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0:00:01 - Kiley Como
Hey everybody, welcome back to another episode of Mind Matters: Navigating Head Injuries and Concussions. This is part two of our deep dive into TBI. Again we're here with our friend and senior attorney in our head injury and concussion group, John Mobley. John, thanks again for being here. Let's dive back in to pick up our discussion where we left off, where we're talking about traumatic brain injuries. You went over some medications, some emergency procedures. Let's talk about kind of the long haul now. You've been in the emergency room, you've kind of gotten stabilized. Now you're back into living life. Let's go to rehab. Let's talk about that.

0:00:52 - John Mobley
Absolutely, Kiley. Thank you for that introduction. And just to update and remind the viewers, in part one, really our goal was to address what our TBI clients and victims do once they receive that diagnosis. So this is post-diagnosis life. So we went over some of the medications, some of the emergency care.

Really the longest portion of this treatment is going to be the rehabilitation and some of those various therapies. You know these therapies can help people with TBIs recover you know functions, relearn essential skills, find new ways to do things, to take you know their new health status into a full account. And rehabilitation can include all kinds of different kinds of therapy for you know emotional, cognitive difficulties, physical difficulties and for any sort of variety of just activities you and I would consider normal daily activities, right? That can be taking care of yourself, taking care of your home, keeping a clean home, driving, interacting with your spouse, your family members and others. All these things are changed in a dramatic way post-brain injury. So depending on the severity of that injury, you know those treatments that may be needed can vary in terms of how long the therapy lasts and how much of it you need. Really, the therapy for serious cases really begins in the hospital.
They're going to bring in someone immediately to begin the process, especially if it's a massive brain injury, severe, moderate, anything like that, you're likely going to need someone to help with walking, speech therapy, basic therapy, balance therapy right there at the hospital, just to even be functional enough to leave the hospital safely. Another thing that rehabilitation generally involves is, you know, a number of healthcare specialists are involved. Family, friends and a neurologist typically will manage and oversee this team and kind of be the quarterback of the case, we like to say. So they'll monitor if you need vestibular treatment.

You know, if you have a vestibular injury, you may not be able to maintain balance. You might be a fall risk. And you think, well, what's the big deal about that? Well, it's a huge deal. You know, especially if you're older, a fall can be the beginning of the end for some older people. You know, if you fall and break a hip, you think so, a fall risk. When, when we have clients that receive that label and then we ask these insurance companies for hundreds of thousands to, you know, sometimes millions of dollars in our settlement demands, it's because, you know, a fall risk, being dizzy for the rest of your life and and having a vestibular dysfunction.

It can involve huge, huge care in the future and financial stress and needing, you know, an in-home nurse, needing, you know, all these things that people don't think about that they're now gonna need when these injuries and the brain doesn't heal. These are all therapies that cost a lot of money. And insurance, you know, if you have, or are lucky to have, good enough insurance, it's great that it helps cover that. But, as anyone who has paid an insurance bill that has health insurance knows, there's usually stuff you have to pay for out of pocket. There's deductibles.

So you know, should our victims be responsible for this or should the, you know, defendant and the insurance company? So that's why we push so hard for big recoveries on some of these cases.

In terms of what rehabilitation therapy may include, just specifically, physical therapy, you know. So we sometimes have to build up the physical strength, the balance and the flexibility of these clients that have brain injuries so that they actually have the proper either range of motion or actual muscle stability to move. You know, if you have an issue with balance and constantly falling, you know, sometimes, and a lot of times, you have orthopedic injuries to boot. You know, problems with your knees or your neck or your back, and you're dizzy. It's just a fall risk waiting to happen. So if we can kind of knock out stuff one by one and strengthen the knees that were maybe injured in the accident, or the shoulder, then it maybe prevents you, when you're dizzy with a brain injury, from dropping things or tripping over your feet and injuring yourself more.

Occupational therapy, on the other hand, is a way for our brain injury clients to learn or relearn how to perform daily tasks such as getting dressed, cooking, bathing. So while physical therapy is strengthening, occupational therapy is, it teaches you how to interact with the world again and around you. And that can be, you know, if you don't have range of motion or having trouble, you know, brushing your teeth teeth, maybe it's getting a longer toothbrush. Sometimes it's, it's things as simple as that. It sounds silly, but when you can't raise your shoulder, your arm high enough due to a shoulder injury, sometimes that's the difference between being able to complete a task or not.

So occupational therapists do an incredible job for our clients that are severely injured with brain injuries. If you were to injure the part of your brain that controls speech, you are going to potentially slur words, have the inability to find words, and a lot of times I have clients in our representation of those who have, you know, mild to moderate to severe brain injuries that say I literally know the word, I know the word I'm trying to say and it can't come out. You know, in some of the saddest cases we have clients where you know it's like the kids, their kids are completing their sentences or get spouses are getting frustrated like just just spit it out, spit it out, and they can't. It's, it's, it's heartbreaking. So one of the things that we try and get our clients to encourage them to do, if the doctors recommended it, is speech therapy. So that includes, you know, trying to improve the ability to form words, speak aloud, communicate properly and including, you know, instructions on any kind of
special communication devices or issues with swallowing, which can also affect speech as well. Because if you think about it, you know, especially if you work any job, communication is key. Sales, just interacting with people. If you can't communicate, then it really impacts your ability to do your job, make money, maintain employment or get those promotions that maybe you were on the track to get previously. So all important things.

Another type of therapy we see is psychological counseling. Just generally that can be, you know, learning to cope with your new condition. A lot of times these severe brain injury cases involve pretty scary impacts where you wouldn't recognize the car if we showed you the pictures. It's just twisted metal or maybe they were pulled out with the jaws of life. All that is super traumatic, right? So we have clients sometimes that either are afraid to get in the car, afraid to drive, or every time they do get in the car they're just constantly looking at that rear view mirror waiting to get hit again. It takes a huge toll on people when just going to the store to pick up a gallon of milk is now a traumatic experience. So these therapists and PTSD specialists do just life-changing work to give these people that are now afflicted with PTSD the proper skills to leave the door in the morning. You know you go out the front door of your house and face the world, because it can be that difficult for people with PTSD.

Another type of therapy that we see is vocational counseling, and that helps a patient and TBI victim actually return to work in the community by assessing their injuries and symptoms and saying, look, here's what you can probably do now. You may not be able to, if you were a roofer or a carpenter and you have balance issues, you can't be a roofer anymore. It's going to be, it's going to be too high to insure, you're going to be a risk to falling off that roof and dying.

So a vocational expert will actually look at what your symptoms are, what your now new permanent neurological deficits are, and they'll say, look, you had this skill, this skill, this skill. Why don't you try this instead? You know, maybe you can't be a roofer, but you could use some of those skills to be a carpenter doing, you know, not elevated, high risk work. When you now have balance and dizziness and vision issues due to your brain injury, let's keep you closer to the ground, but you can still do these things here. So it's really important so that someone can continue to pay those bills, pay the family and take care of the family with a new job.

So these are all just interesting things that really help people get their lives back. The last one would be cognitive therapy, and that is more intense therapy that helps improve memory, attention, learning. When you have a real severe injury, they help with the actual cognitive aspect of that.

0:09:35 - Kiley Como
It truly takes an army to take care of some of these folks. It sounds kind of similar to a stroke, right? Somebody who's had a stroke. So that's an obviously long and drawn out process. And I often think of the family and friends you mentioned up front that I think their jobs in all this is to encourage our clients to take hold of these resources that are going to be available, that they're going to need, right? So cognitive therapy. That is a fascinating area of work. It gets super complicated, very deep. Can you dive into that a little bit more?

0:10:06 - John Mobley
Sure. So just some of the specifics that a brain injury victim may address with a cognitive therapist is verbal fluency games, tasks and tools. They may prescribe you something as common as relaxation and actually scheduling time in your day to relax. Letting your brain battery recharge is how I've seen it explained by neurologists at, you know, some brain injury conferences, where it's like, look, your battery just isn't operating at 100 percent anymore, so if you do not take time to take care of yourself, your life is going to be a lot harder. You need to break up your day with smaller breaks, and that can include-- we previously spoke about the vocational rehab therapist. That can include, like, them sometimes giving a plan to present to your boss too. I've had clients say I'll work longer hours, but allow me to schedule in breaks during the day, right, because that's what my brain is going to need to be high functioning now and to do the same job that I did before. Cognitive therapy can also, you know,
include things like brain games, mnemonics, so sometimes it's actually your brain is viewed as these therapists as like a muscle and you have to exercise it and bring it back.

So you know we're thinking like Sudokus and brain games like that that actually work out your brain and get it firing on all cylinders. Again, we see these prescribed all the time across the board from various different neurologists saying like look, it's important that you focus on relaxation, your brain and concentration games, so that you can get some of that cognitive battery power back, which is crucial.

And when we're talking about the cost of this stuff, it's not cheap. It can be $500 to $1,500 per session and you can have 24 to 48 sessions on more serious brain injuries, sometimes less, and sometimes it just goes on and on and on. So when we have permanent injuries with these brain injury victims, we have to sometimes use life care planners to be like look, what is this gonna look like on an annual basis until this person lives, until the national estimated death age of 79.4 years, because they may need it every single year just to be baseline, normal. Scary thought. And it's expensive. And that's why these cases we take so seriously and ask for so much money, because if indeed the symptoms are permanent, then it's something this person now has to deal with for their entire life.

0:12:39 - Kiley Como
A grim but hopeful picture you paint there, right, there's a lot to it. I know a lot of times we see in clients that we have that are dealing with something so deep and potentially long standing as this, is that treatment fatigue right? It's so important to stay focused on your treatment. You mentioned it's like a muscle, right? When you build those muscles you're building new fiber, the brain's kind of similar, right? If you've got a damaged area of the brain you have to allow that to build new neural pathways almost sometimes. So sticking with it, not giving up, not getting tired of the treatment big part of that key. Is that not right?

0:13:15 - John Mobley
You really hit it right there, Kiley. And the thing is is that treatment fatigue is such a serious issue on these cases, and treatment compliance is another issue, because sometimes we have brain injury victims that forget appointments, they can't organize their calendar, they have trouble complying with the treatment, they miss three, four, five appointments just because they can't keep up with all or they seem overwhelmed. So it is truly a delicate balance and it's so helpful to have and I know we've discussed this prior numerous times on other podcasts, but it's important to have that support structure of family members. You know, fellow churchgoers, neighbors, co-workers, anyone who's willing to pitch in to help to allow these brain injury victims to succeed is absolutely crucial.

You know, in terms of some of just the one-off treatments that we see used and utilized by our brain injury victims is, we will sometimes see things like meditation, mindfulness, yoga, massage, reading, believe it or not. Alot of times we'll see, please limit your screen time, and that's a scary thought for anyone in this day and age you know, as we're now, all on our phones or computers all day, every day, and everyone's got a cell phone addiction, seemingly it's,it can be a hard pill to swallow, but one of the things that they'll recommend, both to relax the brain, allow that battery to recharge and if you have visual disturbances and visual issues from your brain injury, screens are not a good thing you know. So they'll say why don't you try alternative activities like reading, the yoga I mentioned.

0:14:47 - Kiley Como
Reading a real book.

0:14:48 - John Mobley
Yeah, a real book not the e-reader, I'm sorry. You got to, the Kindle has got to go back in the cabinet. You got to crack open the old book and that is these alternative you know activities are ways that you can not stress your brain further. You know, in terms of some of the other things that are used sometimes I mentioned trouble keeping up and organizing and remembering appointments. We'll see where some of our more successful brain injury clients will use like a calendar, even carry small notebooks with pen and paper, really to kind of avoid multitasking. You really need to learn how to write stuff down and log it somewhere, because your brain may not be able to do that for you anymore. So these are important things.

We've also seen our neurologists recommend rose tinted glasses and what that can do is filter certain light in wavelengths to prevent issues with whatever the brain injury is. If they have visual disturbances, it helps with that. And one of the big things is if you are hit so hard that you develop something called tinnitus, tinnitus, which is a fancy word for just the worst ringing in the ears you've ever had and this, unfortunately, we see sometimes that these tinnitus cases yield million dollar plus verdicts and you're thinking how, how would, why would any jury award a million plus dollars for ringing in the ear? Well, until you've had it, you know, you don't know and and and the level of impact, um, and what we have, what we, the feedback we've gotten from some of our clients, is look, I lay down to bed, it's completely silent and all I hear is the sound of cicadas in my ear.

Imagine, you know, noise warfare when you're trying to relax in your ear and it's just, you can't relax. You never have a moment of silence, a moment of peace. That's why jurors, once they hear the impact, you, you see these million-dollar plus verdicts because they have essentially, we're not-- people with tinnitus end up developing depression. They have social withdrawal because they can't, even if they're at a bar or a restaurant, they can't hear conversation because it messes up how you hear certain noise and process conversation. It's like a social death sentence, unfortunately in the most severe cases.

The medical device that is used to help that is called a tinnitus masker and it's basically a device that can help with that sound that causes so much grief for these people with this very, very unfortunate diagnosis. Another thing can be white noise machines, fans, listening to soft background music. It's like I said, this is life changing stuff and now this is just your life. So what does that mean? You got to travel with a fan whenever you want to go out of town somewhere. You have to drag music or have it present somewhere where you can receive some sort of peace instead of hearing that either that cicada sound or that underwater pressure sound that people with tinnitus have. Some huge impacts on life.

Another treatment that is a little newer and a lot of people don't realize is actually Botox injections, because Bot-- you know, we think it keeps us looking young and beautiful, well beyond our years but it actually has medical purposes too, and one of those is that it inhibits, you know, local neural, neurologic, neurologic inflammation, and it can inhibit some of these symptoms and relieve and improve sharp and shooting pains for people with neck and brain injuries. The studies are very promising, shows up to 88% of sufferers experience actual relief from these, so it's a true medical benefit. Now, if there's any leftover, you can always negotiate with your medical professional if they can put it in your face and make you look younger, but we don't know about that. So the cost for these Botox injections, of course, is going to sometimes be outside of insurance, and it can be $2,000 to $8,000 per treatment, and we see them done in huge series. So tens of thousands, tens of thousands of dollars over and over again. Especially if they provide relief, they may do a series of them.

So once again just goes to show. This is why lawyers like us ask for so much money on these brain injury cases because everything is very expensive and only getting more expensive. In this day and age, where the cost of goods is rising, well, medical goods rise with those costs too. They don't stay stagnant. So when we're doing life care plans, we have to project out not only the cost of goods, medical treatment today and medical medicine today but also what it's going to be in the future. Some other sorts of treatment that our clients receive is you know things like vitamins, riboflavin. These can help reduce issues with headaches as well as some symptoms from brain injury. We also see magnesium being used pretty heavily. It just does a lot of things for stimulating blood flow and it's great for sleep and sleep health. So big thing now a lot of people are taking magnesium for that, same goes for brain injury victims.

So, as you can see it's it's a lot of stuff, Kiley, and we've gotten through pretty much all of it, but it just goes to show exactly how much is at stake in what is being prescribed to these brain injury victims. And we met someone with a mild to moderate brain injury may see all of these that we've gone through recommended for 90 percent or 80 percent, but still it's a tremendous amount of treatment. It requires support from family and friends to get to this treatment and keep them complying with it and going to the appointments and reminding them that they have an appointment, helping them drive to the appointment if they can't drive themselves. So, like you mentioned, it takes a village it really does for successful brain injury rehabilitation and it's very expensive. And it remains very expensive into the future for these, for these injury victims, and that's where we come into play to help get them the recovery that they deserve, to even attempt to make them whole again.

0:21:13 - Kiley Como
John, that is amazing. What a deep well of information you are, man, and so glad that we have advocates like you out there that can help our clients not only understand, as we're doing in this podcast, but, as you're saying, to do the work with them, walk through the process with them and get them, you know, get them better and give them the compensation that they deserve. So, thank you, John, appreciate it. Alright everybody, that's going to do it for another episode of Mind Matters: Navigating Head Injuries and Concussions. Again, thank you, John Mobley, for joining us and sharing your knowledge with us. Everybody, if you wouldn't mind hitting that like and subscribe button, and always remember that if you're in pain, call Shane at 980-999-9999.

0:00:09 - Kiley Como
Hey, welcome back everybody. Welcome to another episode of Mind Matters: Navigating Head Injuries and Concussions. My name is Kiley Como. I am the nurse coordinator with Shane Smith Law. Here today with one of our senior concussion and brain injury group attorneys, John Mobley. John, thanks for taking some time to be with us and sharing your knowledge. So today we're going to be talking about traumatic brain injury. We're going to kind of take a deep dive into this. There's a lot of information, so we're going to break this up into two parts. So stick with us, please. So, john, let's get it going. Let's talk about some treatments for TBI. You know, for so many things, we're in allergy season. You can take a pill off the shelf, take care of your sniffly nose all of those things. But TBI is a little different than that. So what are we looking at there?

0:00:49 - John Mobley
Absolutely, Kiley, thanks for that intro. And really what we wanted to do, our big goal today was to kind of address some of the things that people can face once they receive that TBI diagnosis, right. What is next? What does life entail? What does the future hold from a medical standpoint, financial standpoint?

You know there's a lot of things that are involved with TBI treatment. You know a variety of treatments can help a person recover from TBI. It can sometimes reduce or eliminate or mitigate certain, you know, the physical, emotional and cognitive problems that our TBI survivors and victims that we represent experience. So the specific, you know treatment, including the type and the setting, the length, depend really on how severe that initial TBI is and really what area of the brain was injured. And I know we've talked about that at length, in depth, with the viewers previously.

You know, depending on what area of the brain experiences the injury results in different types of symptoms that our clients and victims see.

0:02:00 - Kiley Como
And so you know the brain, it's vast, it's complex, we know there's a lot we don't know about it. We'll say TBI is kind of similar, right? So I know one thing that the firm sees a lot in its clients, you know that, those varying degrees of TBI that you mentioned, let's start with that mild TBI kind of something that may be a little more insidious, right? So tell us about that.

0:02:14 - John Mobley
Absolutely, Kiley. So you know we've gone over in the past kind of the spectrum that a head injury victim can sustain on a medical chart. It can range everything from a mild concussion to post concussion syndrome, to a mild TBI, moderate, severe and up to death. So depending on where you fall on that line in that diagnosis depends on how bad that initial either impact is or basically how the brain responds to the injury. Every brain is different and this is something that we have to explain to our clients. And sometimes our, in these victims of these motor vehicle accidents or head injuries is that, you know, every brain is going to react differently. For mild TBIs it's, it's interesting, Kiley, because it is, there's nothing mild about it. It's almost a misleading label, but that's just the terminology that the medical community has chosen. But trust me, if you have experienced or been diagnosed with a mild brain injury, there's nothing mild about it because it will have a huge impact on your life.

Mild TBIs can include everything from concussions, things like that.

They may not require specific treatment other than just rest sometimes.

However, you know, it can be important to follow your healthcare provider's instructions for, you know, complete rest and a slow return to normal activities for recovery from a mild TBI.

You know, one of the things that we see is that if someone tries to resume their normal life activities with a mild TBI too soon or before completing the treatment, they experience real setbacks. Real setbacks and real complications, either with home life, normal activities or, a lot of times we see, with jobs. And depending on if your job is something that requires, you know, some serious responsibility or cognitive abilities. People really struggle. So we urge our clients to treat until you get completely better, and sometimes that includes even interviewing family, friends or spouses, because a lot of times it's really a sad reality, Kiley, our clients don't even realize they're experiencing some of these traumatic brain injury deficits until we talk to the spouse, until we talk to the family member who sees them every day, and then they tell us they're not back to normal. So that's the real imperative that we place and the onus we place on our clients is just go to the treatment, follow the medical
professional's advice.

They do this for a living all day, every day, and that's typically like your primary care physician. But for an elevated treatment path it would be the neurologist who is a brain doctor. These are smart guys and gals and they really help clients, give them a good treatment protocol path to get better. And it really helps for them to navigate what can be one of the hardest times and injuries of someone's life.

So, you know, other things we see with mild TBIs is certain activities such as working on a computer, concentrating for too hard or too long can tire the brain out, even though it's not necessarily physically demanding. A lot of our mild TBI clients will say you know, I used to be able to go four, five, six hours on the computer straight at work and now I have to take, you know, breaks every 30 minutes. So that's just an example of some of the stuff that we see.

0:05:32 - Kiley Como
Yeah, that's, I mean there was a lot there. You hit on some gold there. I think one of the things that struck me the most is, you now, with mild TBI, I think it's something we probably see the most in our clients, right? Those, those more severe ones are are less frequent, which is great. But mild, can, you know, be-- it's misleading, that name, don't you think? I mean you mentioned it. It's uh, it's something that our clients take, need to take, very seriously, and that's one thing I do appreciate about these podcasts and folks like you sharing your expertise and knowledge with everybody listening because it is such a serious issue. So that's some things about mild. So what about, like when a traumatic brain injury first happens, we might be in an emergency situation.

What might that look like if we have an emergency?

