David Dwork

This was a talk that Kim Gorgens did for a TED conference. If you or someone you know has been touched by a concussion and you would like to discuss the details of the situation with Boston attorney, David Dwork, please contact him at (617) 723-9800 or via email, dpd@barronstad.com.

The potential for a full recovery following a traumatic brain injury is very dependent on the immediate detection of early signs and symptoms after an accident. In some cases, traumatic brain injuries are immediately apparent following a jolt or blow to the head. However the CDC reports that “75% of TBIs that occur each year are concussions or other forms of MTBI (Mild Traumatic Brain Injury).”

The long-term affects of MTBI, according to the CDC, “can have serious and long-term impact on a person’s cognitive, physical and psychological function.”

Signs and symptoms of a concussion can not always be so obvious. Many can often be confused with being stressed due to hectic schedules and job situations resulting in one feeling fatigued. However, one must seek medical attention if these symptoms of a mild traumatic brain injury persist:

• Difficulty thinking clearly or concentrating
• Difficulty remembering new information
• Persistent headache and sensitivity to light
• Nausea, vomiting and dizziness
• Irritability, sadness, nervousness or anxiety
• Sleeping more or less than usual and difficulty falling asleep

The CDC also outlines what danger signs should be noticed and treated immediately. Following an accident, one should seek medical attention if they have a persistent headache, weakness and decreased coordination, repeated nausea and/or slurred speech.

Following a mild traumatic brain injury, recovery times can vary amongst adults. Recovery times are dependent on the severity of the concussion, age and health. Due to these varying circumstances, proper care for a concussion and its symptoms after an injury are also critical for recovery. The CDC lists that those afflicted should, among other things:

• Get plenty of rest at night and throughout the day
• Refrain from strenuous physical and mental activities and return to these gradually once clear by your doctor
• Operate machinery or a vehicle only when cleared by a doctor
• Avoid alcoholic beverages and other drugs not deemed acceptable by your doctor
• Avoid multi-tasking

Long-term health problems from a mild traumatic brain injury can persist if care is not taken immediately following an accident. These problems are increased with an additional and subsequent traumatic brain injury, regardless of the severity of the original or following instances.

If you are seeking legal representation or advice following a traumatic brain injury in the Boston, MA region, David Dwork can help. David Dwork is the head of Barron & Stadfeld’s Traumatic Brain Injury Group and has been representing TBI survivors for over thirty years. Dwork is the premier Boston personal and head injury lawyer. He can be contacted at (617) 531-6580 or by email at drp@barronstad.com.

Lawmakers in Massachusetts, Rhode Island and Connecticut all passed new laws in 2010 designed to ensure student athletes who suffer suspected concussions get the proper treatment and do not return to action too quickly. The law requires education for coaches, parents, volunteers and young athletes regarding the signs and symptoms of concussion, guidelines for managing a concussion, and information on the risks and consequences of not taking action.

Laws addressing high school athletics and concussion training have already been passed in New Mexico, Oklahoma, Oregon, Texas, Virginia and Washington, while national legislation is making its way through Congress.

From high school playing fields to National Football League stadiums, increased awareness about the serious long-term impacts of sports concussions is changing attitudes about an injury once casually dismissed.

The Massachusetts Sport Concussion Law requires any athlete with a possible concussion be immediately removed from a practice or game. They cannot resume playing without written permission from a doctor.

Massachusetts law has ‘return-to-play’ guidelines and requires concussion awareness training for all coaches, trainers, athletic directors, parent volunteers, school nurses and even marching band directors. Parents or guardians of the estimated 165,000 public school students who play extracurricular sports must also be educated about concussions.

A 2009 survey by the Massachusetts Department of Public Health found that more than 18 percent of student athletes in Massachusetts reported receiving at least one blow to the head in the previous 12 months and experiencing symptoms such as loss of consciousness, memory problems, blurry vision, headaches or nausea.

The state has yet to draft specific guidelines for concussion training, so in the interim, the health department is referring schools to free online programs offered by the Centers for Disease Control and Prevention and The National Federation of State High School Associations offers this PDF, A Parent’s Guide to Concussion in Sports.

David Dwork is a Boston, MA based attorney focused on representing survivors of traumatic brain injuries. If you have questions regarding brain injury and your legal rights, please contact David Dwork at (617) 531-6580 or dpd@barronstad.com. In the past David Dwork has been involved in verdicts and settlements related to automobile accidents, premises liability, and severe, moderate and mild traumatic brain injury cases.

A common question after a TBI (Traumatic Brain Injury) is “what is the recovery time”?

