems can also occur.
After head injuries, people may experience a wide variety of symptoms. One of the more peculiar ones is phantosmia, more commonly known as an "olfactory hallucination." When people experience olfactory hallucinations, they will smell scents that actually do not exist around them. According to the Mayo Clinic, these scents typically cannot be masked by food, and can occur in one or both nostrils. Aside from head injuries, olfactory hallucinations can occur from causes such as a stroke, upper respiratory infections, or epilepsy. Additionally, these scents are typically unpleasant, commonly resembling smoke, rotten eggs, gas, or a chemical-like odor. So what causes these hallucinations?
III. Keep the Medicine Simple.
I believe the most important thing we did to achieve success for the family was to keep the medicine simple for the jury. "Simple" in the context of a complicated medical injury is difficult to do. I do not mean to suggest that you or your experts will never need to discuss complex medical terms or concepts. What I mean is this: your or your expert's brilliant comprehension of the medical concepts in a birth injury case won't do you any good unless you can teach these concepts to the jury. As lawyers, we don't spend enough time reversing roles with our jurors and I have seen many fine lawyers become intoxicated with their own lofty and intellectual grasp of complex medicine.
So what do you do? The medicine in a birth injury case is complex. First, both you and your experts will have to have a deep understanding of the medicine. In a birth injury case this includes the intricacies of the delivery process, how to interpret sophisticated medical test results, and the complexities of how an injury (your view) or an infection (the defense's view) resulted in a damaged newborn. Next, you must teach the medicine to your audience. To do that you must do what all great teachers do -- you must make the medicine accessible to your audience (the jury).
II. The Role of Experts in the Birth Injury Case.
Experts play a critical part in any birth injury case. You can expect both sides to employ a host of experts covering issues that span the child's entire life - literally starting with what occurred in the delivery room all the way through the child's current mental and physical condition.
In the context of a birth injury trial, this means the first experts on the stand in the plaintiff's case are probably doctors, nurses or midwives discussing the Standard of Care for the delivery, followed by pediatricians or neonatologists (highly-specialized doctors within pediatrics dealing with complex newborn issues), then pathologists and pediatric infectious disease specialists (doctors discussing testing of the blood and tissue) often followed by pediatric neuroradiologists (imaging experts), a neuropsychologist, pediatrician, or neurologist to discuss the child's mental and physical deficits and, finally, a life care planner to discuss the child's future medical needs
In our most recent trial, we employed virtually all of these experts.
Check back next week for Part III - "Keep the Medicine Simple" - by Nelson Tyrone, III
Our firm recently had success in a birth injury case in Gwinnett County, Georgia. In that case we represented a family against the labor and delivery team that delivered their daughter and the hospital where they worked. Following her delivery, their daughter was diagnosed with Cerebral Palsy. The term "Cerebral Palsy" refers to several different kinds of permanent brain injuries that occur before, during, or shortly after birth. Victims of Cerebral Palsy can suffer a variety of symptoms including: limited movement, speech difficulties, learning disabilities, visual problems, hearing problems, and epilepsy, seizures or spasms. She suffered from many of these. By the time of trial, she was a ten year-old who suffered grand-mal seizures, had limited use of her right arm and leg, and whose intellectual development had stopped at the level of a three year-old.
In her case, the jury was faced with two very different stories of how her injuries occurred. Our story was that she had suffered a hypoxic injury (lack of oxygen during delivery), and the defense claimed she had developed an infection. Although there was medicine and experts supporting both sides, the jury found our story the most credible. They returned a verdict for the family of $12.9 million.
According to Dr. Travis Stark, E.R. physician, avoid sugar and processed foods. RSD is an inflammatory condition and so when you are eating highly processed, high sugar foods, you are putting yourself at risk for a whole body inflammatory reaction.
You also have to be very careful with things like caffeine, which can stimulate your sympathetic nervous system. So stick to decaf.
Dr. Joshua Prager, an RSD specialist, says "In some cases we have seen non-healing wounds, where the wound leaks and will not heal. This is something where hyperbaric oxygen can be extremely helpful in treating the wound, as well as helping with the RSD.
Also Dr. Prager says, "unless you have a whole team working together, and that includes physical therapy, psychology, relaxation therapy, an interventionalist to help the pain, etc... if all these people are not working together at the same time, you are pretty much doomed to failure. "
View this video at: http://www.thedoctorstv.com/videolib/init/9968
For Kathy, RSD is much more than a painful diagnosis - it's her life. She says her life has completely changed since she was diagnosed with RSD. She wakes up at 4:30 a.m. "At that time the pain level is about a 4 - not too bad," she says.
She works out every morning, even though she has been on crutches for about 8 years now.
"It used to take me an hour and 15 minutes to get ready," she says "where now it takes 3 hours". Four days out of the week I'm either doing pain management or physical therapy. I go to the surgery center and get sympathetic nerve blocks in the lower part of my back. This is where they actually go into the nerves and shut the nerves down.
"The pain in my foot will wake me up out of a deep sleep," she says.
Her husband Ken is very supportive and has learned over the years how to read the signs of her pain, whether through breathing or facial expressions. "It's so important to have someone that understands and supports you," Kathy says.