0:06:12 - John Mobley
Absolutely. So the emergency care treatment for a TBI generally focuses on stabilizing and keeping the patient alive. That includes everything from, you know, making sure the brain gets enough oxygen to controlling blood and brain pressure and preventing, you know, further injury to the head or the neck. Stabilization, that's always the key with the ER. So a lot of the times we'll see in the ER, you know, the main, one of the main scans they do is a CT scan.

We talked about how mild TBI can be a sometimes misleading label. Well, a CT scan can unfortunately sometimes mislead a person to thinking that they have dodged a serious injury, because a CT scan is only going to show brain fractures, bleeding in the brain. The real serious stuff only a later, only later testing in a more powerful MRI scan that they don't typically do at the hospital, believe it or not, is going to reveal more of the nuances and more of the specifics of the brain injury. And so sometimes we have to explain to our clients, look, the ER said follow up with a neurologist for a reason. It wasn't just for fun. It's because you probably need to do some additional testing to rule out these mild TBIs or some other brain injuries that you may have experienced.

But at the ER in the emergency medicine, you know, one of the things that they do is it can be dealing and removing with blood clots. Bleeding in the brain or between the brain and the skull can lead to, you know, large areas developing clots. Sometimes we see hematomas or subdural hematomas. What that means is that you've got some bleeding, and bleeding on the brain or around the brain is never a good thing and it's definitely a medical emergency.

So, and I know we've addressed it on past podcasts, but the big thing, if there's one walkaway here, is: if you've been in a motor vehicle accident or taken a bad fall on a slip and fall on at a business or at someone's house and you hit your head and you have any sort of symptoms nausea, dizziness, vertigo, ringing in your ears, double vision, it's crucial that you get checked out. It's crucial because something like bleeding that could be easily controlled in an emergency hospital setting, if it goes unchecked, can create a life-threatening emergency. So we always say just please go, get checked out. This is not a time to try and save money or to be wary of going to the doctor. If you're someone who's allergic to going to the doctor, now is not the time. You really just want to get checked out.

Sometimes it's as simple as a brain scan, so that's what they do another thing in the emergency room that they'll do sometimes is, you know, actually repairing skull fractures. That can be, you know, removing pieces of, of the fracture of the skull or other debris in the brain area, so that that healing process can actually begin. You know, another thing that the emergency room will do is relieving pressure inside the skull.

And you, as a medical professional as well Kiley, you're probably familiar with, you know, intracranial pressure. That's a big fancy word, for you know the brain is an enclosed area, so if there's an injury that occurs and swelling, all that swelling and pressure has nowhere to go. So that's another medical emergency and reason why you need to go to the emergency room. Because if you are experiencing that intracranial pressure, it can be a thing that can kill you and that's, that's a scary thought, but another, usually easy fix if you just go to the doctor. So, you know, that's, that's one thing we reiterate to our clients, especially if they call us early. We're like, and they're, they're complaining of headaches and oh, I've been-- sometimes my clients will say I've been sleeping for two days straight. These are not good signs. You need to go and get checked out. Don't wait for, you know, being seen by your family doctor. You probably either need to go to an urgent care and let them assess, or an emergency room.

0:10:01 - Kiley Como
So right. I've seen a lot of things. You're right, the emergency room is where usually that initial care goes on. But you know the brain right, it's inside the skull. It's a finite space. There's nowhere for it to go except for the little opening at the bottom of your skull where the spinal cord comes through. And if you, like you said, if you build up pressure, there's nowhere for that brain to go but through that hole and that can be catastrophic and life-threatening as you said.

I've seen it happen. You know, another thing I've seen is people feel fine, they go home, you know everything's great, but they have this sudden increase. There's a bleeding in the brain that happens suddenly in this epidural space or like one of these small spaces. You felt fine and all of a sudden you don't. So I think the job's not over. You mentioned the family, the friends. It takes a village. You got to keep watch on that person, right? Because if you see anything changing, even though the doc at the ER said you look great, scans are clean, you still got to watch that for quite a while after that right?

0:10:49 - John Mobley
Absolutely. Couldn't agree more. That's the big thing, is that sometimes people don't realize is the ERs main goal is to kind of triage injuries and make sure you are not dying. But some of the kind of finer, specific things that may be impacting your health afterwards are things that really need to be fleshed out under a closer microscope by a specialist. And that's really why the ER you'll see when they give you that little packet and when, on your way out the door, right before you have to stop off at the billing office, you know it'll typically say something along the lines of, like you know, here are your medications and here are the specialists that you need to call immediately to get scheduled with. So please do that, folks. That's important.

0:11:29 - Kiley Como
Yes. Let's talk about that. Medications that can be daunting to some people, especially for people who are otherwise healthy and really don't take medicines. What, uh, what might we expect from a medication list for someone with a TBI?

0:11:41 - John Mobley
Right. So we want to talk about medications because, you know, this is the point of this discussion today is I've been diagnosed with a TBI. What next? What do I expect? One of the huge, you know, medical tools that our medical practitioners use to get our clients who have sustained a brain injury better is medications. Medications can help treat symptoms of TBI. They lower the risk of, you know, some of the conditions that are associated with it.

And when we talk about conditions associated with it, we're talking about all those weird symptoms that just sprout up out of nowhere seemingly depending on what area of the brain you injured. So some medications are useful immediately after a TBI, while others will treat symptoms and problems related to the actual recovery way after the injury. These medications, and there's a list of them, but it's important to go over them just because we see a lot of times that this whole list is recommended to our clients who have sustained particularly bad head injuries.

So that can include, you know anti-anxiety medications, things like an alzaprolam or anxiety medication. Because a lot of the times, you know, if the part of the brain that controls your stimulus response you know fight or flight gets damaged, we see clients that all of a sudden develop nervousness disorders or fear or just general PTSD and depression. That's a symptom of a head injury as well, is that is actually yhey go hand in hand is depression and PTSD. So we'll have clients that are like I just feel down and blue and that anti-anxiety medication can help them return to normalcy while the brain is healing. Anticoagulants would be used to prevent blood clots and improve blood flow for some of those brain bleed and clotting issues that we discussed earlier at the ER. In very serious cases we'll see anticonvulsants sometimes used Kiley, and that is used to actually prevent seizures. So in the more serious cases or sometimes we have clients that have had seizures in the past or maybe have a seizure disorder that has been under control and then they have a particularly bad brain injury and those seizures either increase with frequency or they come out of dormancy and all of a sudden they're having seizures again. And that's such a sad situation because anyone that has a family member with seizures knows the life impact that has. You're talking about the loss of the driver's license, revocation of driver's license, inability to, you know, sometimes be alone without someone watching you. So when we talk about the symptoms and the impacts of these brain injuries, they're some of the most serious cases we handle.

Another thing that is used is antidepressants. I know we talked about anti-anxiety medication, but antidepressants are used too because they'll help treat the symptoms of depression and mood swings. Believe it or not, mood swings is one of the top symptoms that we see reported by not our injury victims but the family members. It's hard to ever admit that you're having a mood swing or step outside of your body to give a proper audit of yourself.

But I'll tell you, when we do the interviews with family members and ask them sometimes to give feedback on the impact that the accident has, you know they're quick to say look, you know so-and-so. The victim used to be so patient, so calm, would never snap at us. And now, after this injury, you know it's like I'm either married to a stranger or, you know, dad is completely different. And now they snap at us at the smallest thing. You know, if there's a mess around the house, they absolutely lose their mind and they were never like that before the accident. Well, it's not that they've suddenly gone crazy, it's just that their brain, and that portion of the brain that controls impulse control, is now damaged. Just a sad, sad thing, unfortunately, because it really impacts who you are as a person. And if you think who you are as a person, that's sometimes the most important thing we all have, who we are. Another thing that is used is muscle relaxants.

So muscle relaxants are used to reduce muscle spasms and relax some of the constricted muscles. We see them prescribed all the time for tension headaches and release, especially when you're thinking whiplash injuries, that forward back hyperflexion motion to the neck causes a ton of inflammation. So muscle relaxers help with releasing that clenching feeling that can, a lot of people feel after being involved in a bad motor vehicle accidents. Stimulants, believe it or not, are used to increase both people's attention and their overall alertness. So one of the big problems with brain injuries is that it completely disrupts people's sleep patterns.

Completely. They'll say, you know, I used to sleep like a baby and now I'm waking up four or five times, or they can't get to sleep. Well, what does that mean? You still have to be functional, especially if you're working a job or the breadwinner for the family and you have a family and a mortgage to pay for. You got to be able to do your job. So unfortunately, sometimes the neurologists and doctors will battle sleeplessness and general fatigue from the brain injury with stimulants, which can range from Adderall, ritalin, the various forms of stimulants, controlled caffeine, so that someone has that alertness, just so they can be functional. This isn't to give them an edge. This is just so they can be somewhat normal again.

0:17:22 - Kiley Como
Sounds like a lot of medicines and I think one thing as a nurse I think I have to throw out there is there are a lot of folks out there that may not like taking medicines right? You know, again, maybe they've not really taken a bunch of medicines prior to all this, but is a new, this is a new stage. It's new normal, like you said. It's temporary, hopefully. So I would caution to say always consult with your doctor before you stop taking any of those medications.

A lot of the medications that you mentioned can be damaging if you just abruptly stop them. So always communicate with your doctor about hey, this is making me feel a certain way, or, why am I even taking this, right? So they can always inform on that. Just you know, you can keep that communication line open, right. ALright. Well, that's going to do it for this episode of Mind Matters: Navigating Head Injuries and Concussions. Please, again let me remind you there is a part two, so come back and visit us to catch that information. John, thanks again for being with us. Everybody, please remember to like, hit subscribe. If you're in pain, call Shane at 980-999-9999.

0:00:09 - Shane Smith
Hey, I'm Shane here with Mind Matters: Navigating Head injuries and Concussions. I'm here with John, one of the attorneys here at Shane Smith Law who's in our concussion and brain injury group. This is our podcast, Mind Matters, where we talk about all things TBI. Our topic today is brain injuries and how it impacts your career and ability to work, right John?

0:00:27 - John Mobley
Correct. Yeah, Shane. So we wanted to just kind of zero in on this portion of brain injury, since it really affects so many people. Just giving a little bit of background for some of the folks who are just tuning in that don't know the basics. You know, TBI, traumatic brain injury, very, very, very common in slip and falls and motor vehicle accidents, almost up to 40% of all accidents potentially.

0:00:50 - Shane Smith
Wow, I mean and we'll talk about that 40%. You know you're talking about it from the brain injury people. We look at some of the studies where they're saying this happens in 40% of cases. Just people don't always treat for it, they minimize it or it's a a minor TBI that heals itself, but it still happened.

0:01:07 - John Mobley
That's absolutely correct and you know that number we think is vastly underreported, for that exact reason that you mentioned, that sometimes they just aren't even diagnosed and we don't have the the data's in numbers when we don't get the diagnosis.

0:01:20 - Shane Smith
And I know one thing we've talked about in the past when we say just a minor TBI, or it just healed and went away, we talked about the fact that if you've had one concussion and you have another one, the symptoms are much, much worse on almost every single grading scale, aren't they?

0:01:36 - John Mobley
That's correct, and once you have one you actually have a higher likelihood to sustain a later concussion, later concussion and then after that, even more Honestly, why we see a lot of times athletes and quarterbacks you know quarterbacks from the past that have taken a bunch of repeated head trauma we see that they continually get concussed and eventually they get pulled by medical professionals saying you should probably think twice about continuing your career.

0:01:59 - Shane Smith
So there is no just minor, you know, just a concussion that healed. It's a permanent injury.

0:02:04 - John Mobley
It makes you much more susceptible to stuff later on Absolutely Increases your lifetime chances for dementia. A whole host of real nasty things. And even the terminology is a little bit misleading when we see mild TBI. There is nothing mild about a mild TBI. The symptoms and what happens in the neurological deficits are very, very, very serious. That's just the unusual term that they decided to give it.

0:02:28 - Shane Smith
All right. Well, I would agree with you. There's nothing mild about it and it's permanent life changing, which you know. We're talking about returning to work after you've had a traumatic brain injury or TBI, and I think what first comes to people's mind is oh, he has a TBI, has a brain injury, he can't work at all. You know, that's the image. Or, if he is working, he didn't really have a TBI. How do we deal with that issue? I guess Right.

0:02:49 - John Mobley
So you know, with traumatic brain injuries we have a whole huge host of symptoms and the reason is because what area of the brain you injure impacts what symptom you have. You know you can have things like forgetfulness, an inability to stay focused on a task. That's huge in the workplace, right, If you can't stay focused on a task, or inattention, that's tremendously difficult. Memory it's hard to, you know, make it to work and remember those meetings and the appointment you have if you can't remember that you had them in the first place. Same with vision issues. I don't know if anyone at home or watching has ever had a migraine or a headache that is so bad it impacts your vision and causes visual disturbances, but it sure makes looking at a computer screen and being a top-notch employee very difficult.

So these brain injuries present with a lot of symptoms that really make work and work life difficult for a whole lot of people. And because the range of brain injury symptoms is so vast, you're right, Some people can go back to work and see like a minor, you know, impact on their ability to their job If it was less severe. Some people can't go back at all. Some people can't even get medically clear by a doctor to go back to work and they say no. It's like you know, we see a lot with some of our clients that have cdls or operate big trucks. They never get to go back to work and that's probably a good thing that is.

0:04:15 - Shane Smith
Yeah, it is not for every light of it, but obviously you know cdl is huge. During those massive rigs we've seen the damage they can do on both sides of the spectrum, from plaintiffs, attorneys and from victims. What's all the research show? I mean, got a TBI job. Do most of these people ever go back to work? Do most never go to work? What's sort of the spectrum Sure?

0:04:33 - John Mobley
So the studies are. You know it's not a great outlook. The numbers have been put at as high as after one and even two year, marks that you know around 40% of people have returned to work. So it is. It is a very, very serious thing that really impacts people's abilities to do their jobs and that's why it's taken so seriously, especially on our legal end and by our medical doctors as well. And that's a really concerning number when you think about it, because you know some people could be returning back to work but not fulfilling their job duties or maybe getting the promotions or seeing the career advancement that they got or were headed for before the accident.

0:05:12 - Shane Smith
You know, have they looked at all about? And maybe this is where the studies come into place. I can easily see where people have a head injury. They think they're mostly okay and then they go back to work and they don't get fired, but they no longer thrive. You know they, like you say, they don't get the promotions. They don't. They're not who they were before, but on paper they sort of look okay. I mean, is that how they started investigating that more? Are we seeing more of that?

0:05:36 - John Mobley
Absolutely is the answer to that. And what we see is that when we have especially we see it with high performing clients and people that, and victims really, who have experienced a traumatic brain injury, we're thinking like CEOs, huge managers, people that have really big responsibilities in their roles at work, you know, and their jobs may require a tremendous amount of brain power. They may be especially gifted or incredibly smart. So it's hard to say like and see that the TBI in the crash had a huge impact on them, but only people around them would say you know, we definitely see that this person is now struggling in their role, you know, but they were so elevated and so high up and so smart before the accident that's hard to see that you know they're not functioning Okay. So we really have to compare who they were before the accident and who they were after, and that's going to vary with each person. Some people it'll be slightly noticeable and other people it will be very noticeable.

0:06:31 - Shane Smith
So sort of the difference in skill level like they're still doing it now they're struggling Makes me think of athletes who you know when they're. Every sport usually has that age where you're you know the most successful, as then, as you age, you become less successful on the professional side. But, that being said, I could take probably a 70-year-old basketball player who's retired from the NBA and they could just wipe the floor with me because I'm terrible at it, but he's still so far below where he was when he played sports.

0:06:57 - John Mobley
right, that's a great analogy and it's like your favorite football player, soccer player, whatever sport you follow. It's like when they tear an Achilles or come back from an ACL tear. They're just not the same. Yeah, really, it's a perfect analogy for brain injuries whereas they're there, but it's just not that same, you know before the injury or before the accident.

0:07:17 - Shane Smith
Emojo or the X-factor, whatever you want to call it. X-factor, what are sort of the predictors of whether you're going to have a good outcome or a bad outcome?

0:07:25 - John Mobley
Right. So you know the main predictors that will give us some sort of indication that the outcome is probably not going to initially. And they use an ER too to initially assess the degree of the head injury and the person's responsiveness. If we see really bad Glasgow coma scores, it typically is an indicator of long-term poor outcomes. Also, we see if the victim is higher in age they don't bounce back as well.

Young children, babies it's been shown that their brains can heal to a certain degree and bounce back much better, much more pliability to bounce back, than a elderly person who sustains something like this. It can be a downward spiral for an older person at that point. Also, we see lower levels of kind of pre-injury education or lower level occupation. They typically have poor outcomes and that isn't so much based off, like you know, the person themselves and their body, but it's mainly based off their ability to access good, you know treatment, medication, care and basically have the background and education to know where to go to get this help. And you know, I think that's one of the key and education to know where to go to get this help.

0:08:45 - Shane Smith
And you know I think that's one of the key things. You know you talk about blowing lower socioeconomic brackets. I guess that care is more limited. You know they don't have as many options as maybe some other people. I mean, if anybody has any resources for those or knows where people can find good care in these areas, despite or whatever their socioeconomic background, I mean we'd love to see that in the comments. If you can put it down below, it might help some other people out.

You know where they can get the medical care. I know when I knew somebody who had a brain injury we were able to get them. You know the Medicaid and Medicare plans quicker by going to the system and then talking to our local representatives. You know our local state and house representatives. They were able to get them on those state plans and they got much more treatment faster. But I know there's some other groups out there. So if any of our listeners know of any, plug it down below. We're always looking to help our listeners out. Oh, any other big symptoms that are going to say, hey, it's going to be tough to get ahead?

0:09:35 - John Mobley
Well, you're mentioning people to drop some information in the comments as a perfect segue to the next point, which is that you know there's also poor outcomes we see for people when they have less social support and that can be from friends, family, churches, others, people that have those you know support and have that access to either information or help, they tend to thrive and be better. We've had clients where they're big active members in their church and the whole congregation did. Meal drop-offs and deliveries allowed them really to focus on the things that matter during that very important right after the accident healing stage, instead of worrying about how am I going to get fed tonight. You have support there stage. Instead of worrying about how am I going to get fed tonight. You know you have support there someone to get you to the appointment, someone to follow up. Maybe if you can't get your meds, go and help you get your medications. It's a very you know it's. You can't underestimate that.

0:10:29 - Shane Smith
Yeah, oh, I hadn't thought about that. But yeah, I mean, I know lots of churches. Our church would take people you know around a doctor If you couldn't go. They would take people to doctor's visits and bring food and things like that after any major crisis, and I know that's a very common thing for churches to do.

0:10:42 - John Mobley
And the final thing that kind of can predict poor outcomes is any history of substance abuse. Main thing being there is that, first, substance abuse can interact with the brain. We know this now. Even high consumption of alcohol can cause shrinkage in the brain. It's all interrelated. But more importantly, if you have a history of substance abuse it tends to worsen or you become more reliant on that after a brain injury and it can really impact your ability to stay compliant with the treatment when you're a substance abuser. So that's the main reason we see worse outcomes, people with heavy substance abuse is that they just they don't comply, they don't do the therapy, they don't heal like other people.

0:11:24 - Shane Smith
I was going to say double-edged sword, but it's even worse than that. I guess because they had a substance abuse problem, but maybe it was under control, they get a brain injury which somehow worsens it. Plus, they're having more difficulty and issues right, which generally drives people to abuse their substance of choice more. And then, because they're doing that, they're not following the treatment guidelines, which also keeps them from getting better.

0:11:43 - John Mobley
I said that just the whole around situation is just terrible, even another element in that terrible vicious cycle is that when you injure your brain you can actually have a reduction in impulse control. So those days where you said, you know, not, today, I'm not going to partake If you have a reduction in impulse control. So those days where you said, you know, not, today, I'm not gonna partake. If you have a substance abuse problem that may be gone after a head injury, it might just be up consumption, consumption, consumption. Whatever your vice was your brain because it was injured. We see that all the time with clients that all of a sudden family members will be like you know, they used to bite their tongue, now it's like they're just saying whatever about anything. In any social situation that's one of the prime symptoms we see.

0:12:19 - Shane Smith
I had not thought about the fact that it destroys your impulse control, which is going to then impact your substance abuse issue. That's really awful, actually. So we talked about the things that are going to project a worse outcome or less likely to have a good outcome. What are some of the other issues they struggle with? Getting to doctors work? How does work usually treat these issues? Some of the other issues they struggle with Getting the doctors work. How does work usually treat these issues?

0:12:39 - John Mobley
You know some of the other hurdles that we see that people need to be prepared and aware of if they've sustained a brain injury. Have a family member that sustained a brain injury is, you know, a key thing just being something as simple as transportation. So how am I going to get to work? And the reason is is because when you have a brain injury, what does it affect? It can cause vertigo, dizziness, vision issues things you don't want to hear when someone's operating a 4,000 pound vehicle, right, so you know that's where that support structure comes in, or a you know, some sort of setup to access public transportation, or a friendly co-worker that can ride share with you. These are the creative solutions that, unfortunately, these victims have to seek out and I could see public transportation.

