VitalityHouse Health Articles

The Assessment of Amnesia Following Mild TBI

I recently found a website which I think will be very helpful to the readers of my blog. The site is an online presentation established by the Department of Psychology at Macquarie University in Australia which is designed to assist people who have suffered from a mild Traumatic Brain Injury through the administration of the Abbreviated-Westmead Post-Traumatic Amnesia Scale. The scale was developed in order to assist in the early identification of cognitive impairment following mild traumatic brain injury (mTBI).

The site states that early identification of patients with cognitive problems after a traumatic brain injury is imperative in the management of the injury. The most common symptom associated with mild traumatic brain injury is memory loss or amnesia.

You can read more on Macquaire University's presentation here.

Advances In Neuroimaging

At present, the gold standard for objectively proving that an individual sustained a mild traumatic brain injury is through neuropsychological testing.  As we know, standard diagnostic testing such as CT scans, MRIs and EEGs, due to their lack of sensitivity, rarely if ever detect brain abnormalities in patients with mild traumatic brain injury.

However, advances in neuroimaging may soon eliminate the need for neuropsychological testing to diagnose brain damage.  Advances in FMRI and diffusion tensor imaging (DTI) will soon become the gold standard.

I recently read an article published in Brain entitled “Structural Dissociation of Attentional Control and Memory in Adults with and without Mild Traumatic Brain Injury”.  The article by S. N. Niogi et al, noted that executive function such as attention and memory are among the most significant human brain processes impacting overall cognitive function.  The study contained 43 patients prospectively recruited with mild TBI, (28 males, 15 females) who were imaged at least one month post injury and 23 healthy volunteers, (17 males, 6 females).  There was no significant difference in mean age, gender, handedness, or level of education between the mild TBI group and the control group.  Those with a prior history of TBI, a history of neurological or psychiatric illness were excluded.  All subjects underwent diffusion tensor imaging along with conventional MRI.  The study provided clear evidence that DTI may serve as a microstructural imaging biomarker for cognitive dysfunctions and variations within normal cognitive functions.  Hopefully, further research will confirm this finding.  DTI has already been accepted in our courts as a reliable neuroimaging mechanism to detect brain injury from trauma.  Further studies such as this will only strengthen its admissibility.

Doubt Is Their Product: How Industry’s Assault on Science Threatens Your Health

In previous blog entries, I have discussed the recent exposé regarding industry’s payment of money to scientists to publish "research" that is supportive in industry’s defense of defective products.  I just finished an outstanding book entitled "Doubt Is Their Product: How Industry’s Assault on Science Threatens Your Health" by David Michaels.  Dr. Michaels is an epidemiologist and Director of the project on scientific knowledge and public policy at the George Washington University School of Public Health and Health Services.  He previously served as Assistant Secretary of Energy for Environment, Safety and Health under the Clinton administration.

Dr. Michaels illuminating book documents "the way in which product defense consultants have shaped and skewed the scientific literature, manufactured and magnified scientific uncertainty, and influenced policy decisions to the advantage of polluters and the manufacturers of dangerous products."

This book follows product after product, toxin after toxin and how the manufactures of these chemicals, drugs and products have deceived, hidden and misrepresented the known dangers of their products.  For all concerned about the public health and how industry has subverted the legal and regulatory systems, this book is a must.  You can purchase the book online here.

Army Announces New Suicide Prevention Tool for Soldiers

Last week I reported on a fascinating lecture I attended at the NABIS medical legal conference in New Orleans.  Readers will recall that at that presentation, Dr. Mary Hibbard of Mount Sinai Medical Center discussed the increased suicide following traumatic brain injury of our soldiers returning from Iraq and Afghanistan. 

Yesterday, the Washington Post reported that the army has unveiled a unique prevention tool-an interactive video to be mandatory viewing army-wide - in order to address the alarming record rate of suicide in its ranks.  The video features soldiers role playing that of an anguished infantry training man and make virtual choices that lead the character to get help or in the worst case shoot himself in the head.  The video is entitled “Beyond the Front” and “leads the viewer through a detailed drama in which [the infantryman] is hit by relationship troubles, financial problems and scraps with the law - what army research shows are major events that precipitate suicide.” 

While this is certainly an excellent first step to address the problem, it is more important that the military address one of the major underlying problems, that of making sure that our soldiers returning from war obtain the appropriate screen for traumatic brain injury and/or post-traumatic stress disorder (PTSD) and most important obtain the needed medical care to address these injuries.

Six Myths Regularly Encountered in Forensic Practices

The June issue of Clinical Neuropsychologist contains an article by Manfred F. Greiffenstein, a psychologist from Royal Oak, Michigan. 
 
In his article, Dr. Greiffenstein comments on six myths that he regularly encounters in his defense  forensic practice.  I earlier discussed my agreement with him where he attacks the idea that only the Halstead-Reitan neuropsychological test battery is legally admissible under Daubert.
 
However, I take exception with him when he implies that there is no permanency resulting from mild traumatic brain injury.
 
In this section of his paper, Dr. Greiffenstein quotes from Dr. Iverson’s 2005 paper stating that the commonly accepted figure for permanent disability following mild TBI is 15% is incorrect. 
 
While Dr. Greiffenstein accurately quotes from Dr. Iverson’s paper, he fails to acknowledge that even Iverson accepts that there is a percentage of mild TBI patients who do not go on to a full and uneventful recovery but rather, develop  long-term chronic and permanent residuals from mild TBI.
 
Dr. Greiffenstein is a co-author with Dr. Paul Lees-Haley of a study dealing with the neuropsychological effects following exposure to manganese.  You will recall that the Center for Public Integrity and Mother Jones recently published an expose with regard to the amount of money paid by the welding industry to Paul Lees-Haley.  Dr. Greiffenstein also acknowledges that his practice includes “defense selected evaluations in personal injury matters.”  He also thanks Drs. Larrabee and Binder for their preliminary reviews and helpful criticisms.  A review of deposition testimony given by Larrabee and Binder reflect that they, like Dr. Greiffenstein, primarily performed defense forensic evaluations.
 
Those who represent people who have sustained traumatic brain injury need to investigate the biases of the authors and journals and editors of journals before being so quickly to accept the authenticity of any cited literature.