Unfortunately, this is nearly impossible to answer for several reasons.  First the brain itself is extremely complicated.  It controls many different parts of the way we breathe, think, walk and talk.  Some patients may walk more quickly than they are able to speak.

The brain quite possibly may:

• Completely heal
• Parts of the brain may re-wire itself, so different parts of the brain take on new functions
• Relearn how to perform a function (compensatory strategy)

TBI does not have a specific guideline for recovery time.  People continue to change and develop for years after their traumatic brain injury.   The rate of progress does reduce over time, with the most progress typically seen in the first few months to years, but it is common for TBI patients to continue to see changes five to ten years after the injury.

David Dwork, Boston personal injury attorney and head of Barron & Stadfeld’s Traumatic Brain Injury Group has been successfully advocating in MA for TBI survivors for over 30 years.  David Dwork has been involved in hundreds of personal injury verdicts and settlements related to traumatic brain injures.

If you have questions regarding personal injuries, traumatic brain injury and your legal rights, please contact David Dwork at (617) 531-6580 or dpd@barronstad.com.

Boston Globe writer Bella English suffered a Traumatic Brain Injury (TBI) in a bicycle accident in the fall of 2010.  As is the case with so many TBI accidents her journey to recovery is full of struggles and successes.  This article, eloquently written by Bella offers you her perspective on her recovery, both physically and mentally.

Accidents such as Bellas can cause a serious brain injury; however there are many causes where the accident itself is not as traumatic, yet the victim still suffers from deficits in their everyday functioning.

Common indicators and symptoms of traumatic brain injury may differ by patient; generally, one finds a change or loss of consciousness, dizziness, headaches, memory impairments, visual disturbances, speech disorders, disorientation and balance difficulties.

David Dwork is a Boston, MA based attorney focused on representing survivors of traumatic brain injuries. If you have questions regarding brain injury and your legal rights, please contact David Dwork at (617) 531-6580 or dpd@barronstad.com. In the past David Dwork has been involved in verdicts and settlements related to automobile accidents, premises liability, and “mild” traumatic brain injury cases.

When a personal injury comes in the form of a Traumatic Brain Injury (TBI) the effects can be physical, cognitive, emotional or behavioral.   While most of us are familiar with the terms physical, emotional and behavioral, cognitive may need clarification.

Cognition: the scientific term for the “process of thought”.

• In psychology it usually refers to an information processing view of an individual’s psychological functions;
• or, the development of concepts

Cognitive skills that we take for granted include: paying attention, awareness of our surroundings, organizing, planning, follow through on decisions, problem solving, judgment, reasoning and awareness of problems.  Memory skills include the ability to remember things from both before and after a traumatic brain injury.

While each traumatic brain injury is unique unto the individual there are levels of cognitive functioning that doctors and rehabilitation teams use to assess the patient.  The Rancho Level of Cognitive Functioning Scale (LCFS) is one of the earliest developed scales used to access cognitive functioning in TBI patients.

LCFS is used in the planning of treatment, tracking of recovery and classifying of outcome levels in post-comma patients.  The scale is comprised of eight levels:

1.       No response

2.       Generalized

3.       Localized

4.       Confused-agitated

5.       Confused, inappropriate, non-agitated

6.       Confused-appropriate

7.       Automatic-appropriate

8.       Purposeful-appropriate

There is a range of abilities within each level and some TBI patients will pass through the levels quickly, while others may plateau at a certain level.  Each TBI case is different as is each individual.

This pdf, written by Rancho Los Amigos National Rehabilitation Center in CA is a resource for the families and friends of someone with a traumatic brain injury.  In it you will find details describing each level of cognitive functioning in the LCFS scale and can be done at that level to provide the support that a TBI patient requires.

David Dwork, Boston personal injury attorney and head of Barron & Stadfeld’s Traumatic Brain Injury Group has been successfully advocating in MA for TBI survivors for over 30 years.  David Dwork has been involved in hundreds of personal injury verdicts and settlements related to traumatic brain injures.

If you have questions regarding personal injuries, traumatic brain injury and your legal rights, please contact David Dwork at (617) 531-6580 or dpd@barronstad.com.

Drunk Driving Accidents Are the Leading Cause of Traumatic Brain Injuries

The leading cause of traumatic brain injuries, (TBI) is drunk driving.  Nationally, 61% of traumatic brain injuries are a result of motor vehicle accidents.  In Massachusetts 40% of driving fatalities were related to alcohol consumption.