0:13:21 - Shane Smith
Depending on where you live and how complex that route would be, that could be difficult also because I know, like in Atlanta, some places if you're not on the MARTA line itself to get on a bus, you might have to change buses, get on another bus, then get on a train. Swap trains, get on another bus, then get on a train, swap trains, get on another. You know what I mean. I can see that alone being difficult and confusing for anybody, but certainly somebody who has memory issues or there's higher functions of damage. So they're not at their best.

0:13:47 - John Mobley
That's right, Even if it's accessible, like if you live in a rural area, which it's usually not. Once you even have access to it, it may be difficult. Like you said, you should navigate it.

0:13:56 - Shane Smith
Any support out there to help people get back to work? I guess what do we have for that? Yeah, so how would they seek help?

0:14:09 - John Mobley
Absolutely Well. One thing, too, is that you know, having a conversation sometimes with your employer about any sort of accommodations that need to occur, like, obviously, if someone is having issues with transportation due to their TBI symptoms, maybe a hybrid or remote work setup might make sense. You know, there's just like various little examples that may increase that person's not only returning to work but staying employable, which is the second half of the issue is. Step one is getting you back to work, to where you can even work, and step two is maintaining your job, because all these things can add up and be difficult and decrease your ability to be a productive employee. We also encourage people if they are trying to get back into the job sector with a very serious TBI is you really owe it to yourself or to a family member to engage and consult with what's called a vocational rehabilitation counselor or expert?

These are people that their sole job is to kind of review and look at what sort of injuries and symptoms you've sustained and then figure out what it's going to take for you to work, determine A can you even go back to your job If you can, what needs to be changed at your job so that you are set up for success and it can help you, help the person get those questions answered that they might not even know how to engage with a job or an employer, to basically be like look, this is all I need. I just need you to send me an outline of what I need to do today, because I can't remember things, but that's my only issue so.

0:15:32 - Shane Smith
But this is not the neurologist who's treating you. No, this is a totally separate person who's familiar with types of jobs and the duties associated with it. So your neurologist is going to say here's everything that's going on, here's what the symptoms are and stuff, and they're going to take it to this secondary person and you're going to have to tell them about your job, or they're going to research it and then they're going to help you. Have a plan sort of.

0:15:54 - John Mobley
That's it. That's exactly it. The neurologist is going to get the medical diagnoses and go through the symptoms, and this person is more equipped to understand the interaction between the diagnosis and then the job accommodations and what you can and can't do.

0:16:10 - Shane Smith
And are these people, are they good for-- I mean this, everybody who's trying to get back to work, who's got strong symptoms.

0:16:14 - John Mobley
They need to go through somebody like this yeah, typically for people that have had moderate brain injuries and above, it would not hurt to consult a vocational rehabilitation expert or counselor, simply because it could make your life so much easier. Now, that's not to say you can't do it on your own, but this is not necessarily a thing. If it's not your area, that you want to just kind of you know wing it.

0:16:38 - Shane Smith
I know this is a tough question. I mean most neurologists pushing clients to go through this vocab know this rehab person to to do it, or most of them like hey sort of I mean and obviously you have good neurologists or patient advocate, neurologist versus non-patient advocate colleges, but is it totally common for them or is it something clients need to be thinking about and family members need to be thinking about, I guess?

0:16:59 - John Mobley
Client and family members need to be thinking about it and if their neurologist hasn't already recommended it, they need to push for it or have the discussion. We see a lot with neurologists that we occasionally work with that are really good. They're almost always recommending this on serious cases. It's not every case, like for minor concussions or some of the lower end TBIs, but for the more serious ones they're absolutely making that recommendation.

0:17:25 - Shane Smith
John, we've talked about saying you're a vocational rehabilitation specialist and stuff. What are people who've lost their job or they didn't have a job. How do they need to incorporate this part into the job search? What happens there when they incorporate it in? Yeah, I mean so. Do they need to tell a new boss what's going on? Or how do they even bring up the conversation of hey, these are my accommodations.

0:17:45 - John Mobley
Yeah, so that's a conversation that it's honestly better to have on the front end, so that everyone's expectations are clear as to what the employee can or can't do and the employer is even aware, so that they know the extent of the injuries, what the symptoms are and what sort of tools they need to now be given in order to be successful. And that is a thing that can be helped with the vocational rehab expert. You know having those hard conversations, but they are truly necessary conversations, especially because you know if you have these symptoms and your employer is not aware, then it can really impact your ability to maintain that job long-term.

0:18:22 - Shane Smith
So what are some accommodations we would sort of have? What would happen?

0:18:26 - John Mobley
Yeah, so just small things. You know if there was someone that had struck the part of the brain that controlled memory and now you know they're otherwise highly the same, high functioning person but the memory is gone. It may be something as simple. As you know, they receive a special report in the morning or outline of what tasks need to be done sent to them. So it's not always these like crazy complex, expensive things. Sometimes it can be very basic things that you know it can be outside of the norm of your jobs or your employers, kind of typical systems and what they do. But you know, if you have an understanding employer, it certainly helps if they're going to be employing you, to have these things so that you can succeed.

0:19:07 - Shane Smith
So let's say we have a receptionist and you know she's at work, she's having issues with motor skills and she's having trouble taking phone messages. What would sort of be an accommodation related to that?

0:19:17 - John Mobley
Yeah, so like a receptionist that was having issues taking notes because you know motor skills have been reduced, you you know accommodations could be something like voice assisted notation software, things that make it easier. I mean, these are simple fixes. They might cost a small amount of money, but it might be crucial for someone that now has a brain injury defect that they get this sort of accommodation to make their job successful like the old dragon dragon speaking software.

0:19:44 - Shane Smith
I mean, yeah, you know, he's a child my age, but that right.

0:19:47 - John Mobley
Exactly the talk to text. It's so common now.

0:19:50 - Shane Smith
But back in the day it wasn't, it wasn't-- okay. I mean, let's just say you were like a file clerk. You suffered that injury where you know you get angry fast, or you at least appear angry. That's how you take, right? You're angry. I can see where that's going to create huge issues, right? No boss likes to be yelled at by their employee right.

0:20:07 - John Mobley
What do they do there? Sometimes it may be for something like that. You know a system of like check-ins and evaluations because a lot of times, shane, these brain injury survivors aren't completely aware of what they're doing, so it has to be spelled out for them. You know, when we see a lot of our clients lose their temper, can't control emotions, you know being patient as an employer and checking in with them and having kind of evaluation sessions to say is this going well? Is this, is there something we need to do to tweak things, to improve things? These are all small but very important potential changes that can help for long-term success.

0:20:45 - Shane Smith
If somebody suffered a brain injury serious one, who's going to be on this team that's going to help them get back to work? What's their winning team look like?

0:20:53 - John Mobley
First and foremost it's going to be healthcare providers, so the doctors that they see, the specialists I mean the quarterback on any major brain injury case is going to be the neurologist who's kind of dictating everything else what sort of treatments need to occur, monitoring medication, beyond that very important vocational rehab expert or counselor that we kind of talked about in depth in terms of your success at getting back to your job, staying at your job and continuing to be able to earn.

And then you know, believe it or not, us, your lawyer, we know a lot of these doctors. We know we see these cases all the time. We know when you know treatment has completely gone off the rails or is just not occurring whatsoever. You know, and sometimes it's not always these doctors fault, sometimes it's that the brain injury is so bad that and maybe a person with that brain injury doesn't have a family member that can go to all the visits with them they're not accurately telling their primary care that all their symptoms because they don't know how to relay that information because their brain injury is so bad. So you know you need to have this discussion with your doctor and just say these are my symptoms.

0:21:57 - Shane Smith
Tell them, not us, and we've seen that before. I mean, one of our protocols sometimes, in TBI case in particular, is to ask the person, but also ask the family member they spend the most time with, because we found that the answers differ Not all the time but a lot of times. So yeah, I mean the lawyer when we're talking to neurologists too. You know I'm a firm believer all neurologists are super smart. But I want a neurologist who works on concussions, you know, or TBIs, a lot of times. Some neurologists do other things. Some, you know, work on a few TBIs, but not a lot.

I want the guy or gal who this is what they do all day long and is most familiar with TBIs and concussions, because they're going to be best equipped to deal with this. Because I got to talk to one doc and he dealt with a lot of TBIs. So when the client got mad and yelled at him in his face, he just took it like that's just part of the day, you know, kind of. But I've talked to another doc who fired a client because he yelled at him and I'm like dude, you know, he's got a TBI Right, you know. So I always want the TBI specialist or doc who does a bunch of those or concussions. If I can pick my doctor, anybody else we know. On the team we've got the health care professionals the neurologist, who's the concussion expert, vocational rehab professional, the lawyer who else?

0:23:06 - John Mobley
Any family friends, like we discussed, that can provide support, but also and since we're talking about returning to work the help and support from employers and any coworkers that can assist with some of the things we went over, like simplest transportation, ride shares to work, accommodations in your job, even support if you see someone who's a victim of a TBI struggling. These are very difficult things, so it can be a positive thing, though, too, to end on a positive note. I mean, when you give people the tools that they need to succeed, they can have great long-term outcomes.

0:23:41 - Shane Smith
Yeah, I mean I was Texas Beach, that's easy right.

I mean it would make a huge difference if that person aren't posting notes everywhere or an outline to work. So all right, John, thanks for being on the show today. We appreciate it. If you've got a question or you've got some of those support groups, plug them down below, especially on helping clients get healthcare and medical care. Those resources, we'd love to see them in the comments. If you like Mind Matters, hit like and subscribe and hit the bell for notifications and if you've got a question for John, you can send it to info@shanesmithlaw.com. And remember if you're in pain, call Shane 980-999-9999.

0:00:09 - Shane Smith Hey, I'm Shane Smith from Shane Smith Law. I'm here today with John Mobley and we are doing Mind Matters: Navigating Head Injuries and Concussions. John is one of the attorneys here from the concussion and brain injury group here and we like to discuss topics around concussions and people who suffer a brain injury. John, thanks for being on the show today. I know we were talking a little bit about somebody who suffers a brain injury. What do we do to get the most out of them in front of a trial, basically, or the most recovery, and to really document that injury? What is one of the best ways to do it? Because up until recently, you couldn't see a brain injury, right, it wouldn't show up on a test. If we did anything like that, right, correct? Yeah, and I know we've we've discussed previously like DTIs, which is a test that will show some brain injuries, but some people are still skeptical of that. So what is the best way we show the brain injury to a jury?

0:01:01 - John Mobley Absolutely Shane. So you hit the nail on the head. We use a lot of fancy scientific tests and diagnostics and specialists to confirm these brain injuries and it's stuff that you know will, we use sometimes to dazzle and improve the injury to the jurors, but unfortunately that's not always enough, and the reason is simply because these are invisible injuries. So we need to go a step further.

0:01:26 - Shane Smith I think we started using more of the technology stuff to show injuries and stuff because, honestly, juries expect some of that. Just, basically, I blame TV and movies, because in the TV shows and movies they've always got all this fancy stuff, so we've had to incorporate some of that. But, like you say, it's still an invisible injury. So how do we? We? And even looking at it, that doesn't show the impact it has on a client, right, because I can show loss of memory and and emphasize that, but nobody really knows what that mean unless we get somebody who can explain it, right, that's exactly right.

0:01:55 - John Mobley And you, you mentioned what jurors expect us to show them and prove them these days has risen. It's kind of like what they call call the CSI effect, where everyone wants to see the fancy science behind stuff and they want to be dazzled as jurors so that they get to see the big brain imaging, the 3D models. People expect that these days when we're trying to explain the injuries that someone sustained. But, shane, you're exactly right, it's not always the be all end all, and the reason is is that sometimes someone could have all sorts of injuries in their brain but they're experiencing no deficits whatsoever or they somehow, miraculously, are completely fine. Now, those cases are few and far between. Usually, when you sustain a bad injury, you're going to see some sort of symptoms and deficits, but that's why we like to do an emphasis on before and after witnesses, to couple with some of the clinical findings and the imaging that we get.

0:02:52 - Shane Smith So we want to have the expert, we want to have the fancy stuff, the fancy tests that you know, everybody thinks you need to have these tests to confirm everything. But you said before and after witnesses. So what is a before and after witness? Because when I hear witness, I think somebody who saw a crime or saw something. How does this relate to that?

0:03:08 - John Mobley So a before and after witnesses in the context of our brain injured clients, is going to be someone that knew who our client was before the accident and who they were after the accident and the reason that that is just so so important to document. We have all sorts of reasons, but the main one being that we can actually see what the accident took away or changed, usually for the worse.

0:03:34 - Shane Smith So this before and after witness is going to be somebody who knew me before I get into the traumatic event normally a car accident. I've suffered a brain injury and they knew me afterwards as well. Right, they can come in and say, yeah, this is what's different, that's exactly right.

0:03:49 - John Mobley And the reason that that's so powerful is because it gives us firsthand knowledge and experience from who this person used to be and who they are now, because sometimes it's not as easy as us just being able to ask our client. You may think, well, just ask your client, well, they can't always tell us or they don't know what's happening.

0:04:08 - Shane Smith And what do you mean by that? They can't tell us if they don't know what's happening. Talk about that.

0:04:12 - John Mobley Because of their brain injury. They may not know that they're being more irritable. We may have to go and talk to a spouse to say know the most peaceful, caring patient person? And now they are not. They scream when something goes wrong. They lose their cool. They're no longer completely patient with a child when they mess up. And these are things that our clients are not even aware that they're doing.

0:04:39 - Shane Smith And I've had clients not clients, but client spouses tell me that you know, before, in particular, you talk about patients or emotion control, you know they were like, yeah, before the accident my husband was a very patient person, you know, rarely raised his voice, really got mad, and afterwards, though, they've got sort of a trigger fuse or a short fuse. They're like that's totally different and out of character for them and, honestly, it's not the same person.

0:05:02 - John Mobley I'm married right, you're exactly right, and that is why these cases we treat them so seriously because losing something like your ability to control your emotions and have good attention span and not lose your cool on family members you think about the lifelong impact that has? It could be detrimental to the happiness of your relationship, your marriage, your relationship with children, friends. You may no longer be a person that people want to be around after a severe brain injury, and what is that worth? I? think it's worth a lot for your friend groups to evaporate for your relationship with your significant other, someone. Something that was going great before the accident, to all of a sudden, now you're getting served with divorce papers because they can't live with you anymore.

0:05:49 - Shane Smith It doesn't even take a huge change to really impact your salary relationship. I mean, if you lose your ability to be patient, that alone is going to impact you at work. It's going to impact you with you, like everybody in your friend circle and, like you say, nobody wants to hang out with the jerk, right? Right, I've seen it where in the beginning after an accident or a brain injury, everybody is very supportive, you know, but after a while that sort of wears off and people just get tired of you being difficult to be around, right? I mean, they get worn down and they're like well, john was in the accident, but it's been a year Now. It's just a jerk as opposed to injured. I mean, how often does that come up?

0:06:24 - John Mobley Yeah, I mean that which you just mentioned, where everyone kind of flocks around the person in this traumatic experience sometimes a terrible car crash everyone's there, the second cousin sometimes you know extended family, kids, but you know, as time goes on and on and this is a permanent injury. You know the the kind of the novelty can wear off for some people and then people start to fade away, disappear and either the client is left and it's a very lonely experience, or just one spouse taking care of them, or maybe a spouse and a child they have to bear the brunt of that and taking care of the person that has the brain injury, just as we're going to go into a lot of detail in this podcast.

0:07:03 - Shane Smith But you know, but you talked about the spouse or the family member taking care of somebody I know we've discussed in the past. There are definitely resources and groups out there where spouses of brain injured people can get together with other spouses of brain injured people and basically support each other and talk about everything they're going through with people who understand right.

0:07:21 - John Mobley Yeah, and those groups are absolutely gold for families that have had people sustain brain injuries, and the reason is is because you find, like situated people or people that have been through your exact same experience, that kind of know the ins and outs of it. They know what needs to be done, and that's very important because you can relate to those people you can get support that you wouldn't otherwise get, because no one can possibly understand the situation where you're in. When you have a brain injury or you're one of the brain injured person's loved ones. It's a it's a very uh, kind of it's a lonely experience.

0:07:59 - Shane Smith I was going to say, and I I've even known some people who've had a brain injury and they in the beginning they want nothing, you know, they just want to hang out with their old friends. But as those friends trickle away, they found some solace and comfort in hanging out with other people who've got a brain injury, which to me it seems like a volatile relationship. But it's people who still understand everything and I think they're more forgiving because they also do the same kind of stuff. That's right, that's it giving because they also do the same kind of stuff. That's right and we definitely would encourage any of our listeners who are dealing with this, you know, contact one of the support groups, because I think it can really I don't want to say change your quality of life, but helps you get through this difficult situation.

0:08:37 - John Mobley Absolutely. I couldn't stress that enough. I mean, the resources that are out there for people are abundant. You just got to know where to look and they can definitely improve in otherwise very tough situation.

0:08:50 - Shane Smith For any of our listeners. If you're having trouble finding a support group, email us at info at Shane Smith Law. We'll be happy to find a local group and put you in. Check the link on our page. We try to list some brain injury support groups on there as well for our listeners, for them and their spouses. Now back, though, to our before and after witnesses. When we talk about this thing in invisible injury and these before and after witnesses can really talk about it do we run into the same situation where people don't believe these before and after witnesses or the defense attacks them? Are they as open to it as, say, our client themselves?

0:09:23 - John Mobley The defense is always going to attack, you know, any witness. It's their job. So they're definitely going to attack our witnesses to some degree. That's why we always say when talking to our clients listen, the more witnesses you give us, the better. So you know, obviously if a brain injured client's spouse or direct kin or family member is testifying, you know a jury may think well, that's just because they're their spouse, they may just say whatever's going to benefit the brain injury client. But you know that's why we try and reach out, even beyond family and friends sometimes. Sometimes we're looking for coworkers, coaches, the mailman. Believe it or not think about if you're a juror and you know theor and the mailman says Mr So-and-so used to always come and greet me and we'd always chit chat whenever I'd come up to his door just a little bit and then I heard he was in a bad accident and he never comes to the door anymore. I never see him outside guarding like he used to. I never see him doing anything. Frankly, those are things that's. Those are things that we see sometimes that are very powerful, because you know what is it to this mailman?

0:10:30 - Shane Smith Right. Why would he lie Right Right?

0:10:31 - John Mobley So we don't always find those witnesses, but we certainly ask about them because they're just so powerful and they truly provide an inside behind the curtains. Look at what this person is going through.

0:10:43 - Shane Smith Your before and after. Witnesses don't have to be huge people that, you see, I don't wanna say every day, but they don't have to play as big a role in your life as like your spouse or your kids. The mailman would be good. A store clerk used to go see the barista where you get your coffee every day. Any of those people would work and sometimes would be better.

0:11:02 - John Mobley There's definitely an argument that they would be better just because obviously a family member, someone who sees you on a day in, day out basis, is going to give us a better account and rundown of all your symptoms. You know like a spouse, someone who knows you inside and out. But you know there's other people like these you mentioned the barista and the mailman or the mail person. They're going to also give us, you know, maybe one or two of the long list of brain injury symptoms and really hammer it home that they're absolutely suffering from this. Right, they may not know that you know the full list of everything that that person is going to, but they at least knew our client before the accident and after the accident.

0:11:39 - Shane Smith And then again talking about those small or big changes and, like you say, it's hard to attack them. Right, Because why would they lie? What are they getting? What's your mailman getting out of testifying and saying you won't come talk?

0:11:50 - John Mobley to them anymore. That's right. So they really do make the strongest witnesses.

0:11:53 - Shane Smith So we talked about spouses. We've talked about family, friends, neighbors, mailman. It's a difficult issue. What about a strained like former friends who were friends with you and now they're not? Or ex-spouses, because I know there's a lot of ex-spouses out there. Would we ever use them as before and after witnesses?

0:12:10 - John Mobley Believe it or not, Shane, yes, and we have. I can count numerous times where I've had ex-spouses, either ex-girlfriends, ex-boyfriends, ex-wives, ex-husbands, basically step up and either the relationship fell apart sometime after the accident due to the injuries or it was in the process of falling apart before the accident. But they keep in touch and they provide incredible witnesses because, truly, then, you know, as a juror, what does this other person have in it. So you know that you're getting good information, authentic information, and, believe it or not, some of these clients that have exes will step up and be like look, you know. As much as we don't get along now, I cannot deny the fact that we have seen some huge changes since the accident and I love when that happens because I know that I've got a really good witness that's going to speak the truth that my client is living with every day.

0:13:05 - Shane Smith Like we said, a lot of ex-spouses have a volatile relationship. I mean, clearly their marriage broke apart and yet when they come in and say, yeah, it was okay before, now it's not, or this was the straw that broke the camel's back, I think that's hugely powerful. Right, a hundred percent. What are the big symptoms his before and after witnesses are going to testify to? What are the big symptoms is before and after witnesses are going to testify to.

0:13:27 - John Mobley What are the big stuff they're going to talk about, right? So we've gotten through the hard part of identifying the before and after witness.

0:13:33 - Shane Smith Let me ask you this, john, too what if you have a client who says look, I don't have anybody. What do we tell them to go find? I mean, how do they go get this person? How do they? What do they need to do?

0:13:43 - John Mobley Right. So I mean, how do they go get this person? How do they? What do they need to do, right? So it's it's very rare that we have a client that has absolutely nobody. That's why we push out to like the male person or, you know, a barista at a local restaurant that they always go to because, you know, unless someone is a complete hermit, shut in beforehand after the accident there's going to be someone out there that we can hopefully find. We may not find the best lineup of witnesses, but there's going to be someone out there that knew our client before the accident. Now we may not have as big of a list as someone that has a huge family and is very socially active, but it's very rare that we couldn't find someone.

0:14:19 - Shane Smith So I mean, and I know, when we've had to dig through and find before and after witness, sometimes we've been like, okay, over the last 30 days, tell me every place you've done or everything you've done and sort of walk them through this whole process to try to find people we can talk to. And that would be one way somebody could do it right. They could talk about the last 30 days, everything they did, or even a week. You know right, who all do you interact with every week? Because, like you say, nobody's got nobody right. I mean. So everybody has somebody and they may not be able to testify to everything, but they could certainly testify to one or two things, even if it was as small as, yeah, you see him every day and not only see him once a month. Right, that's a change. Or we had a witness on one case where they said, yeah, before the accident he was sitting in the stands with his kid watching baseball. He was sitting in the stands with his spouse watching baseball. After the accident he couldn't sit in the stands because it was too claustrophobic for him. He had to stand on the periphery and sort of watch it and he couldn't even be there that long. So everybody can testify about it, or everybody has somebody who can testify and then wait to this right.

0:15:16 - John Mobley Yeah, I think that's the case, and some of those examples that you gave are absolutely examples that we've struggled with or gone through in our case to track down these witnesses, because it's such an important, important part of the case that you know we just we got to do it.

0:15:32 - Shane Smith What are the big things these witnesses are going to testify to? What are the main areas?

0:15:37 - John Mobley Right. So after identifying the before and after witness, which is, you know, the usually the longest portion of the process, you know, we want to make sure that the before and after witness is giving us the information that they see, and what we want to know is a lot of the symptoms which we've talked about here on this podcast before is going to be, you know, things like issues to your memory, comprehension problems, mental processing speed we talked about a little bit before but that restraint and patience thing, self-control, essentially are huge ones. but and, and those are just like the big personality trait ones that make a person who they are. You know, besides that, um, the obvious ones that people would think about when they're thinking of a brain injury is going to be things like headaches, changes in your vision, ringing in your ears, dizziness, nausea. Those are the big, immediate ones. So what we like to do is, when we're talking to these before and after witnesses, you know, sometimes we'll be like well, what have you seen in relations? And sometimes, I say nothing but a lot of the times I say, you know, come to think of it so-and-so, the brain injury client would complain about, you know, not getting sleep that night or being tired at work, because every time he turns off all sound he hears the ringing in his ears which impacts our ability to sleep and stay asleep, and that's, that's a very common injury after after a brain injury. So these are things that we like to address with the witnesses.

0:17:10 - Shane Smith And and the way you describe that. You know the him talking, the client talking about the ringing in the ear, so that seems like a very specific instance. Which one do we prefer?

0:17:19 - John Mobley Do we prefer you know more general, like, yeah, I have a terrible memory or a specific instance associated with, like, you have a terrible memory or a specific instance associated with having a terrible memory, I guess Definitely, you know we're humans, so stories and storytelling resonates more with us, and that's definitely what we're looking for when we're trying to get this information out is examples and stories, like you said, versus just if I, as the attorney, am only getting a list of what seems to be like diagnoses or symptoms. Yeah, that's not obviously as illustrating of what the person's going through versus like well, you know, this person used to be, let's say, the before and after witness was, was the the employer or the boss? And they're saying well, you know, the brain injured victim, our client, used to be a top earner. They would always be five minutes early to a meeting. Now, all of a sudden, they're. You know, ever since this accident they've started missing meetings. They miss calendar events. He went from the top salesperson down to about the eighth salesperson. He's, uh, no longer completing his task on time and we've been getting complaints. Those are stories versus symptoms. You know the symptom there may be inattention or memory issues. Those are the symptoms. But what really brings it out and fleshes it out and allows me, the lawyer, to paint the picture of the injury for the jury, is stories like that, because that's what we're doing we're storytelling.

0:18:41 - Shane Smith And yeah, and the witness is storytelling and I feel like from a defense lawyer, attack side is it's even harder. It's hard to attack a specific story you know somebody talks about, hey, he didn't have attention to detail. I can try to find ways to prove he really does have attention to detail. But if you tell a story like hey, he's always late or he's missing tasks, or he dropped from top salesman and number eight salesman, it's hard to attack that. I guess it seems legitimate, seems real to me.

0:19:07 - John Mobley You couldn't be more right because, listen, a defense attorney and once again, this is their job they're always going to try and hire one of the biggest, most expensive defense experts to say exactly what they want them to say, or hope that they say exactly what they say, and it's gonna, of course, gonna be trying to pick apart the diagnoses on the paper that our client has been giving, but it is very hard and sometimes impossible for them to pick apart these stories that the before and after witnesses give when they explain that. Look either the 12 before and after witnesses we have up here that are all telling stories about how this person's attention and memory have changed, or we have up here that are all telling stories about how this person's attention and memory have changed. Or we have 12 liars that we brought before you and a jury is just not gonna buy that. They're gonna say what? Why are all 12 of these people that they brought saying the same thing about the attention, the detail lacking and the memory issues? Are they all in it together or what's the more rational explanation, which is the?

0:20:00 - Shane Smith person has a brain injury, yes, and they're suffering greatly. I was gonna say, yeah, I mean, either they're all liars or our client is a great actor and fooled everybody, right? Or, which is much more likely, they have a brain injury, right? That's the question we ultimately want to put to the jury, right, I mean because if you think they're lying, then obviously they don't deserve anything because it's a lie, but think they're lying, then obviously they don't deserve anything because it's a lie. But you bring in five, ten, twelve jurors or twelve witnesses, you talk about it. It's hard to say they're all lying.

0:20:28 - John Mobley Yeah, they're a great actor and don't get me wrong, it's not just those 12 witness, hypothetical witnesses, it's also that we then couple that with the neurologist who said that they experienced or they've seen these symptoms in the patient, and then the imaging which shows that the part of the brain that controls attention and memory has a big bruise on it or vascular damage or some sort of brain injury. So when we couple the imaging with the neurologist clinically confirming it with the 12 witnesses, that is the recipe for making what is usually an airtight case it sounds like it, john.

0:21:00 - Shane Smith I mean I was going to say it sounds like you just laid out the playbook. Really Get the neurologist or the doctor to confirm the concussion and brain injury, get the imaging that shows the concussion or brain injury and then get the witnesses who can tell the stories that corroborate the area of the brain that was injured.

0:21:16 - John Mobley Yeah, that's about the best we can do to prove our client's case.

0:21:20 - Shane Smith John, I want to thank you for being on the show today. I think the information is helpful and it sort of shows out the plan on how we do things when we're pushing a case towards jury trial, but also just in the demand of the insurance company to really illustrate the impact it has on our clients. Because I think, honestly, the gathering of these stories and putting them together shows the true impact it had on our client and it pulls it off from just a diagnosis from the doctor and makes it real. Everybody has those friends and family. Everybody is used to talking to them. So when we put those stories out there, like you said, that's when you get a good, solid brain injury case that we can present to the other side and get a fair result or a great result. Right. If you like information about head injuries and concussions, I encourage you to hit like and subscribe to our podcast Mind Matters. Hit the bell for notifications, and remember: if you're in pain, Call Shane 980-999-9999. If you have a question for John, just send it to info@shanesmithlaw.com.

0:00:08 - Shane Smith Hey, welcome to Mind Matters: Navigating Head Injuries and Concussions. I'm here today with Thomas, one of the attorneys here at Shane Smith Law on the Concussion and Brain Injury Group. Today we're going to be talking about youth sports and the impact concussions can have on them, but also maybe some of the ways we're trying to prevent them. So, Thomas, thanks for being on the show, and let's get into some youth sports. So particularly the one that comes to mind, you know, once we knock football out, which we discussed in a prior episode, is soccer. I mean, because soccer in the last 10 years has just really grown and seems like it's everywhere. You know, it's on ESPN, it's in the high schools. I mean, it seems like soccer's just grown, grown, grown. And you know it's not like football or martial arts where you're kicking people in the head or slamming into each other, but it's certainly not a no contact sport, right, or something where you can't get injured. And I know people think about knees, but is concussions a big deal? Well, obviously concussions is a big deal in soccer. So let's talk a little bit about that. What can you tell us about concussions in soccer?

0:01:05 - Thomas Ozbolt Yeah, when you think about youth sports a lot, I think the first thing that everyone's mind goes to when they think about concussions is football. It's like, oh, that's so dangerous, and you know they're just running into each other and smashing each other and you know, if you think about football, it just catches a lot of strays there and soccer just manages to scoot by because people aren't getting tackled in the true sense of the word. They have their slide tackles and stuff. But this is another sport where concussions are a significant concern. Football gets the headlines because, due to the nature of the sport. Soccer has its own risks, especially you're talking about heading the ball, whacking your head on a ball that's coming in 50 miles an hour, maybe faster, or collisions with other players, the ground, goalposts.

0:01:45 - Shane Smith I was gonna say soccer has evolved over the last 10 or 15 years where it's just much-- everybody's better is what I'm gonna say. So 40 years ago when I was a kid, it was sort of new, at least in the States or where I live, so the skill level was much, much lower. Now, I mean soccer's everywhere. Kids have played soccer from the time they're four years old, all up to high school. So that's 10, 15, 12 years of you know coaching, so they're much better. I mean travel leagues, all that kind of stuff. So as the skill level rises, my guess is the risk of injuries goes up significantly because the players are better.

0:02:20 - Thomas Ozbolt Yeah, you think about what we talked about before: bigger, stronger, faster. And you look at old videos of soccer and Diego Maradona. He looks like he's about 40 pounds-- well, maybe not 40, you know somewhat overweight guy scooting down the field. You look at the guys now running around like gazelles. It's just a whole different game. A whole different game.

0:02:36 - Shane Smith And as they get faster and stronger and their techniques improve, injuries goes up.

0:02:44 - Thomas Ozbolt Yeah, it's right up there. It's among the leading sports with concussion rates in youth athletics, along with football, basketball and hockey.

0:02:51 - Shane Smith Anything they're talking about, any specific measures coming up in soccer to sort of deal with this?

0:02:56 - Thomas Ozbolt Yeah, there's been some efforts to make the game safer. For example, one of those is US Soccer. They implemented guidelines that prohibit players 10 and younger from heading the ball. Okay. And also limits the amount of heading in practice for those between the age of 11 and 13. This is for the purpose, of course, of reducing those head impacts that could potentially lead to concussions. And, along with that, there's a growing emphasis on education, like we talked about with coaches, players, parents about recognizing those concussion symptoms and the importance of proper recovery before returning to play.

0:03:29 - Shane Smith Now soccer, unlike football, which is, I'm going to say, mostly in the United States played. You know, soccer is played all across the world. Is any area doing a better job of concussion management, or is it just sort of there's room for a leader to come by and say, hey, let's make it safer for everybody, or how's that come into play?

0:03:49 - Thomas Ozbolt Yeah, I don't know that we have the data quite yet to know for sure. You would think that you know maybe the United States, because we have some guidelines that are in place. But you just got to think about is there reporting in countries where there's not as much capability to do that reporting and get that data to somebody who's going to collect it?

0:04:09 - Shane Smith So yeah, I guess ours is more centralized, or more, I'd say, we just like more data.

0:04:14 - Thomas Ozbolt Yeah.

0:04:15 - Shane Smith I mean, you know, for lack of a better word. So there's no, it's not like we can say, hey, in Argentina they're great at managing concussion of their players. So there's no clear leader. So it looks like it's an opportunity for the United States to sort of establish those hard lines and say, yeah, this is what we think the world ought to do. Yeah. So we've talked about in football, you know, in the NFL in particular, you know, if they think somebody's got a concussion, they're pulling them out through the NFL protocols. And some of the Heads Up programs that they're pushing out through youth football. They're saying you know, if we think you've got a concussion, you shouldn't play. Is that trickling down to youth soccer as well, or is it just not there?

0:04:52 - Thomas Ozbolt Whether it is or not, I think we're going to see over the, you know, the coming years. I think what everybody's really concerned about is ensuring that athletes can enjoy the sport they love while minimizing that risk of injury. But the focus needs to be on health and safety and having those measures in place like educating about concussions, the safer play rules. And just fostering that culture that we talked about with football, that takes player well-being and, you know, their future as as being more important than, you know some outcome of some minor game, whether it's football or on the soccer pitch.

0:05:23 - Shane Smith And I would feel like probably, as, you know, the professional soccer leagues have got continue to develop and grow, we're gonna see more of that safety come into play because soccer is treated as a more serious sport as opposed to when there were no pro leagues, or they're very small. It's just not the money and attention and focus on it.

0:05:42 - Thomas Ozbolt Right. Yeah, as it continues to grow, I think we'll see even more, things get more systematized, more centralized in terms of data collection and just probably, as leagues grow around the country, we'll just probably get more and more data to help influence what we do.

0:05:57 - Shane Smith All right, now legislation, any governing bodies or even sports associations pushing anything down for soccer, or is it still in the developmental phases right now?

0:06:09 - Thomas Ozbolt Yeah, it's a, it's a little bit broader than than just soccer alone, but since 2009, every state in the United States has passed legislation that's aimed at protecting young athletes from the dangers of concussions. These laws are focusing on three components. We've basically mentioned those, first one being education. Second one immediate removal from play if the concussion is suspected, and not allowing a return to play without medical clearance.

0:06:33 - Shane Smith And are they pushing a lot of guidance for coaches and parents and referees on, hey, this is a suspected, you know, these are the criteria for a suspected concussion? Because, to be honest, when I was a kid, the whole criteria was, can you, you know, how are your pupils? That was it. I mean, that was really all anybody ever talked about or was on TV. So what are we doing to to help with that?

0:06:54 - Thomas Ozbolt Yeah, I think they're trying to educate, you know, stakeholders in different sports on things like that SCAT test that we talked about for the NFL. You know, just orienting, trying to get their orientation on where they think they are. Like, hey, where are you, what time is it, who are you playing, what's the score? Things like that can be where you're at, I mean, I played a little bit of soccer and the only thing that they'd check with me when I took a header and got my bell rung, they'd say, you okay, yeah, yeah, I'm good, like let's go, let's get play, yeah. So, uh, I think there's an effort to get some of the knowledge that the NFL has brought in terms of of those different assessments, to bring some of those to soccer and you know other uses.

0:07:36 - Shane Smith And how many questions you think would would be on one of those on a day-to-day you know kind of thing, if I saw a kid take a hit?

0:07:41 - Thomas Ozbolt Three questions. I think it's usually, I think we talked about before the Maddock's questions. And you know it's just getting that general orientation as a baseline. It's like, all right, where are you, who are you playing, what's the score? What team are you on? You know different things like that, or what are we doing?

0:07:57 - Shane Smith We could download that and we could put those together, but they're pretty simple. We could do a checklist like that. So if anybody was interested, they could just download it, say okay, this at least gives me a starting point on knowing if somebody's in the game or not.

0:08:07 - Thomas Ozbolt The workaround with that is, you know, you'll probably see one of our other videos. You got Julian Edelman and Danny Amendola from the Patriots talking about hey, you know, I got rung up in one game and you know Danny's running over to me and telling me hey, we're playing the Browns. You're down seven.

0:08:23 - Shane Smith Here's the cheat sheet.

0:08:25 - Thomas Ozbolt Yeah, I just see-- so there's, there's ways to work around that, enterprising youth will certainly find.

0:08:31 - Shane Smith And I'm sure they will. It makes me think, years ago I was at a youth and the kids were really really small and uh, I showed up because it wasn't my kid and they, I said, what's the score? And they're like, well, they don't keep score at this level in the league because we just want the kids to play. And then I said something to one of the kids and they immediately told me the score and told me who won. And they knew every-- you know what I mean? The parents aren't keeping score with, but they all are. Yeah, that's right. So you know there's going to be a workaround that the kids will do, but certainly it's, it'd be a start. That's what I say. At least they got to work around it, that's what I'll say.

0:09:00 - Thomas Ozbolt Yeah, they got to have the wherewithal to actually, you know, be there enough to work around.

0:09:05 - Shane Smith Have their buddy fake the answer. I know we're all worried about, you know, kids and concussions, or at least we're very worried about it, and I know parents are worried about youth safety. We've got laws, guidelines. Do you think there's ever going to be a spot where we're going to shift over to, you know, if we're in doubt, you know, pull them out of the game, basically like the NFL has. Or do you think that's not going to happen?

0:09:28 - Thomas Ozbolt Yeah, I think that whole phrase we hear when in doubt, sit them out. It's simple, powerful. It's a guideline that emphasizes erring on the side of caution when it comes to head injuries. It means that if there's any suspicion of a concussion, the athlete should be removed from play immediately and not returned until cleared by a medical professional. I think that's crucial, because the signs of concussion can be subtle, may not be immediately apparent, but if you adopt this mantra and this kind of you know motto for life and sports, coaches and parents can play a crucial role in preventing further injury, including tragic things like what we talked about earlier with second impact syndrome.

0:10:07 - Shane Smith That's what I was going to say. This is exactly like that. Second impact syndrome would all be prevented. If we were questionable, we pulled the kid out. They weren't another-- now, obviously hindsight's 20-20 or you know, Monday morning quarterbacking or whatever, but I think that's where we need to get to. When in doubt, pull them out, you know, or let them rest and get checked out by a nurse or a volunteer nurse or some, you know, somebody who can make that call other than just the kid themselves.

0:10:31 - Thomas Ozbolt It's like, what's the worst thing that happens if you pull the kid out? I mean that's, I think that's a good question to ask. What's the worst thing that happens? You miss a couple plays and they go back. What's the worst thing that happens if you keep them in?

0:10:42 - Shane Smith Right. A lot of people worry about it, you know, concussion protocols, and regular folks I'm gonna say coaches, parents, you know implementing these. Where do the medical professionals come into play? I know we talked a little bit about Dr. McDonald from the American Academy of Pediatrics as a medical establishment on board with this so they're fighting it, what do they say?

0:11:01 - Thomas Ozbolt Dr. McDonald, he's had some interesting comments and it brings an interesting perspective to the situation. He's someone who's both a physician and an attorney. He's expressed concerns about the potential for concussion laws to create unrealistic expectations. And with that, he worries that, even with proper evaluations and treatments, athletes might still experience complications from concussions, and this in turn could lead to a situation where medical professionals, they're seen as being responsible for any adverse outcomes, potentially resulting in medical malpractice cases.

0:11:33 - Shane Smith So, like we talked about earlier, I'm the doc on the sideline. The player gets a workaround by his buddy, and then I say, okay, you're cleared to go back on the field, and then you get second impact syndrome or something else happens and it's made worse. Now it's like, well, why, doc, why didn't you catch it, right? Is that what he's worried about?

0:11:51 - Thomas Ozbolt Yeah, I think you see situations like that, or in the instance of one of these other young men who suffered tragic consequences on the field. It's, you know, maybe one of them, it was the initial traumatic brain injury that caused it. It's hard to really put a finger on that, and if the doctor's being blamed for that, it just gives us that idea of that balance that we're looking at.

0:12:16 - Shane Smith I was gonna say, yeah, so he's concerned about concussion laws. Everybody's concerned about and, like we said, you don't overrule it, basically, and and take all the, suck all the joy out of sports and get rid of that, because I think we all agree it's great for our children. So what's the next step I guess, or where are we at?

0:12:34 - Thomas Ozbolt Yeah, I think if we just keep going back to that thought of having comprehensive education and training for everyone involved in youth sports, and that's not just in recognizing and responding to concussions but understanding the nuances and limitations of medical evaluations and the unpredictability of recovery processes.

0:12:56 - Shane Smith So sort of like the medical malpractice laws, you know, a lot of the medical malpractice laws, there's an emergency room sort of escape hatch. It says if it's in the emergency room they're given a little bit of leeway and bandwidth because they don't have a lot of options. Same as like a coach or a nurse or somebody out on the side of the field. They don't have all the tools in place to do a full diagnosis. They've got what they've got. So I mean, the law shouldn't be used to penalize that person.

0:13:17 - Thomas Ozbolt Right yeah, it's just creating that culture of safety that respects the complexity of brain injuries.