Direct trauma to the brain can occur when the skull strikes an object, for example a steering wheel in a car.  Even without a skull penetration or fracture, in these types of accidents, the forces imparted to the brain can cause the brain to collide with the inside of the hard skull.  This can cause bruising of the brain (a contusion) and bleeding (hemorrhage). Traumatic brain injuries in automobile related accidents can cause damage to parts of the brain closest to the point of impact, quite often the tip of the frontal  lobe. In cases of blunt head trauma the brain can also be injured directly opposite the site of trauma — on the other side of the brain, an injury known as contrecoup. This injury typically occurs when a moving head strikes a stationary object like the windshield. At impact the brain opposite the site of impact is pulled away from the skull, injuring the brain there.

There are many common myths about traumatic brain injury.  One misconception is that psychological effects such as depression are not related to TBI, another is that brain injuries are similar based on the type of accident.  Warning signs of TBI include:  nausea, seizures, confusion or other cognitive problems, a change in personality, depression, irritability, and other emotional and behavioral problems.  The consequences of TBI can range from a mild concussion to permanent physical, cognitive, and behavioral/emotional impairments, seizure disorders, paralysis, coma and death.

Drunk driving is always a serious matter, as is traumatic brain injury.   Boston personal injury attorney and head of Barron & Stadfeld’s Traumatic Brain Injury Group, David Dwork, has been successfully advocating in Massachusetts for TBI survivors for over 30 years.  David Dwork has been involved in hundreds of personal injury verdicts and settlements in Massachusetts, related to traumatic brain injuries (TBI) resulting from automobile accidents with drunk drivers to “mild” traumatic brain injuries  sustained by  automobile accidents.

If you have questions regarding personal injuries, traumatic brain injury and your legal rights, please contact David Dwork at (617) 531-6580 or dpd@barronstad.com.

Most of us typically think of ourselves as having a “good” or “bad” memory, and as we age often we feel that our memory isn’t as good as it once had been. As you most likely already know, there are different types of memory: verbal and visual. Verbal information is stored in the left hemisphere and visual information is stored in the right hemisphere of the brain. There is also your immediate memory (information that is briefly saved), short-term memory (information you remember after 30 minutes) and long-term memory (information we recall after a day, week or years).

Any brain function can be disrupted by a traumatic brain injury (TBI), resulting in difficulty concentrating, sleep disturbance, depression, irritability, emotional outbursts, and slowed thinking. Memory loss is one of the most common cognitive side effects of traumatic brain injury (TBI), even mild TBI can result in memory loss.

In general, information flows in through the middle of our brain and branches out like a tree, first going through a filtration process. A traumatic brain injury (TBI) causes swelling, which puts pressure on the middle areas of the brain obstructing the flow of information, or access to our memories. A TBI patient’s memory typically returns as the swelling goes down over a period of weeks or even months. Temporary memory loss may also be an emotional response to the stressful events surrounding a TBI. Other times memory is more seriously affected and in all cases there are strategies that may help the patient and their memory:

• Work with a memory specialist – your memory is similar to the other muscles in your body, the more you use it, the stronger it becomes.
• Get organized – specific places for items and routines helps our memory.
• Break it down – learn small bits at a time instead of a whole string of information (think phone numbers, a chunk of three numbers, three numbers, four numbers).
• Use Association – organize similar information together
• Use a daily planner – write everything down in one spot while it is fresh in your mind.
• Make a “To Do” list

A traumatic brain injury is both psychically and emotionally shocking on the system, and memory loss can be very upsetting. With strategies, support, and frequently time the situation can be improved upon. Please consult the Frequently Asked Questions page as a resource to common questions associated with traumatic brain injury such as: how is a brain injury diagnosed and what are the common causes of traumatic brain injury?

David Dwork is a Boston, MA based attorney focused on representing survivors of traumatic brain injuries. If you have questions regarding brain injury and your legal rights, please contact David Dwork at (617) 531-6580 or dpd@barronstad.com. In the past David Dwork has been involved in verdicts and settlements related to automobile accidents, premises liability, and “mild” traumatic brain injury cases.

Sleep disturbance is a relatively common complication following Traumatic Brain Injury (TBI).  It has been reported that individuals with brain injury have significantly more insomnia (56%) and pain complaints (59%) than those who are non-brained injured.  One recent study reported 30% of individuals with brain injuries were found to suffer from insomnia. Oftentimes, factors such as pain, depression, anxiety, medications, and the nature of the brain injury play a role in the sleep disturbance.