0:13:22 - Shane Smith And understands it's not an easy thing to diagnose. I mean, I would say even doctors struggle to understand the complexity of a long-term concussion or a brain injury, which is why you sometimes hear well, you just have a concussion, even from medical professionals.

0:13:34 - Thomas Ozbolt And then the advances that we have in terms of what we're learning every day. And you know it's hard, you would think that everybody would be up to speed on that, but you know, you see it all the time. It's, everybody has a responsibility to have continuing medical, continuing legal education, but does it always turn out like that in practice in terms of what people should know and do know? No.

0:13:53 - Shane Smith And I think concussions, as we've discussed, everything we've learned is growing so rapidly and quickly. If you're not an expert in this area or don't spend a ton of time on it, maybe you didn't take the CLE that talked about concussions this time. And if you're a primary care doctor, maybe you just took a class on what you see a lot of, I mean broken arms or-- yeah. So just because they've got continuing education doesn't mean a continuing concussion education this year or in the last five years, right?

0:14:19 - Thomas Ozbolt Right, yeah, I don't know that there's any specific requirement broken down into subject matter. So it's, you know you satisfy your continuing medical education credits and you know you might never have to touch neurology since you looked at it back in med school in 1988. So now you're working off science.

0:14:36 - Shane Smith That's 35 years old, right? And I know when my wife was a nurse she talked about sometimes, you know, they have a stat delivery coming in and there's no labor and delivery doctor on site. They just ring for a doctor. You could get a you know a cardiologist, who he's a doctor or she's a doctor, but they don't know anything about birthing babies. Yeah, that's wild. So it just comes right into this. Thomas, I know we've dug down into concussions and how they're managing it in youth sports. I think this is a key topic for you. I know you've got some young children. I used to have young children. For our listeners I think it at least gives them something to think about. And look at those five questions. You know it's just something that can be pushed out as we continue to sort of dig into this and and talk about things that are coming up. For all of our listeners. This is Mind Matters: Navigating, Head Injuries and Concussions. If this is a topic that interests you, hit like and subscribe and hit the bell down below for notifications and remember, if you're in pain, call Shane 980-999-9999.

0:00:09 - Shane Smith
Hey, Shane here from Shane Smith Law. We're here today at Mind Matters: Navigating Head Injuries and Concussions. I'm here with Thomas from the Concussion and Brain Injury Group here at Shane Smith Law, and we're going to be talking about youth sports safety. Basically, if you heard on one of our prior podcasts, we talked about the NFL concussion safety protocol. Now we're going to be talking about how it sort of trickles down into youth sports.

0:00:31 - Thomas Ozbolt
Yeah, thanks for having me, Shane. It's really important to keep having these conversations, especially when we're talking about concussions and youth sports.

0:00:38 - Shane Smith
And I know, that's become a bigger thing over-- and you know repeatedly it becomes a bigger thing. I think we're just-- I don't think they're more frequent. I think it's just more aware of it.

0:00:45 - Thomas Ozbolt
Absolutely, and today, you know, we're focusing on concussions. It's a increasingly concerning issue as our young athletes get bigger, faster and stronger.

0:00:55 - Shane Smith
I was gonna say, I think, I think that is documented that the athlete, the kids, are bigger and stronger nowadays, or, or maybe training's better, or nutrition is better, I mean all of that, but they're, they're hitting harder than they used to right?

0:01:05 - Thomas Ozbolt
Definitely. Definitely. I think we're seeing that charted out in lots of different ways all across society. I think one of the biggest issues when we're looking at youth sports and concussions is the second impact syndrome.

0:1:17 - Shane Smith
What is that? And why do we need to worry about it?

0:1:20 - Thomas Ozbolt
So sudden impact syndrome occurs when an athlete suffers a second concussion before the first one that they had has fully healed. This can lead to catastrophic outcomes, including cerebral swelling or even death. It can be pretty rare, but when it does happen, the mortality rate is about 90%. Terrifyng.

0:01:40 - Shane Smith
Holy cow. So that's awful for our kids. And unfortunately it's not like there's a red light, green light, right, that says you're totally healed and now you're not. I mean, that statistic is scary as can be. I mean it's hard to really, I mean even think about that, I mean because all the kids in sports. But it's not just numbers, I mean these are real kids, real people. I think there was Chad Stover's case out in Missouri this year. What happened there?

0:02:02 - Thomas Ozbolt
Yeah, Chad Stover. He was a high school football player who sustained a brain injury during a playoff game. He was hospitalized and tragically passed away two weeks later. And that kind of started to underscore the dire need for immediate and cautious handling of any head injury that happens on the field.

0:02:20 - Shane Smith
And obviously, we know, big game. I'm sure he had pressure, wanted to play. I'm sure his family wanted him to play, coach, I mean, obviously nobody wanted this to happen. But he's not the only one that happened this year, right? I mean, didn't someone get injured in Arizona as well?

0:02:34 - Thomas Ozbolt
Yeah, there was a young man, Charles Youvella, from Arizona. Another heartbreaking story. He was tackled and his head hit the back of the the ground really hard. He stayed in the game for two more plays, but then collapsed and passed away three days later. Just another poignant reminder of why athletes need to be removed from play immediately after a head injury.

0:02:56 - Shane Smith
Which is why the whole NFL concussion protocol came up, right?

0:02:59 - Thomas Ozbolt
Right, exactly. Just looking at these tragedies and trying to find a way to prevent them from happening, because it's a tough thing to know when one of these things has happened sometimes.

0:03:11 - Shane Smith
I know the kids just like professional athletes that want to play. I mean, nobody wants to sit on the bench and rarely does somebody want to, I mean, even for medical reasons, everybody wants to play, right?

0:03:19 - Thomas Ozbolt
Yeah, you just feel like you've done something wrong if you're not out there with the team.

0:03:23 - Shane Smith
And I know you were telling me before too there was another child. Another one. What was it? Damon Janes?

0:03:27 - Thomas Ozbolt
Yeah, Damon Janes. He lost consciousness after a helmet-to-helmet collision. You know, one of those big things you always see when you're watching on TV oh, helmet-to-helmet, immediate flag. People are like, oh, that wasn't that bad. But here, you know, Damom, helmet-to-helmet collision, got rushed to the hospital and died a few days later. And you look at that, you look at the protocols that have come into place, you know, his tragic death shows the need for strict protocols and immediate action after a suspected concussion.

0:03:54 - Shane Smith
And in all of these cases did everybody know they'd had the prior concussion?

0:04:01 - Thomas Ozbolt
In Charles' case, where he hit the back of his head on the ground and suffered a concussion, you know, played in two other plays, and, you know, he had suffered the concussion on the first hit and then essentially got dinged up again on the second one and that was what took him.

0:04:13 - Shane Smith
So the biggest issue is not so much I had a concussion on Monday, I think I'm okay, I'm going to go play a week or two weeks later. It's when they have a super hard hit where a concussion is likely and they're not pulled off the field or evaluated for the concussion. It's just sort of the, "you doing okay, you're okay," kind of deal, back into play, is that?

0:04:33 - Thomas Ozbolt
Yeah, it's, you know, having the, the wherewithal, the spotters on the field, a staff that's identified to see the signs of a concussion, to get someone off the field. Because this can happen like that. It's, it's not like the concern is weeks or days down the road. The concern is immediately after this game. Yeah, this game, this 10-minute chunk of life.

0:04:54 - Shane Smith
When we don't deal with these, we see the tragic consequences you know, which is I mean these kids' lives are cut super short. What are the assessments? I know the NFL has done their, they have their concussion protocols. What are, what have we got in youth sports?

0:05:06 - Thomas Ozbolt
Yeah, there's several measures that have been put in place or several things that we can do at the youth sports level to prevent tragedies like this. First, an obvious answer is education, you know, it's your education awareness, but coaches, players, parents being informed about the signs of concussions and the risks of returning to play too soon. So it's not something that's brushed under the rug or thought to be insignificant. So that's kind of the first step. From there you think about access to medical professionals like athletic trainers or neurologists at games and practices. That can make a significant difference in immediate concussion assessment and management.

0:05:41 - Shane Smith
I think the key, like you talked about, is coaches, right? I mean coaches and assistant coaches or somebody on the team paying attention. And like in the Army, on a range, you can, anybody can call a safety issue and get everybody stopped. Now it doesn't happen often, but something out on the field, I guess, to say, hey, let's slow down and pay attention, this kid got hit really hard. How do we balance this out right? I mean, obviously sports has tremendous benefits to children, to youth, you know their development and responsibility and all those things. How do we balance that versus, you know, the risks of injury?

0:06:14 - Thomas Ozbolt
It's one of those hard decisions that I think every family has to make because, you know, with every increase in safety you have, you know, an increase in, you know, I guess you could say freedom, you know, in people's ability to participate in different things that they want to participate in, because nothing can be completely safe, right? So you know, it's one of these things where, if we have responsible participation by the different individuals who have a stake in all this, then you can assess things as they go and start to, if there's responsible management of the process and responsible look and education about what the significance of concussion for a young athlete can do. It would mean maybe some more expense, maybe some more care taken, but I think that's a way that you can start to balance it, because I mean, you could put everybody in bubble wrap and everything would be really safe, but then everybody would be wearing bubble wrap.

0:07:11 - Shane Smith
And I know from the youth perspective usually they're very resistant to any new stuff. And I can remember when bicycle helmets became new and thinking I didn't need a bicycle helmet when I was a kid, I mean we jumped, we did all kinds of stuff with no helmets and then it shifted over. But I even remember that was seatbelts. Yeah, I mean there was all this resistance to seatbelts. So I'm aware of the balancing aspect and we don't want to coddle our kids, but we also don't want to put them at unnecessary risk. For me it seems like, like you say, some kind of culture of awareness out on the field. And I don't know who should play that role.

0:07:46 - Thomas Ozbolt
The NFL has kind of led the way to an extent with its visibility in terms of improving their protocols. You know, which we talked about before with the sideline neurologists, in-game monitoring. On the other hand, with youth sports, you know you don't always have a large governing body, you know that's responsible for all, you know, travel teams, recreational sports, school sports. You don't really have that kind of governing body that you have with the NFL that measures, you know, the biggest game in the world.

0:08:13 - Shane Smith
And you don't have the money either, right? I mean, I know a lot of rural programs or small schools, they don't have any budget to do it. So I mean it's like how do you do this, right?

0:08:23 - Thomas Ozbolt
It's hard enough to get equipment to play football. I mean, you have pads, you have helmets, you have-- there's a lot of things that, you know, soccer, all you need is a ball. You don't even need shoes. It's a much more expensive sport. So youth sports, particularly with football, they're lacking these comprehensive measures and that leaves decisions like this in the hands of non-medical personnel like coaches, which can be problematic. I mean, we've probably, I've had a coach in the past, "Oh yeah, you just got your bell rung. Get back out there."

0:08:50 - Shane Smith
Get back in there. Well, certainly if you have a coach who's been around a long time, that was sort of the prevailing model, right? If you can get up and run and you say you're good to go, you're good to go, right? I mean, that's sort of how we grew up. I mean I'm thinking about even in martial arts and all of that. I mean, kick to the head, it's, you good? You're back out on the field, which is what they were doing, they do here. Has the government done anything? Have they come up with any programs to encourage the safety and awareness out throughout the high schools? I know the CDC some stuff.

0:09:19 - Thomas Ozbolt
Yeah. So there's been some, some frameworks, both legally and policy wise, that have been established at state and national levels. When we talk about clear, enforceable guidelines, those can support coaches and organizations in making the right decisions for their athletes' health. In terms of specific programs, we've got the CDC's Heads Up Concussion and Youth Sports Initiative and also USA Football's Heads Up Football Program.

0:09:46 - Shane Smith
How are these helping, I guess, coaches at the high school level, or even younger?

0:09:50 - Thomas Ozbolt
Yeah, so this is an example of a government entity taking the initiative to educate coaches, parents and athletes about concussions and use sports comprehensive sort of vision with it. For the CDC, it's something that provides resources to help recognize, respond to and minimize the risk of concussions. One of the key components there is educating the different stakeholders on the signs and symptoms of concussions, and part of that is ensuring that anyone with a suspected concussion is immediately removed from play.

0:10:20 - Shane Smith
And I know that's-- like we've talked about, that's super tough for a coach. I mean, your star player, you know, takes a hard hit. I know you want to err on the side of caution, nobody wants anybody to get hurt, but you also want to win. I mean, so are these programs, are they pushing out, hey, these are all the signs and symptoms of a concussion. This is everything you need to be looking for to sort of make it simple or I don't want to say dumb it down, but I mean simplify the process. So I'm like, oh, you got some warning signs.

0:10:47 - Thomas Ozbolt
It's putting some of what we know and what the NFL has implemented out there in terms of having resources for people and getting it out there and raising awareness about it. One of the biggest challenges implementing these guidelines at a grassroots level is, like you said, there's rural areas. There's, you know, all these counties all over the country that have different levels of, you know, of programs, right.

0:11:10 - Shane Smith
Yeah, programs. Some have a coach and that's it. Sometimes the coach is a volunteer, even. Yeah, I mean, so they're not getting paid anything, so they don't have any money. So I mean making it easy for them to identify and say, okay, hold on, we need to slow down, is really what's needed out there right?

0:11:27 - Thomas Ozbolt
Yeah. And then you talk about awareness. Yeah, awareness is great, but if you don't have any action, I mean, what's awareness worth? It's like, oh, I know about it, but what am I going to actually do about it? We have that awareness. We have to make sure that awareness is getting translated into action, like having a proper medical evaluation or adherence to those return to play protocols. And that's a hurdle.

0:11:36 - Shane Smith
And you know, just sitting here and thinking about it, I mean it seems like the referee bodies would be a good area to push it down to, because they're supposed to be neutral, right? I mean, and I hate to say it, but it seems like everybody hits the ref anyway, at least when they make calls against your team. It seems like that might be an opportunity. You know, another area instead of just the coaches who have a vested interest in their team playing, you know, maybe the refs have the ability to, I don't know, do a medical hold or something on it. I don't know if that's something anybody's looked at or not.

0:12:12 - Thomas Ozbolt
Yeah, maybe put another one on the field like a independent, similar to what they have in the NFL with an independent evaluator. But let's put a ref on the field who's in there, close to the huddle, like some of the other ones are, just keeping an eye on things. That could certainly be something that you would think would be effective.

0:12:31 - Shane Smith
And hopefully fairly cheap. That's what I was thinking about, for, you know, poor coaches. Now we talked a little bit about some of the other programs. I know USA Football's got a Heads Up Football Program. What's that about?

0:12:41 - Thomas Ozbolt
Yeah, it's-- this program by USA football focuses specifically on the sport of football. And it aims to make the game safer by educating coaches on proper tackling techniques, equipment fitting and, of course, concussion recognition and response protocols. This is a more targeted approach and it includes certification for coaches and it emphasizes safer play through education and practice. And it's a partnership with the NFL, so that gives it more visibility and resources. But, like the CDC initiative that we talked about, it focuses heavily on awareness and education without having these clear, actionable tools for actually putting these things into practice. So you have a gap there again between knowledge and action.

0:13:24 - Shane Smith
And it sounds like some of the focus on this is on prevention of concussions by teaching better and safer tackle protocols, right? Yeah. And it's funny, I was actually talking to one of my kids and they were talking about they had an old school football coach who had done wrestling, so they taught them to tackle differently than one of the other coaches had done, which, after talking to him, is actually a safer way, which sounds like I mean, I don't want to give him credit for it, I don't want to do, but it sounds exactly like what this program is trying to teach the coaches to do.

0:13:56 - Thomas Ozbolt
Yeah, I think you can even see it in the name of it too. You know the Heads Up, you know, you don't want to attack with your head down. That's where you see a lot of the injuries happen. It's like leading with your head, you know, keeping your head up, kind of leading with your shoulder, and you know, when you talk about that it's a--

0:14:10 - Shane Smith
It's a good, I don't want to say it's a good, easy way, but it takes away the, I'm going to make the call, does he have a concussion? Let me pull him out because we're teaching safer fundamentals to still do the sport everybody loves.

0:14:23 - Thomas Ozbolt
Exactly yeah, starting at the ground level, it's building up those practices the right way.

0:14:33 - Shane Smith
We talked about targeted education and practice. That seems like the key things to this program and any other program as implementation. Have they been successful? Do we have any data on that?

0:14:41 - Thomas Ozbolt
Well, so, there's evidence to suggest that education and proper tackling techniques can reduce the risk of concussions. But again, the success of these heavily depends on consistent and universal adoption across teams and leagues, and, you know, I don't know that we have a lot of data on that. We have all these leagues and then actually having it implemented and then report it back to a data collecting, for instance.

0:15:07 - Shane Smith
And it's hard to disprove a negative right? You didn't have a concussion, so everything went well. But it's also, it would seem like then, if we push out all this education on how to identify concussions, you know, the rate of concussions is going to spike in all the games, but not because it's any worse, but just because we're identifying it and responding to it appropriately. So disencourages anybody to do it, because now suddenly we're in an unsafe or it's dangerous. responding to it appropriately.

0:15:30 - Thomas Ozbolt
Yeah, it almost creates a false perception of what's going on. It's like you hear with the news people are like, oh, there's so many tornadoes, there's so much all this bad stuff going on all over the world. It's like, well, we have 50 different news channels, right, nothing changed, we're just reporting it more. Same with the concussions. Yeah, everybody has a news camera in their hand now and yeah, of course there's going to be more, because we have more visibility of it.

0:15:53 - Shane Smith
Right. So all right. So we, we know they are pushing these programs out. We know USA Football has got the Heads Up program. You know it seems like the only way for it to work is, like you say, adoption throughout all the leagues, consistency, pushing this over and over. But we don't know how we're gonna get any data, basically. I mean, or we don't really know how it's gonna be effective or not, other than, I guess, less of these tragic deaths. Is that right?

0:16:15 - Thomas Ozbolt
Yeah, it's you know, go ask where we see in those those gaps between the concussions being managed and having prevention. And one of the things you can see with all that is like, even if we had the data all the way across the board in terms of it being reported, what are we going to do about having immediate on-field medical response? There's not the resources. You think, at youth level, every high school game across the country, to have medical professionals there at games, and not just games but at practices.

0:16:44 - Shane Smith
Yeah, I was going to say practice is a whole other can of worms, right? Because even at a game you say you've got to have an ambulance or something which I've seen at some games. Are you gonna make an ambulance be at every practice? I mean that-- pretty soon it seems like some of these less, less wealthy counties and they just have to close down the program.

0:17:03 - Thomas Ozbolt
Yeah, you don't have the resources, so it's, well, we've got, you don't want to choke out the goodness of the game and the goodness of sport by having too many regulations, but at the same time, it's so, well, how do we figure out something like a compromise? How do we bridge this gap? We just need more objective tools in terms of perhaps just having people screen on the sidelines or on the team to have these sideline concussion evaluations that can support those without medical training.

0:17:30 - Shane Smith
Right. So at least it would be like check, check, check looks like you're good to go. At least there's some assessment, some evaluation by somebody to encourage you to slow down a little bit I guess. Yeah. Key takeaways you would give to coaches, parents around this area. What would you say?

0:17:48 - Thomas Ozbolt
Yeah, I think, just the importance of education, proper training and having clear, actionable protocols in place and creating a culture of safety where the well-being of the athlete is paramount. Not, hey, you know, winning some Pop Warner, you know, quarterfinal game. It's, let's think about, you know, little Timmy 5, 10, 15 years from now, and the person he's going to be and the life he's going to have. And everyone who's involved in youth sports, whether it's coaches, parents, leagues and the athletes themselves. They all play a role in making it safer. But advocating for the resources and policies that best support the best practices of concussion management and prevention, that's crucial. It's just getting everybody to buy in, getting everybody to realize the issue and just go with it.

0:18:37 - Shane Smith
And you know, obviously we're highly concerned about concussions and brain injuries because that's what we see every day and we talk to people who have suffered, you know, serious concussions and brain injuries. So we talk to them or their families and they've got personality changes and the long-term impacts. And that's one of the reasons why I think you know you're so passionate about, hey, parents need to take at least take a look at this and understand a little bit. Nobody wants to get rid of football. We just want the kids to be safe, right?

0:19:03 - Thomas Ozbolt
Yeah, you see people's lives transformed. They're one person one day and then the next there's somebody who nobody even recognizes, not even themselves. I don't know the person who I've become, but I know it happened because of this brain injury I sustained, and you think about the tragedy of that happening to a child.

0:19:16 - Shane Smith
I know, Thomas, we're super passionate about it because we spend all day looking at concussions and brain injuries and we talk to families of people who've had brain injuries. And one of the things they say is that personalities change and all that. What do your clients say about that?

0:19:31 - Thomas Ozbolt
Yeah, when you think about what happens to someone when they have a brain injury and they talk about everyone around me, they think I'm a different person. And I even think I'm a different person in terms of you know who I am before this happened and who I am after the brain injury. Seeing that transformation and seeing the devastation that it does to the life of the person it affects and everyone around them. And then you think about that happening to a young boy or a young girl, you know Timmy or you know Josie, whoever it may be and think about what was taken from them and what could have been prevented with just a little bit more care and a little bit more attention to the lives of the most innocent among us. And so that's what I'm passionate about. It's like making sure that things that are tragic and life-changing if we have a way to prevent them and keep them from happening, that we do everything we can to do that. I think that's one of the duties that we have.

0:20:21 - Shane Smith
Without taking away from the joy of the sport, right? I mean, it's like, helmets didn't destroy bicycles, right? Right. I mean, or having to wear a helmet while you ride a motorcycle doesn't make it not fun. And they still do all the kind of things on regular bicycles that they used to do, I think, and they're just safer and they wear a helmet and have less deaths.

0:20:42 - Thomas Ozbolt
We don't have to regulate sports to death. We don't have to become overly, you know, hands-on control-freaks, but all it takes is a little bit in terms of, yeah, ounce of prevention is worth, you know, 10 pounds of cure. In this instance, it's just taking a little bit more time focusing on what's important, and that's the lives of our children. That's all we need.

0:21:05 - Shane Smith
So, Thomas, thanks for being on the show today. I know we talked about youth football today and I think in another episode we're gonna be talking about how it impacts other sports, particularly soccer, I know, is on the list. For anybody out there, this is Mind Matters: Navigating Head Injuries and Concussions. If you enjoyed this, hit like and subscribe and hit the bell down below for notifications and remember you're in pain, Call Shane 980-999-9999.

0:00:08 - Shane Smith
Hey, Shane Smith here with Mind Matters: Navigating Head Injuries and Concussions. I'm here with John Mobley from the concussion and brain injury group here at Shane Smith Law, and, John, we're gonna talk about basically how to pick out a car, the safest car for yourself, right?

0:00:22 - John Mobley
That's right. So we wanted to kind of focus today's chat Shane on what sort of vehicles and what features that people can keep a lookout for when they're picking their vehicle, to keep both them and their family members safe and to try and reduce and minimize injuries to the greatest extent possible.

0:00:47 - Shane Smith
Now I know, years ago my mom used to always look at consumer reports and whatever that said the safest car was that's it. But I know we're going to talk not just about cars but also features inside of the cars, right? Absolutely, yes. And is there a clear winner?

0:00:55 - John Mobley
We work sometimes with some outside referral attorneys and, in some cases, products liabilities attorneys, and one of the major brands that they've said has been just far and away the best from a safety feature standpoint throughout the years is Volvo. Ah, the little car brands I know.

0:01:14 - Shane Smith
I say that just because that's what my mother used to drive and she always harped on Volvo over and over and, to be honest, they were never my favorite car, so I was hoping you were going to sell me something else.

0:01:26 - John Mobley
Yeah, unfortunately that's the one. I too inherited a very old Volvo from my parents with the same thing, they wanted to keep us safe back in the day.

0:01:33 - Shane Smith
Yeah, and I just never loved the body style of that car compared to my little BMW or my little sports car, which I'm sure is not as safe as the Volvo.

0:01:50 - John Mobley
Nowadays we have a lot more data and information available, available for people making that decision. You mentioned consumer reports. Still a great one, because they factor a lot of some of these organizations that we're going to talk about a little bit later on into their uh, their, their safety top pick features. So a lot more information is out there now, because it truly does span the entire spectrum. One car is not created equal to another car brand when it comes to safety, and sometimes it's even hard to navigate because certain cars within a company may be safer than other models that the company makes.

0:02:22 - Shane Smith
And even similar style cars, this one can just be much safer than the other one, even within a company? Right. Great. So what's our first topic? And we're gonna talk about features, right?

0:02:32 - John Mobley
Yeah, absolutely. We've come a long way in the past few decades, and even beyond that, with adding safety features to cars that really help protect occupants and reduce the level of their injuries that they sustain. Because when we have cars that are traveling 30, 40, 50 miles per hour, and you have sudden impacts where you go from 40 miles an hour to zero miles per hour very fast, it exerts an incredible amount of energy and damages onto the bodies of the people inside those cars. And that's why we see our clients sustain concussions, brain injuries, just all sorts of things, whiplash injuries, things that really impact and hurt people when they're involved in these accidents. So one of the safety features that we see having a huge improvement in more recent models is just the glass that's used. It used to be a type of glass that would basically spider web and shoot shards everywhere.

0:03:35 - Shane Smith
I know I remember those days, I mean, and glass would be everywhere inside of a car.

0:03:41 - John Mobley
It just really compounds the injuries. These days, it's more of a laminate that's used. The glass is actually sandwiched in between some laminate. What it does is, when impacts occur to the glass, instead of breaking into a million pieces, it actually keeps all the glass together, protecting some of the occupants. Also, the material that the glass is made out of, actually, when like a head or a body part impacts it, it actually has better results in terms of injuries.

0:04:02 - Shane Smith
The glass itself is safer in the sense that it cushions it a little bit, I guess, and it keeps all the glass together, so you have less of those fragments coming in and cutting people and--

0:04:24 - John Mobley
That's absolutely right. And, and that's kind of one of the big things that we've seen advancements in, just to protect people in motor vehicle accidents.

0:04:25 - Shane Smith
Is it all the glass inside the car, all the windows, or is it just like the front windshield, or is it sides and back too?

0:04:31 - John Mobley
So for this specific type of glass it's mainly the front windshield. Okay. Some of like the side window glasses, they may have it, but I would imagine the majority do not. They're gonna break normally in the way that glass used to break.

0:04:46 - Shane Smith
Okay. After the glass, so we want this particular type of glass, which is pretty common now in windshields, right?

0:04:51 - John Mobley
Correct. Without a doubt, one of the biggest safety features added to protect people in high speed, low speed, moderate speed accidents is the introduction of the seat belt. Seat belt usage around the 1980s was about 17%. In the 2000s, it's up to 75%. So campaigns and the word has helped. Wearing your seatbelt does in fact save your life.

0:05:15 - Shane Smith
That and the dinging in the car right, ding, ding, ding, until you buckle up.

0:05:17 - John Mobley
Having that annoying alarm go off is, I know it reminds me, and I certainly--

0:05:23 - Shane Smith
Definitely does, and they've done a good job of programming our children too, because I remember when mine were younger, if they heard the ding, it was like, dad, you got to buckle up you know.

0:05:32 - John Mobley
And another thing as well is that in years past, just from a law standpoint, we've seen a lot of states introduce criminal statutes, traffic citation statutes, that basically say if you're not wearing a seatbelt we're gonna write you a ticket. It used to be a secondary offense and now it's even moved to even a primary offense where you can be pulled over for literally not having your seatbelt on, and definitely given a ticket if you are not buckling up your minors or some of your underage occupants.

0:06:00 - Shane Smith
Now, on a side note, I know that the seatbelts is actually an area where a lot of people don't inspect it after an accident, and it's something our clients definitely should. You should make sure the seatbelt's functioning. I know that there's some of the pendulums on the internal parts of it, in a high-speed collision those sometimes need to be replaced, even if they appear to be functioning 100%, because they're just made for one hit kind of deal. One severe hit, I guess, is what I would say.

0:06:27 - John Mobley
Shane, that's a great point that I didn't even include here. But you're absolutely right. After an accident like that, they should absolutely be inspected for things like fraying, any sort of malfunction at the lever or base point, but definitely the fraying too, because whenever you affect the structural integrity of the seat belt, it may not perform as well the next accident that you get in.

0:06:51 - Shane Smith
Right, exactly. So we got glass, we got seat belts. What's the next safety feature?

0:06:53 - John Mobley
So the big one is the head restraint. A lot of people know about some of the glass features and the seatbelt features. Something a lot of people don't understand is the head restraint is very, very, very important when it comes to what we focus on a lot here, which is brain injuries and whiplash injuries. Not only do you need to have, pick kind of the right head restraint, but you need to arrange it so that it's optimized for your body type.

0:07:24 - Shane Smith
And when you say head restraint, that's the pillow almost that goes right above the main seat.

0:07:29 - John Mobley
That's yes, that's right. Okay. And the reason that we see there's a lot of injuries with the head restraint or improper head restraint, is that, you know, number one: we still don't have, you know, adequate performance requirements, so manufacturers can make just about you know anything and it doesn't necessarily have to stop the head during rear impact.

0:07:51 - Shane Smith
Really? Okay. So there's no standard. I would have never guessed that.

0:07:55 - John Mobley
Number two: you know most of the restraints do not have vertical locking devices, which allows the restraint to collapse during contact with the head, which is very important as well. Of course the manufacturers just haven't done a great job educating the public on proper use. We always hear about, put your seatbelt on, I don't know if I've ever seen a commercial saying make sure your headrest is correctly aligned to your body.

0:08:22 - Shane Smith
And I know that's a huge thing, the alignment or the proper placement of the headrest, it's just never done. You know, they just get into a car and the headrest is in the wrong position, or they're, somebody was taller than them, and so it doesn't feel right. In the accident, rather than preventing injury, it almost exacerbates it or makes it worse, because it's there.

0:08:39 - John Mobley
If two different people are using like a driver's seat in a shared family car and one person is 6'2" and the other person is 5'4", it's going to need to be adjusted. You know, we'll have an image here that we can share with the viewers that basically shows what proper alignment looks like, and it should be where the seat lines up with your head and if it, if you deviate or change from that, then you actually will worsen your outcomes in a rear-end accident. And what that means is, more likelihood that you sustain a brain injury, higher likelihood you have cervical trauma to your neck, because it's because the head does not hit the seat correctly and at a different timing from the rest of your body, and that's how these injuries occur.

0:09:25 - Shane Smith
Also when adjusting it, I know there's stuff on YouTube nowadays that can show you how to adjust it. I also know a lot of police departments and fire departments will, if you come by and ask them to do a free inspection kind of deal, will adjust it correctly per I guess what the manufacturers, or what generally is known to uh, to position them correctly.

0:09:45 - John Mobley
Absolutely. Firefighter stations are a great resource. I know in a lot of communities they also will install child seats correctly for you as well, if you swing by.

0:09:54 - Shane Smith
I was gonna say, I laughed just because I remember the first time I tried to put a child seat in, it was not as easy as the book made it out to be, is what I would say. What about airbags?

0:10:03 - John Mobley
Yeah, so airbags are another big one. Obviously, some of the worst accidents we see in this firm and I've personally seen throughout my career is when we have clients that are involved in catastrophic accidents and they're in vintage cars or very old cars, vehicles that don't have those airbag safety features. Airbags are crucial to preventing terrible outcomes in high speed accidents. We've seen beautiful vintage cars just get crumpled like an accordion and no airbag deployment, and the injuries in those cases are always so, so, so bad. So it's definitely something you want to factor into your decision making process as a family, especially if you have toddlers, young children or you just want to keep everyone safe. You may want that, you know, '79 chevy corvette, but you may be better suited to get the, you know, the minivan. It's not going to be as cool but it will likely, if made you know later, like in the 2010s, have much more updated safety features to protect you in an accident.

0:11:13 - Shane Smith
And I've seen airbags even evolve over time, obviously like everything else. But I mean, in the beginning it's just a driver's airbag, then it was a driver's si-- you know, you and a passenger, and now they've got side impact and door airbags and tons and tons of airbags in cars to keep everybody as safe as possible.

0:11:30 - John Mobley
That's so true, the amount of airbags has quadrupled. Uh, you know, I've even seen airbags that shoot up in between people in back seats. What happens is that backseat passengers, when you get jostled and thrown around at 40, 50 miles per hour, you end up striking other occupants in your vehicle. And that's why it's also important going back to seat belts that everyone in the car is buckled up, because in a high-speed accident, if one person's unbuckled, they essentially become a missile traveling around the car, right, yeah, and it can injure and hurt other people, and a lot of people don't understand that. So not only do you want to keep yourself safe, you want to buckle up, you also want to make sure everyone else buckles up.

0:12:14 - Shane Smith
And that also goes for objects you might put in the back. I'm not saying ever you need to tie everything down, but I mean, if you have very dangerous objects back there, something to consider, do you have one of those throw up dividers or something else? Because I remember an accident where a Jeep rolled over and a shovel came over the seats into the front windshield.

0:12:23 - John Mobley
My driver's ed teacher back when I was 16 years old always liked to tell a story of a buddy of his who kept a Kleenex box in the back kind of window area of his car. Got into an accident, and the Kleenex box hit him in the back of the head at about 40 miles per hour. Oh wow! Don't leave stuff in the back of your seat folks. So that's just something to keep in mind as well.

0:12:50 - Shane Smith
Any other safety features we ought to be on the lookout for, or particular cars?

0:12:54 - John Mobley
Those really are the top ones in terms of safety. Now, if you want to dive deeper into how to find out about all the safety features, and from a trusted source, we recommend reaching out to nhtsa.gov or iihs.org. There are actual services that will rank these cars, rank some of the safety features. They actually conduct tests and grade the safety features so that you know us as just average consumers don't have to try and figure out all this stuff on our own. They'll rank them and then you can make the best possible decision.

0:13:30 - Shane Smith
And we'll make sure to put those in a link down below as well for any of our listeners who want to go check it out themselves.

0:13:37 - John Mobley
Basically, that is the full rundown of the the main safety features. Uh, we just wanted to kind of explain the, the one that a lot of people don't understand the head restraint. The head restraint I think is the key. Uh, if we can give the viewers one walk away, it's to, uh, make sure you're on top of your head restraint placement and to make sure you have some of those features we discussed.

0:14:00 - Shane Smith
And just to round up, John, the uh, the bottom of your head-- where does the bottom of the headrest need to be?

0:14:02 - John Mobley
It needs to be right at about the mid-level of your head.

0:14:05 - Shane Smith
Good deal. So check out your cars, folks. Make sure you do that, that's what I'll say. And if you've got car seats, have the firemen put it in, they do a great job. John, now one of the things we talk about is assuming you've done everything, assuming you've got the seatbelt buckled, you know, your car has airbags, your head restraint is is done correctly. You've got that situation where you're stopped and you know, oh no, there's gonna be a wreck. Either you see the guy or gal and you just know they're gonna go through that light or go through the stop sign. Or, worst case scenario, you're driving down on and the guy drifts into your lane and it's coming at you head on. What do you do? So you can't avoid the wreck, right? I mean, obviously, if you can, obviously drive out of the way, but if you can't, what do you do?

0:14:47 - John Mobley
Right, so we can do everything to prepare and be safe drivers, but sometimes we just can't control when someone is not paying attention, especially now that everyone's texting on their phones and, just you know, come up and barrel into the back of your car. But what you can do to mitigate your damages, both from a head injury standpoint and a neck whiplash standpoint, is, first, you want to look straight ahead. All right. Reason for this is that we see that whenever people are looking to the right, to the left, in some sort of twisted you know, contorted body position, we almost always see that the injuries are worse.

0:15:23 - Shane Smith
I've definitely seen that. I've talked to chiropractors and I've talked to orthopedists, who've all confirmed that, and they also have explained to me why sometimes what seems like a minor impact or not that big a deal, if they were looking to the right or adjusting the music or talking to their passenger that's why they're hurt so bad, even though on its face it looks like a minor accident, because the neck's not made to bend that way.

0:15:47 - John Mobley
That's right. The kind of the thought process there is that when you're, you know, twisting or extending your body out in an unnatural position, it's kind of putting it in a stress point and any sort of additional energy, like a rear end, is going to make the injury much worse. The second thing that you can do is basically place your hands flat against the wheel. Don't grip it, because this can result in shoulder injuries. And also there's a second type of whiplash called wrist whiplash that we see too, and a lot of times it's because people are just bracing too hard and unnaturally, exactly, on the wheel and what happens is that if you are too stiff and just gripping that wheel with a death grip, all that energy, once it goes forward, is getting transferred either to your elbow or to your shoulder and it's going to cause those extremity injuries.

0:16:42 - Shane Smith
And shoulders are delicate, is what I would say. We see a lot of shoulder injuries and sometimes those are teeny tiny muscles and difficult to diagnose and difficult to treat and difficult to repair. Like you say, as you're gripping it, there's nowhere for that force to go right, because your arms are tight and the shoulder is sort of the weakest spot there.

0:17:02 - John Mobley
Right, it's the end point for that energy. So unfortunately it would take the brunt of that energy transfer when you get rear-ended.

0:17:07 - Shane Smith
Don't grip the wheel, but what? Just put your hands on it?

0:17:11 - John Mobley
Yes, like a loose grip, where you're not either flexed or gripping it too hard, you're just kind of holding onto the wheel for stability.

0:17:19 - Shane Smith
Okay. But definitely don't lock the arms out. Correct. And you also don't want to lock the legs out. You want to, loose is probably the wrong word, but certainly have bends in them to absorb that shock.

0:17:30 - John Mobley
That's correct. And speaking of legs, this one's a bit of a harder one, but it's kind of the third thing that's recommended is that you put at least one of those feet on the brake. The reason is because when you get hit from behind at a high rate of speed, if that foot is not on the brake and then you either get concussed or knocked out and your car may be in drive when you're waiting for the light to turn green, your car could start moving. If there's two lanes and your last thing was you're waiting to take a left, so the wheels turn and you get hit and your foot's not on the brake, then you could be drifting into another lane and sustain potentially another impact from an oncoming car which, unfortunately, we see that a lot too in practice.

0:18:11 - Shane Smith
Definitely going to add complexity and increase your chance of being seriously injured in a second collision. All right, so we've got look straight ahead, loose grip with the hands, with some bend in the elbow, bend in the knees if you can, but with one foot on the brakes so that if something happens you're not drifting off into the middle of the road in another accident. So obviously this doesn't guarantee you won't be injured, but hopefully it will lessen your chances of being seriously injured.

0:18:37 - John Mobley
That's right, and that's the main goal. And you know, another one you can do is kind of be cognizant of where your head is. It's also recommended that you would put your head and back snug against the head restraint and your seat against the restraint, because when you're, you know, pressed against the seat, it's not additional movement going forward and back, and forces being exerted on your body. So that's something that can help people as well too.

0:19:02 - Shane Smith
To minimize some of that whiplash whipping of the head, I guess. Right. I think that's everything we've got to talk about today, John. Thanks for helping. I like the key points: fix your headrest, that's simple and easy. And if you're going to be in an accident, can't avoid it, try to be as loose as possible and looking straight ahead. That's correct. All right, for our subscribers: hit like and subscribe for more Mind Matters: Navigating Head Injuries and Concussions. And if you've got a question for John, info@shanesmithlaw.com. Always remember if you're in pain, call Shane. 980-999-9999

0:00:09 - Kiley Como
Hey everybody, welcome back to another episode of Mind Matters: Navigating Head Injuries and Concussions. Today we're going to be talking with John Mobley. He's one of our senior attorneys with our concussion and brain injury group. My name is Kiley. I'm sitting in for Shane today. I'm the firm's treatment coordinator and a registered nurse. So, John, let's kind of pick up and talk about traumatic brain injury from the family's perspective.

0:00:32 - John Mobley
Absolutely, Kiley. Thank you for that introduction. In kind of preparing for this podcast, we wanted to take a little bit of a different approach. One of the things we wanted to do is that basically just identify the fact that when a brain injury occurs to one of our clients, they're not the only person impacted, because immediately their family, friends, spouses, they get pulled into this injury as well, almost as if the injury can occur to them. And so what we want to do by virtue of this, this podcast is go over some of the things that could potentially educate the family member or the spouse of one of our brain injured clients so that they can just be better equipped and better prepared to know what to expect.

Because it is a very, very overwhelming process. From the moment the impact, the fall or the motor vehicle crash occurs, it is just a domino effect of all sorts of things that no one is ever going to be prepared for. You're in the middle of the process of shock, then grieving, then trying to get ducks in a row while being in shock and grieving, and it's just an immensely difficult, difficult situation for any person to be put in. So that was the main thing we wanted to do here is just kind of go over some of the things of what to expect so that people can be more adequately prepared. And just to kind of circle back for those people tuning in for the first time is that you know brain injuries, just a little background on them. You know they are highly, highly prevalent and common. About 1.4 million Americans per year are diagnosed or experience it, with a nice asterisk by that number because most are underreported or never reported. So we think the number is much greater.

The most common causes are, you know, falls, motor vehicle accidents, assaults, things like that. A lot of clients come to us for all those reasons. If the fall occurred because someone else wasn't doing what they're supposed to do, a lot of times those clients come to our firm for help. The impacts range from mild to severe. This whole story kind of starts in the, typically the emergency room when it's a bad accident, and that's kind of where we pick up here.

So the first category and segment we kind of wanted to jump into is the immediate aftermath and, you know, what to expect at what we've labeled the hospital phase. That's where maybe you get a call driving to work one day that your spouse or family member has been in a motor vehicle accident and you know they found in their wallet or purse contact information and this might be the first call you got. So you rush to the hospital. A million things are racing through your mind. You don't know what's going on. You have more questions than answers. It's a really jarring, shocking experience and traumatic experience for you know people to get that news. So once you get to the hospital, you know the first thing we want to point out is: who are the people you might meet?