For those with TBI, sleep disturbance can be particularly disruptive to neurobehavioral function – resulting in increased agitation, poor performance, decreased attention, memory confusion, somatic complaints, and decreased seizure threshold. For some TBI patients, sleep-inducing medications may be enough to manage the problem. Yet, in many cases, a combination of strategies must be implemented to improve their ability to sleep

The process of reducing sleep disturbances begins with making modifications to sleep hygiene and environmental factors. This is particularly important for those with brain injuries. These necessary changes include creating a restful sleeping environment, going to bed and waking up at a consistent time, maintaining a room temperature of between 65 and 72 degrees Fahrenheit, incorporating moderate exercise into one’s daily routine, limiting intake of both alcohol and caffeine, and playing white noise.

Along with improving sleep hygiene, cognitive behavioral therapy has also been proven to be beneficial in minimizing sleep disturbances following TBI. This form of psychotherapy is utilized to assist in changing behavior, perception, and feelings about sleep.  By helping individuals with TBI identify and correct thoughts and beliefs that contribute to sleep disorders, cognitive behavioral therapy can help establish sleep goals.

As well, many TBI patients suffering from insomnia spend too much time in bed unsuccessfully trying to get enough sleep. In these cases, a sleep restriction program can be beneficial. Using this technique, patients are allowed only a few hours of sleep during the night. Then, gradually the sleep time is increased until a normal sleep pattern is achieved.

Finally, relaxation therapy is frequently recommended to individuals with TBI who suffer from sleep disturbances. Methods of relaxation therapy, such as progressive muscle relaxation (PMR), imagery, self-hypnosis, and deep breathing techniques, are often used to augment other forms of treatment. In fact, there is growing research that theorizes that deep breathing may actually contribute to the healing process following a brain injury as it helps feed oxygen to the brain. Most experts recommend a daily routine of relaxation techniques in conjunction with other therapies to enhance the effectiveness of overall treatment of sleep disturbance.

For TBI patients, maintaining healthy sleep patterns is an essential component to recovery. This requires the proactive assistance of a team of healthcare professionals that often includes physicians, psychotherapists, psychiatrists, and hypnotherapists. Once a comprehensive treatment plan is developed and managed by this collaborative team, patients have their greatest chance to overcome their sleep disorder and ultimately heal from their injury.

David Dwork is a Boston, MA based attorney focused on representing survivors of traumatic brain injuries.  If you have questions regarding brain injury and your legal rights, please contact David Dwork at (617) 531-6580 or dpd@barronstad.com.

This story was featured on NPR (National Public Radio) and on the NRP Radio website.

The U.S. Army honors soldiers wounded or killed in combat with the Purple Heart, a powerful symbol designed to recognize their sacrifice and service.

Yet Army commanders have routinely denied Purple Hearts to soldiers who have sustained concussions in Iraq, despite regulations that make such wounds eligible for the medal, an investigation by NPR and ProPublica has found.

Soldiers have had to battle for months and sometimes years to prove that these injuries, also called mild traumatic brain injuries, merit the honor, our reporting showed. Commanders turned down some soldiers despite well-documented blast wounds that wrenched their minds, altered their lives and wracked their families.

The Army twice denied a Purple Heart for Sgt. Nathan Scheller, though the aftereffects from two roadside explosions in Iraq have left him with lasting cognitive problems, according to the Army’s own records.

The 29-year-old former tank commander navigated an M1A1 Abrams through Baghdad’s urban battlefield of bomb-strewn highways and sniper-filled alleys. Now he gets lost driving familiar routes around his home. An honor student in high school, he can no longer concentrate enough to read the adventure novels he once loved.

“I don’t see how somebody else can tell me that I don’t deserve one,” Scheller said of the Purple Heart. “I may not have wounds on the outside. But I have wounds on the inside.”

The denials of Purple Hearts reflect a broader skepticism within the military over the severity of mild traumatic brain injury, often described as one of the signature wounds of the conflicts, according to interviews, documents and internal emails obtained by NPR and ProPublica.

High-level medical officials in the Army debated whether head traumas that are difficult to detect — often leaving no visible signs of damage — warrant the award, the emails show. Most people who sustain such blows, also known as concussions, recover on their own, but studies show 5 percent to 15 percent may have long-term impairments.

In 2008, Brig. Gen. Joseph Caravalho, then the top medical commander in Iraq, issued a policy blocking medical providers from even discussing the Purple Heart with soldiers who suffered mild traumatic brain injuries. Doctors were not barred from discussing the award with soldiers who have other injuries.

“In many cases,” Caravalho wrote that concussions with “minimum medical intervention will not warrant this award.”

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