You know, who are you gonna run into? Who is gonna be a part of your life for the next day to weeks, depending on how long your loved one is there. We call these people the recovery team. Typically it's gonna be, you know, one of the specialists you may see, depending on if it's a very severe accident, maybe the neurosurgeon, brain doctors, brain surgeons, very smart people. And you know, they may be the first person to have a conversation with you because they sit at the top of the totem pole for injuries like this. They're going to be the, the, the field general for the treatment for your loved one, making the biggest decisions really, surgical decisions. They will best be able to advise you on immediate outlooks. If your loved one is suffering some severe brain injury or potentially a life-threatening one, they're probably gonna be the one that breaks the hardest news to you as well. And those are difficult conversations.

We also will see a lot of times neurologists pulled in as well, brain doctors, they may not do surgery but they specialize in the nervous system, its disorders. We see them come in a lot once the immediate threat to life has settled down a little bit, that would be the neurosurgeon. And you'll have a lot of hard and difficult conversations but be able to get a lot of your questions answered with the neurologist as well when you say, well, are they going to be back to normal?

You know, it's too early to tell at that point. And any good neurologist will educate you on this and answer the family's questions, so that you can focus that time instead on grieving and being there for your loved one and working with them.

We also see a lot of these injuries will also have orthopedic aspects to them, so you may also interface with an orthopedic surgeon. There's any sort of, a lot of times when someone hits their head so bad on a steering wheel or a windshield, they have herniations in their neck, bulging disc, or they may you know experience fractures to the face, neck, anything like that. At that point you'd probably be talking and getting advised, especially if your loved one is not completely coherent or is still out of it. You may, depending on you know your ability or your, what sort of documents you have in place, you may be able to, you may be the one making decisions for your loved one. And then, beyond that, there's also the neuropsychologist. Neuropsychologists they basically specialize in, you know, people with brain injury and their behavior and the relationship between those things. And they typically come in a little bit later. They may be consulted in that initial phase, but they will come in later as well as
part of the assessing just how serious this brain injury is, and neuropsychologists have a large amount of tests and abilities to gauge just how bad the brain injury is. That might come later on, though.

Of course then you have nurses. That's probably going to be the people that you talk to the most. They'll be on the front line dealing with the patient and their injuries and dealing with pretty much every aspect of the care and answering questions. They'll probably be the person you get to know the most. Absolutely.

And then beyond that, we have physical therapists and occupational therapists. Once we've reached that point of, is the patient in a coma or threats to life, and once stuff starts to stabilize a little bit, then we kind of shift towards that therapy and what do we have to do to get them back on their feet? What do we have to do to get them back on their feet? What do we have to do? Do they remember how to walk? Was the brain injury so bad that they've lost motor function? And that's going to be a long process with the therapist to get some of that pre-accident ability back or even just for you know, baseline functionality so that you know they can actually walk out of that hospital, or do things or be able to know what's going on. Some of the other doctors that, or specialists that we may see on rare cases is like respiratory therapists.

Yes, believe it or not, the brain controls breathing. So when you hurt your, usually if respiratory therapists is involved, it means that the brain injury was quite severe and there's just no ifs, ands or buts about it. So it's one of those things where you just need to be prepared as the family members or the spouse, that, if you have, some of these doctors showing up, it means that you're in a very, that your loved one's in a dire situation.

And beyond that, we also see involvement with, you know, case managers and social workers. If the person, if they're deemed to not be able to take care of themselves or maybe they don't have that support structure and they need really like a government entity to step in and a medical person to step in, we see assignment of some of these social workers and case workers to help them navigate what's going to be a very difficult process moving forward.

And one of the final specialists that we see, Kiley, a lot, is the neuro-ophthalmologist. That's if the client or the patient is having vision problems, they will actually get sent to a special eye doctor that, you know, focuses on the interaction between the vision and the brain so that your loved one can get their vision back.

We constantly see clients with moderate to severe brain injuries tell us all the time that their prescription, their glasses, changed since the accident, or they now need to have some sort of corrective lens. And it just, while people, you know, unless you do this for a living or you see people impacted with brain injuries, you wouldn't think that that's something that occurs. But you can actually hit your brain so hard that your vision changes. So that's why these specialists get called in.

0:09:14 - Kiley Como
And I can say with an absolute certainty, as a bedside, I was a neuro ICU nurse for many years, everything John just said was 100% accurate. All those docs, everything, 100% how it works out. So, John, amazing, amazing stuff. That's so true. It's an army of people in there taking care of that patient and it very much is in that kind of stages, as you said. It's very touch and go for a while but, uh, you just, just starting right. I mean, you're in it for months, years potentially. So thank you for that. It's a serious injury, this traumatic brain injury. Um, the family's got a lot on their minds right up front, but you know there's a lot to be done correct? So kind of help us walk through what a family member of somebody who suffered a traumatic brain injury might be faced with, like what kind of things might they be ready for?

0:10:01 - John Mobley
Absolutely. And you know, in preparing this portion we wanted to give you know, really actual checklists so that they can work to not only be there for the loved one, but you know, a lot of, there's a lot of downtime with some of this stuff. Especially if your loved one is unresponsive or, you know, in a coma, or is incoherent, then you know there's going to be a lot of time. There's a lot of sitting around at the hospital. They don't, they don't tell you about this, but you're in there, you're in the room, you're feeling helpless, you're sad, you're mad, potentially at the person that hit them in the vehicle. You just have this full range of emotions and a lot of people, they just they want to do something. They want to be able to do something actionable. You know what's the first thing we ask as humans? We say, well, what can we do to help?

You know, can we bring the casserole when you're, when you're feeling sick? You know, what can we do to actually be of help instead of just sitting there, because otherwise you're just left in that hotel room with your thoughts, and a lot of times they're not good. So you know one of the things you can do after you know, obviously we want any client to, and a family member to be able to, grieve and give support, but you can also do some very good things to help immediately assist that loved one. just basic things. One is you know, go ahead and get that social security card or begin looking at benefits that may now, all of a sudden, depending on the severity of your brain injury, might be things that you're gonna need help with. We're talking about entities that may be able to help foot the bill on some of this therapy. If they're going to be for sure deemed disabled, you may want to start collecting information and beginning the processes to be able to have access to some of those benefits.

Just basically-- just for basic things to get, we of course want them to locate insurance cards. Those are certainly things you can do. That can be everything from health insurance to car insurance, any sort of disability cards or benefits that they may have. Because a lot of these companies have, you know, reporting requirements where we just wanna know who to call, who to contact, to be you know if there's money out there. A lot of people have something called MedPay on their car insurance. That gets activated and we can go after it. It's called MedPay, the long name is medical benefits coverage. Okay. Depending, some people have $100,000.

And all that you have to do is, once the accident happens and this would be on your car insurance, any car insurance that you paid for, it becomes, you know, immediately accessible. And you can use that money to help pay for immediate bills, keep stuff out of collections. So these are important things that the sooner you can get them, obviously we'd rather have money sooner rather than later, because in a serious brain injury accident, you know you're not only facing medical difficulties but it might be the most financially stressful moment of any person's life. So, you know, having quick access to money, government benefits and any sort of existing insurances you may have is absolutely crucial.

Some other things that we like to do is, you know, any birth certificate, school records, these are all important things in preparation for what may turn out to be a potential case, just in terms of getting the basic evidence that we would need as the attorney to show who they were before and who they were after. If the client or if the person who sustained the injury was on the job working at the time, they may potentially have a workers' comp claim right? So what that means is you know they'll need things like work records and things of that nature that could potentially be asked for or collected so that you know they can begin the process of that workers' comp claim.

Also, tax returns are a big thing. We as attorneys, when we're going after lost wages, we need tax returns to show not only what you have lost by virtue of being in that hospital for your long, you know, multi-day or two week or longer stint. If you're going through therapy and trying to get a full rehabilitation, you may be out of work this whole time, you know, and if you're not making money, you're not able to pay rent, your mortgage, all the bills that everyone is, acutely aware of that have to be paid in life. You know, none of that's able to happen when you are, when you've sustained a terrible brain injury.

So that's why we really have to have go into rapid response mode to get any and all documentation that's going to do whatever we can to find any and all monies to make your life easier. Because, unless-- not many Americans have some huge nest egg of savings laying around. Studies are out there, I can't quote them here, but the studies are out there that a lot of people don't have a huge amount of savings. Only a lucky few really have rainy day funds. So when you are out of work, not working and incurring huge medical bills, it's absolutely imperative, on something as serious as a brain injury, that we find all these monies for you. That's why we would always recommend, if it's a bad brain injury, reaching out to an attorney immediately, because we can help.

We've been through this process so many times and we can help speed things up. Sometimes speed is the name of the game.

When you've got bills coming in and your loved one is essentially not able to do anything, meet their requirements, and that becomes your problem as well as the spouse or the loved one. It can be very, very, very difficult. Some other things that we kind of want to know is any assets owned by the-- or the family members can look for, is any assets that the person with a brain injury has so you know what bills need to be paid.

You know what things need to be taken care of if it's not on auto pay, so that we know, you know, is the mortgage being paid? You know, because a brain injury can be a very long, long-term battle and who knows who the person that emerges hopefully survives, uh, emerges out on the other side. Are they capable of handling all their business affairs?

If they own a business, are they capable of paying payroll? Do you need to make arrangements to get that you know done to keep the business afloat? There's just all these things that we don't think about, that only become very, very apparent once the injury occurs and it's, it's overwhelming. So we try and just break stuff down so that we can get the right foot forward for family members so they can kind of know, you know, with all those thoughts racing through their head, what, exactly, what are the highest priority things?

So another thing that may come up for family members while in that hospital room is, you know, getting a copy of the accident report. But something that we see is that a lot of times, especially if the injured family member or spouse or whomever taken by EMS directly to the hospital, the officer who showed up on the scene may not have gotten their statement about what happened. So they may come to the hospital room and actually find your loved one and try and do an interview, who they may or may not be able to give any sort of statement or be in the condition if they can. And it really helps to kind of help guide your loved one through that process. We always recommend trying to get the, you know, card and contact information of the officer. So if they later need a statement to formulate that accident report, you can give them a statement so that your point of view, especially if it's like a he said, she said situation, makes it

into the accident report. So it's not being formulated just based off of one person's opinion or one person's interview, maybe the other vehicle. Something else to point out is, you know, is it's really important for these family members to also focus on their own self-care and their own nutrition and things while they're going through this process, because you're only gonna be so helpful to your loved one if your body is also standing up to the task at hand. So you wanna make sure you're eating and doing things like that to stay healthy and keep your sanity while you're going through this process. That's a big part of it. And then you know typically what happens is you know there's a transition process that occurs when the person is eventually moved from the ICU and into what's called like the more you know, regular patient room or rehabilitated portion of their care.

0:18:20 - Kiley Como
Well, that's going to do it for the end of this episode. We've got a lot more we want to talk about, so make sure you come back to join us on our next episode with John Mobley. That's going to do it. Please hit, like and subscribe to our channel and remember if you're in pain, call Shane. 980-999-9999.

0:00:09 - Kiley Como
Hey everybody, welcome back to another episode of Mind Matters: Navigating Head Injuries and Concussions. Today we're going to be talking with John Mobley. He's one of our senior attorneys with our concussion and brain injury group. My name is Kiley. I'm sitting in for Shane today. I'm the firm's treatment coordinator and a registered nurse. So, John, let's kind of pick up and talk about traumatic brain injury from the family's perspective.

0:00:32 - John Mobley
Absolutely, Kiley. Thank you for that introduction. In kind of preparing for this podcast, we wanted to take a little bit of a different approach. One of the things we wanted to do is that basically just identify the fact that when a brain injury occurs to one of our clients, they're not the only person impacted, because immediately their family, friends, spouses, they get pulled into this injury as well, almost as if the injury can occur to them. And so what we want to do by virtue of this, this podcast is go over some of the things that could potentially educate the family member or the spouse of one of our brain injured clients so that they can just be better equipped and better prepared to know what to expect.

Because it is a very, very overwhelming process. From the moment the impact, the fall or the motor vehicle crash occurs, it is just a domino effect of all sorts of things that no one is ever going to be prepared for. You're in the middle of the process of shock, then grieving, then trying to get ducks in a row while being in shock and grieving, and it's just an immensely difficult, difficult situation for any person to be put in. So that was the main thing we wanted to do here is just kind of go over some of the things of what to expect so that people can be more adequately prepared. And just to kind of circle back for those people tuning in for the first time is that you know brain injuries, just a little background on them. You know they are highly, highly prevalent and common. About 1.4 million Americans per year are diagnosed or experience it, with a nice asterisk by that number because most are underreported or never reported. So we think the number is much greater.

The most common causes are, you know, falls, motor vehicle accidents, assaults, things like that. A lot of clients come to us for all those reasons. If the fall occurred because someone else wasn't doing what they're supposed to do, a lot of times those clients come to our firm for help. The impacts range from mild to severe. This whole story kind of starts in the, typically the emergency room when it's a bad accident, and that's kind of where we pick up here.

So the first category and segment we kind of wanted to jump into is the immediate aftermath and, you know, what to expect at what we've labeled the hospital phase. That's where maybe you get a call driving to work one day that your spouse or family member has been in a motor vehicle accident and you know they found in their wallet or purse contact information and this might be the first call you got. So you rush to the hospital. A million things are racing through your mind. You don't know what's going on. You have more questions than answers. It's a really jarring, shocking experience and traumatic experience for you know people to get that news. So once you get to the hospital, you know the first thing we want to point out is: who are the people you might meet?

You know, who are you gonna run into? Who is gonna be a part of your life for the next day to weeks, depending on how long your loved one is there. We call these people the recovery team. Typically it's gonna be, you know, one of the specialists you may see, depending on if it's a very severe accident, maybe the neurosurgeon, brain doctors, brain surgeons, very smart people. And you know, they may be the first person to have a conversation with you because they sit at the top of the totem pole for injuries like this. They're going to be the, the, the field general for the treatment for your loved one, making the biggest decisions really, surgical decisions. They will best be able to advise you on immediate outlooks. If your loved one is suffering some severe brain injury or potentially a life-threatening one, they're probably gonna be the one that breaks the hardest news to you as well. And those are difficult conversations.

We also will see a lot of times neurologists pulled in as well, brain doctors, they may not do surgery but they specialize in the nervous system, its disorders. We see them come in a lot once the immediate threat to life has settled down a little bit, that would be the neurosurgeon. And you'll have a lot of hard and difficult conversations but be able to get a lot of your questions answered with the neurologist as well when you say, well, are they going to be back to normal?

You know, it's too early to tell at that point. And any good neurologist will educate you on this and answer the family's questions, so that you can focus that time instead on grieving and being there for your loved one and working with them.

We also see a lot of these injuries will also have orthopedic aspects to them, so you may also interface with an orthopedic surgeon. There's any sort of, a lot of times when someone hits their head so bad on a steering wheel or a windshield, they have herniations in their neck, bulging disc, or they may you know experience fractures to the face, neck, anything like that. At that point you'd probably be talking and getting advised, especially if your loved one is not completely coherent or is still out of it. You may, depending on you know your ability or your, what sort of documents you have in place, you may be able to, you may be the one making decisions for your loved one. And then, beyond that, there's also the neuropsychologist. Neuropsychologists they basically specialize in, you know, people with brain injury and their behavior and the relationship between those things. And they typically come in a little bit later. They may be consulted in that initial phase, but they will come in later as well as
part of the assessing just how serious this brain injury is, and neuropsychologists have a large amount of tests and abilities to gauge just how bad the brain injury is. That might come later on, though.

Of course then you have nurses. That's probably going to be the people that you talk to the most. They'll be on the front line dealing with the patient and their injuries and dealing with pretty much every aspect of the care and answering questions. They'll probably be the person you get to know the most. Absolutely.

And then beyond that, we have physical therapists and occupational therapists. Once we've reached that point of, is the patient in a coma or threats to life, and once stuff starts to stabilize a little bit, then we kind of shift towards that therapy and what do we have to do to get them back on their feet? What do we have to do to get them back on their feet? What do we have to do? Do they remember how to walk? Was the brain injury so bad that they've lost motor function? And that's going to be a long process with the therapist to get some of that pre-accident ability back or even just for you know, baseline functionality so that you know they can actually walk out of that hospital, or do things or be able to know what's going on. Some of the other doctors that, or specialists that we may see on rare cases is like respiratory therapists.

Yes, believe it or not, the brain controls breathing. So when you hurt your, usually if respiratory therapists is involved, it means that the brain injury was quite severe and there's just no ifs, ands or buts about it. So it's one of those things where you just need to be prepared as the family members or the spouse, that, if you have, some of these doctors showing up, it means that you're in a very, that your loved one's in a dire situation.

And beyond that, we also see involvement with, you know, case managers and social workers. If the person, if they're deemed to not be able to take care of themselves or maybe they don't have that support structure and they need really like a government entity to step in and a medical person to step in, we see assignment of some of these social workers and case workers to help them navigate what's going to be a very difficult process moving forward.

And one of the final specialists that we see, Kiley, a lot, is the neuro-ophthalmologist. That's if the client or the patient is having vision problems, they will actually get sent to a special eye doctor that, you know, focuses on the interaction between the vision and the brain so that your loved one can get their vision back.

We constantly see clients with moderate to severe brain injuries tell us all the time that their prescription, their glasses, changed since the accident, or they now need to have some sort of corrective lens. And it just, while people, you know, unless you do this for a living or you see people impacted with brain injuries, you wouldn't think that that's something that occurs. But you can actually hit your brain so hard that your vision changes. So that's why these specialists get called in.

0:09:14 - Kiley Como
And I can say with an absolute certainty, as a bedside, I was a neuro ICU nurse for many years, everything John just said was 100% accurate. All those docs, everything, 100% how it works out. So, John, amazing, amazing stuff. That's so true. It's an army of people in there taking care of that patient and it very much is in that kind of stages, as you said. It's very touch and go for a while but, uh, you just, just starting right. I mean, you're in it for months, years potentially. So thank you for that. It's a serious injury, this traumatic brain injury. Um, the family's got a lot on their minds right up front, but you know there's a lot to be done correct? So kind of help us walk through what a family member of somebody who suffered a traumatic brain injury might be faced with, like what kind of things might they be ready for?

0:10:01 - John Mobley
Absolutely. And you know, in preparing this portion we wanted to give you know, really actual checklists so that they can work to not only be there for the loved one, but you know, a lot of, there's a lot of downtime with some of this stuff. Especially if your loved one is unresponsive or, you know, in a coma, or is incoherent, then you know there's going to be a lot of time. There's a lot of sitting around at the hospital. They don't, they don't tell you about this, but you're in there, you're in the room, you're feeling helpless, you're sad, you're mad, potentially at the person that hit them in the vehicle. You just have this full range of emotions and a lot of people, they just they want to do something. They want to be able to do something actionable. You know what's the first thing we ask as humans? We say, well, what can we do to help?

You know, can we bring the casserole when you're, when you're feeling sick? You know, what can we do to actually be of help instead of just sitting there, because otherwise you're just left in that hotel room with your thoughts, and a lot of times they're not good. So you know one of the things you can do after you know, obviously we want any client to, and a family member to be able to, grieve and give support, but you can also do some very good things to help immediately assist that loved one. just basic things. One is you know, go ahead and get that social security card or begin looking at benefits that may now, all of a sudden, depending on the severity of your brain injury, might be things that you're gonna need help with. We're talking about entities that may be able to help foot the bill on some of this therapy. If they're going to be for sure deemed disabled, you may want to start collecting information and beginning the processes to be able to have access to some of those benefits.

Just basically-- just for basic things to get, we of course want them to locate insurance cards. Those are certainly things you can do. That can be everything from health insurance to car insurance, any sort of disability cards or benefits that they may have. Because a lot of these companies have, you know, reporting requirements where we just wanna know who to call, who to contact, to be you know if there's money out there. A lot of people have something called MedPay on their car insurance. That gets activated and we can go after it. It's called MedPay, the long name is medical benefits coverage. Okay. Depending, some people have $100,000.

And all that you have to do is, once the accident happens and this would be on your car insurance, any car insurance that you paid for, it becomes, you know, immediately accessible. And you can use that money to help pay for immediate bills, keep stuff out of collections. So these are important things that the sooner you can get them, obviously we'd rather have money sooner rather than later, because in a serious brain injury accident, you know you're not only facing medical difficulties but it might be the most financially stressful moment of any person's life. So, you know, having quick access to money, government benefits and any sort of existing insurances you may have is absolutely crucial.

Some other things that we like to do is, you know, any birth certificate, school records, these are all important things in preparation for what may turn out to be a potential case, just in terms of getting the basic evidence that we would need as the attorney to show who they were before and who they were after. If the client or if the person who sustained the injury was on the job working at the time, they may potentially have a workers' comp claim right? So what that means is you know they'll need things like work records and things of that nature that could potentially be asked for or collected so that you know they can begin the process of that workers' comp claim.

Also, tax returns are a big thing. We as attorneys, when we're going after lost wages, we need tax returns to show not only what you have lost by virtue of being in that hospital for your long, you know, multi-day or two week or longer stint. If you're going through therapy and trying to get a full rehabilitation, you may be out of work this whole time, you know, and if you're not making money, you're not able to pay rent, your mortgage, all the bills that everyone is, acutely aware of that have to be paid in life. You know, none of that's able to happen when you are, when you've sustained a terrible brain injury.

So that's why we really have to have go into rapid response mode to get any and all documentation that's going to do whatever we can to find any and all monies to make your life easier. Because, unless-- not many Americans have some huge nest egg of savings laying around. Studies are out there, I can't quote them here, but the studies are out there that a lot of people don't have a huge amount of savings. Only a lucky few really have rainy day funds. So when you are out of work, not working and incurring huge medical bills, it's absolutely imperative, on something as serious as a brain injury, that we find all these monies for you. That's why we would always recommend, if it's a bad brain injury, reaching out to an attorney immediately, because we can help.

We've been through this process so many times and we can help speed things up. Sometimes speed is the name of the game.

When you've got bills coming in and your loved one is essentially not able to do anything, meet their requirements, and that becomes your problem as well as the spouse or the loved one. It can be very, very, very difficult. Some other things that we kind of want to know is any assets owned by the-- or the family members can look for, is any assets that the person with a brain injury has so you know what bills need to be paid.

You know what things need to be taken care of if it's not on auto pay, so that we know, you know, is the mortgage being paid? You know, because a brain injury can be a very long, long-term battle and who knows who the person that emerges hopefully survives, uh, emerges out on the other side. Are they capable of handling all their business affairs?

If they own a business, are they capable of paying payroll? Do you need to make arrangements to get that you know done to keep the business afloat? There's just all these things that we don't think about, that only become very, very apparent once the injury occurs and it's, it's overwhelming. So we try and just break stuff down so that we can get the right foot forward for family members so they can kind of know, you know, with all those thoughts racing through their head, what, exactly, what are the highest priority things?

So another thing that may come up for family members while in that hospital room is, you know, getting a copy of the accident report. But something that we see is that a lot of times, especially if the injured family member or spouse or whomever taken by EMS directly to the hospital, the officer who showed up on the scene may not have gotten their statement about what happened. So they may come to the hospital room and actually find your loved one and try and do an interview, who they may or may not be able to give any sort of statement or be in the condition if they can. And it really helps to kind of help guide your loved one through that process. We always recommend trying to get the, you know, card and contact information of the officer. So if they later need a statement to formulate that accident report, you can give them a statement so that your point of view, especially if it's like a he said, she said situation, makes it

into the accident report. So it's not being formulated just based off of one person's opinion or one person's interview, maybe the other vehicle. Something else to point out is, you know, is it's really important for these family members to also focus on their own self-care and their own nutrition and things while they're going through this process, because you're only gonna be so helpful to your loved one if your body is also standing up to the task at hand. So you wanna make sure you're eating and doing things like that to stay healthy and keep your sanity while you're going through this process. That's a big part of it. And then you know typically what happens is you know there's a transition process that occurs when the person is eventually moved from the ICU and into what's called like the more you know, regular patient room or rehabilitated portion of their care.

0:18:20 - Kiley Como
Well, that's going to do it for the end of this episode. We've got a lot more we want to talk about, so make sure you come back to join us on our next episode with John Mobley. That's going to do it. Please hit, like and subscribe to our channel and remember if you're in pain, call Shane. 980-999-9999.

0:00:09 - Shane Smith
Hey, this is Shane Smith from Shane Smith Law. We're talking on the Mind Matters Podcast: Navigating Head Injuries and Concussions and all the effects associated with those. I'm here today with Thomas. He's one of the attorneys here at Shane Smith Law with the Concussion and Brain Injury Group. We're talking a lot about seizures and car accident or head injury related epilepsy, which is very similar to regular epilepsy and is essentially the same thing. We're talking about that in our episode today. When our clients have the trauma, they have the impact that in our case, usually a car accident or some kind of slip and fall they hit their head.

They have the trauma. When do they start showing up? What happens after that?

0:00:46 - Thomas Ozbolt
Yeah, so first, you know, talking about post-traumatic seizures, these will depend on the severity of the injuries. Some studies say that, and this is a very, you know, wide range, four to 53% of people will have these, while others say it's 35 to 65%.

0:01:04 - Shane Smith
But either, so it's a bunch, either way, I guess four, four out of a hundred. I know people who bet with those odds. You know all the time and gambling. But four to fifty percent. Fifty percent is one out of every two people with a brain injury, right, and 35 to 65 percent is two out of every three right?

0:01:18 - Thomas Ozbolt
Yeah, it's uh, you know, definitely needs some more studies done on it, but it's uh, there's definitely a high, there's a high chance of it. It seems at least likely.

0:01:27 - Shane Smith
And that's one seizure, or is that, that's seizures developing into epilepsy? Well, I guess that's the triggering seizure, right?

0:01:36 - Thomas Ozbolt
Yeah. And so usually, depending on the severity of the injury, that will increase the likelihood of a seizure. So five to 7% of people who are hospitalized as a result of the TBI, five to seven percent of those have at least one seizure. They show up in greater incidents with penetrating head trauma. So post-traumatic seizures, you know they're classified according to when they happen in relation to the injury. And there's three categories for that. There's immediate, early and late.

0:02:01 - Shane Smith
One thing you got me thinking about Thomas is you said you know, one of the types of seizures people have is where they're just not there. You know, right? They may be looking forward, but they're, you know, they're off somewhere else, basically.

Their own mind is going, I don't want to say frequently, but many times in car accidents there are people who've hit their head, and many people on the scene will be like, yeah, they just weren't responsive to me, or they weren't, you know, even when they're sitting out on the curb, they're just not responsive to me. Is this a seizure, or is this like a loss of consciousness, or is it, would that qualify as a seizure, or could it qualify, I guess?

0:02:31 - Thomas Ozbolt
Yeah, I think it's a great question. And you know, one of the ways of thinking about it is, you know, it definitely could be. You know it depends on the diagnostics that they get done, how detailed those descriptions are. Certainly the way that people describe things, or they talk about the aftermath and looking at somebody, they, that certainly sounds like a seizure in a lot of cases. But you have to think that it's one of these things that can't always be caught.

And a lot of medicine, you know, whether we like it or not, or whether insurance adjusters, defense attorneys, plaintiffs attorneys, a lot of it's kind of guesswork. You know, doctors can't know everything. We give them this power to, to know kind of everything. We put everything in their hands but, man sometimes they just don't have the information to know it. It certainly seems like, and you talk about concussion in an altered state of consciousness. Yeah. If you have that altered state of consciousness and there's other kind of convulsive movements going along with it that somebody observed, I think you definitely could have a diagnosis of a seizure.

0:03:25 - Shane Smith
Well, because I know it's not uncommon for children, for instance, to fall and hit their head and have a seizure, right then. So I don't know what would be different about car accident having that seizure as well. Right, you know, and I know that's every parent's, I mean get scared to death if their kid hits their head and has a seizure. But that doesn't, you know, I mean it's, it's there, it would seem like if you're in a car wreck, you hit your head, you're totally unresponsive, but your eyes are open and, that sounds like a seizure to me. And I guess that's where those eyewitness accounts matter so much, right, to corroborate what happens in the hospital, or even to tell the doctor right? You need to be paying attention to this, because if the doctor doesn't know, the EMT doesn't write it down, or the eyewitnesses don't write it down, and now you're talking, the doctor wouldn't even know to investigate that right?

0:04:06 - Thomas Ozbolt
Right. And you gotta wonder just how much it's being correctly diagnosed, cause you think oftentimes the picture that you hear about somebody at the scene of an accident is yeah, I showed up, you know, my husband. he was just sitting there on the curb, staring off into nowhere and just rocking back and forth. You know, it's like, to me that sounds, according to this definition, like that could be some seizure activity. But is that something that's going to be diagnosed? Is there more that we're going to learn? It certainly seems like, you know, like the brain, we're always learning something and maybe there will be more ways to find that out.

0:04:33 - Shane Smith
It seems like for our listeners that definitely, if you were to have a spouse or family member who, who was acting that way at the scene, to be particularly paying attention for a second seizure, right, or to something else that looks similar to that, so you can tell the doctor. Because I mean, two is, two is definitely seizures I would say right?

0:04:52 - Thomas Ozbolt
Yeah. And well, at least when you go to the doctor, talk to the doctor about what you saw the person doing at the scene.

It's not just an opportunity for them to talk, because they might not remember, you know, they might've been an altered state of consciousness. It's your job to advocate for your loved one and tell them what you saw when you got there. Because that could say, that could give the doctor the information they need to say huh, well, that's concerning. Let me do an EEG and figure out if there's any kind of abnormal electrical activity.

0:05:19 - Shane Smith
And when we talked before, you know you said the, I think the percentage of people who have an EEG that's normal, even who have epilepsy, you said was 10%, which sounds like a super small percentage, but that's one out of 10. Yeah. So if I line up 10 people with epilepsy, one of those people has a perfectly clean EEG all the time. Yeah. So I mean, and out of a 100, that would be 10 people. So I mean it's a significant percentage. So the EEG is gonna, it's there but it's not persuas-- I mean it's not persuasive to me.

10 out of 100, I mean, is a lot. Now, these all 10 people they came up clean, right?  

0:05:51 - Thomas Ozbolt
It's not a great tool. It's, it's more of the eyewitness accounts that are really gonna, you know, help, help the doctor. You can't measure that, it's, it's what somebody saw.

0:06:03 - Shane Smith
And the bad part is I, I can't be an eyewitness for myself, right? Right. I mean I've got other people that have to help me, right, because I might not even know it right? I mean, would I always know that I had that seizure? Or--

0:06:11 - Thomas Ozbolt
I don't think you know at all. I think you know you're, you're not, you're not there. And you, we talk with clients all the time. Well, I blacked out, I, I, I don't what happened, and then all of a sudden I was outside my car. So what other people saw that you know our client doing in that situation is crucial because they're not going to remember it. It's a lot of times there there's just, you know, that kind of localized amnesia to that event and there's just no memory of it.

0:06:34 - Shane Smith
So, so what we would tell everybody is, if your loved one is this way, pay close attention for the next bit. I mean because, another seizure could be coming, or another one that we can diagnose as a seizure can come, versus this one where they're like well, you had a loss of consciousness or something. We can diagnose that as a seizure and they can start looking for damage right?

0:06:53 - Thomas Ozbolt
Right. We talk about those different categories of how post-traumatic seizures are classified. You've got immediate, you've got early and you've got late. And those break down into different things that you can look for.

0:07:05 - Shane Smith
Let's talk about the categories of seizures and how they-- these are diagnosed, or these are types based on the time, right? When the seizure occurs? Right. And I think the first category was like immediate right? Immediate, boom.

0:07:18 - Thomas Ozbolt
Immediate occur at the time or within minutes to hours after the injury, with an incident rate of 1% to 4%. So only 1% to 4% are immediate seizures.

0:07:27 - Shane Smith
So 1% to 4% have an immediate seizure at the scene that's corroborated and diagnosed.

0:07:34 - Thomas Ozbolt
Right. Next category would be early seizure. When do those start? These occur within the first week after the injury. And that has an incident rate of 4 to 25%.

0:07:48 - Shane Smith
So significantly more. I mean obviously that's a big range, but that depends on which study you're following, right? And I mean the cynical part of me would say is, who's paying for that study? I mean cause some people would certainly want to minimize the number of seizures they have, and others just tell the truth is what I would say.

0:08:02 - Thomas Ozbolt
Exactly. And there are risk factors that can kind of tell you whether you're going to be more susceptible to an early seizure. You know some of those being, you know, development of early seizures occurs more likely when there's bleeding within the brain or skull, or when there's a loss of consciousness or when it's a pediatric age group. You know, like we talked about for children, they're at a greater risk for developing seizures than adults.

0:08:28 - Shane Smith
All right. So if I've got blood in the brain, definitely pay attention. Child, definitely pay attention. And what was the other one?

0:08:36 - Thomas Ozbolt
The other one is a loss of consciousness.

0:08:42 - Shane Smith
Alright. So if I got knocked unconscious, my family needs to be watching out for this? Right. And that's four to 25. So 25 is what? One out of every four people? Right. All right, I mean, who suffered a brain injury to seen one out of four? That's a lot. Right. What's the next category there?

0:08:51 - Thomas Ozbolt
Moving on to the late seizures. Okay. Maybe even more surprisingly, these occur with an incidence rate of 9% to 42%. Holy cow. These occur after the first week of the injury, with approximately 90% of these seizures happening within the first month.

0:09:09 - Shane Smith
Okay, so, so you're definitely not out of the woods after the first week. As a matter of fact, it's worse.

0:09:15 - Thomas Ozbolt
Right. It seems like it's more likely going to happen in this period. And that's where you have the disruption in the normal brain activity. And it leads to a lot of effects that take time to play out, something that's not appreciated a lot of times by you know, adjusters, defense attorneys, just you know, normal, everyday people. How would you know that?

0:09:32 - Shane Smith
So we've talked about the fact, that fact that you have the injury, you go home, you sort of think, I don't want to say think you're okay, but you think you're on the road to recovery and then this cascade effect now it's like the virus is in you kind of deal and it now, it gets worse. Which is why that incidence rate goes up.

0:09:49 - Thomas Ozbolt
Right. Boom, seizure. And you know I've had clients who say, yeah, you know I had this weird incident. I was in the shower, client actually just talking about her daughter. Her daughter was in the shower about a month after the crash happened, big rear end collision. Her daughter collapsed in the shower, had a seizure. Like, well, we don't know what's caught, what, you know, let's get to the doctor and get them to find out. But this is probably related to the brain injury she was diagnosed with.

0:10:13 - Shane Smith
I was going to say, according to the statistics you found in the medical peer reviewed articles because that's where these come from, is medical articles, I mean there's at least a 45% chance it was a car accident.

0:10:25 - Thomas Ozbolt
Yeah, I mean even get this. Most of these occur within the first year after the injury but the risk, it can extend out over 10 years.

0:10:35 - Shane Smith
Holy cow.

0:10:35 - Thomas Ozbolt
10 years after a brain injury. And you've got different risk factors that are associated with that for development. Those are some of what we've talked about. You've got, if there's intercranial bleeding at the time of head trauma, 10 years down the road, you could be it, you could be suffering from, from seizure. If you have a lower Glasgow coma score, if you're older than 65 years old or if there's, you know, prior chronic alcoholism of some issues.

0:11:00 - Shane Smith
So there's a whole bunch of things. So I guess what I take from this is, it's very difficult to know, and it can pop up, but you certainly shouldn't discount-- if anything happens in that first year, you definitely need to tell your doctor and your lawyer.

0:11:13 - Thomas Ozbolt
Right. And you know finding out, you know when, when you have that post-traumatic epilepsy or seizure. Post-traumatic epilepsy, that's a condition of having recurrent unprovoked seizures after the initial one. But the time period where you need to be keeping an eye on things is within that two years after your first seizure. Let's say you have one in that late period, two months after the crash, the injury. Within two years after that first seizure, 86% of those individuals will have a second seizure. Wow. If you have one within two years, 86%. 50 to 67% of those who experience a seizure after TBI will have their second seizure within the first year following the post-traumatic seizure.

0:11:58 - Shane Smith
Okay, so 50 to 60% have a seizure within the first year after having one. But then the stats if you extend it out a little bit further from that seizure to two years, it's like, did you say 80% if you've had one? What that says to me quite honestly is, hey, if you've had one seizure, you're probably having another one, and if you have two, that's epilepsy. And, and the issue with that is when we think about epilepsy, I know there are many that can impact lots of aspects of your life. It can impact your driver's license, impact to get a pilot's license, all these things that are no longer eligible for you.

Because, to be quite honest, the government is concerned. You may have another seizure while driving on the road right? Because it's not like you have a lot of warning. Some of these, there's no warning.

0:12:38 - Thomas Ozbolt
Yeah, affects a lot of things people like to do. Also, you know you think about all the activities that involve flashing lights. You know video games, television, movie theaters, amusement parks, all types of things that people like to do for leisure activity, you know that can trigger those epileptic episodes.

And you know, this is another really interesting fact is, when you look at, you know causes of epilepsy, traumatic brain injury is the leading cause of epilepsy in young adults. Wow. Think about a young person, a young adult that you know, and it's a leading cause of epilepsy for them.

0:13:10 - Shane Smith
So all those video game warnings, they're talking to these people right here, right? Yeah. To our listeners and people who have had one as a result of a car accident?  

0:13:20 - Thomas Ozbolt
Yeah, and you think about it, if you have one associated with the accident, your second one could be triggered by playing a video game, and then you essentially have a diagnosis of post-traumatic epilepsy at that point.

0:13:30 - Shane Smith
Wow. So I sort of thought there were two sort of two different things, you know right, but, but no, that's not the case. I mean the same warnings for everybody with epilepsy applies, or brain injury folks as well. And I think about moms and stuff, every one of them who has

a kid who's suffered a brain injury is going to then be concerned forever, right? I mean, I know my, my kids, when they were teenagers, loved to play video games and, and fortnite and all these things and the warnings, or you look at a movie and it pops up, or like you say, the roller coaster, all these things. As soon as you get that diagnosis, you're concerned about them and mom's gonna be worried, dad's gonna be worried, kid, you're gonna be worried.

0:14:05 - Thomas Ozbolt
Yeah, it's a game changer, a life changer. Everything changes, can change just like that.

0:14:12 - Shane Smith
So, once they do all these diagnoses, how do they treat folks? How do they help them? How do they help them deal with all of this? Is it medication, is it therapy? What are they doing?

0:14:21 - Thomas Ozbolt
Yeah, the goal here with recurring seizures is to prevent them from occurring. A seizure is harmful to a person's health because there's this tremendous metabolic stress that it places on the brain cells.

0:14:33 - Shane Smith
Merely the aspect of having the seizure, that alone causes damage and is harder on the body. I mean obviously, but I mean, it's devastating the body you said.

0:14:39 - Thomas Ozbolt
Right, it's just tremendous stress on these brain cells. And you think about what that does in terms of just exciting things and sending them to a new level in terms of their activity. This can endanger someone's life. You know, like you talked about, if it happens in a precarious position, like if someone's on the road. You know, we had a client, this happened to her while she was driving. Wow. It happened to her twice within a couple of weeks.

It's unfortunately a case we couldn't take, but that was you know something that happened to a client. And, or say you're working on a ladder as a construction worker, you have a seizure, you know it's over.

0:15:12 - Shane Smith
Or at home, just up on a ladder right? I mean, as we said a lot of times, there's no notice, so--

0:15:15 - Thomas Ozbolt
Right. And you know, if you talk about this happening within a month after an injury, you think everything's all right. You're working out on the ladder cleaning out the gutters and you know you have a seizure that, caused by your traumatic brain injury and your life's over.

0:15:29 - Shane Smith
Or a shower, bath? Yeah. The goal is to prevent them? Right. How do they do that?

0:15:31 - Thomas Ozbolt
Essentially, what we have to do this right now is medication, but there's no medication available that prevents the development of post-traumatic epilepsy.

0:15:40 - Shane Smith
It's not like I can just take something prophylactically to prevent it from occurring.

0:15:45 - Thomas Ozbolt
Well, there's meds that can reduce the recurrence. These are called anti-epileptic drugs or anticonvulsants. These will suppress the epileptic discharges from the brain or limit the spread of those discharges through the brain. So when we talked about that localized focus, spread into generalized, it can kind of, you know, almost nip it in the bud. And that's what we have right now.

0:16:04 - Shane Smith
So you have sort of mini, it, it hits one area but it doesn't spread everywhere. It's like a cage. Confines it to one area?

0:16:10 - Thomas Ozbolt
Right. You gotta just, you know, almost snuff it out, is almost the way you want to think about it. Now, most people's post-traumatic epilepsy can be controlled pretty effectively with these anticonvulsants, but there's a subset, the TBI cases, with up to 13% in one study, that are difficult to control, no matter which type of anti-epileptic drug that you have. Just really important in these situations, in any situation where you have a traumatic brain injury, to get connected with an experienced neurologist who cares about you and who's going to listen to you. And I think that really starts with, you know, getting a lawyer who's going to listen to you and advocate for you and try to get you the best treatment you can get in the world.

0:16:51 - Shane Smith
And you said the neurologist, who will really listen and care, care and try to help you. I think that's a key part here. Sometimes we think just any doctor, but you want an actual doctor. I'd say the best of the best doctors, right, the ones who have real bedside manner, who wanna listen to you and deal with this, which probably isn't just the nearest doctor to you.

0:17:05 - Thomas Ozbolt
Right. And especially, you think about a neurologist. 87% of the counties in the United States don't have a neurologist.

0:17:10 - Shane Smith
Right, we talked about that in a prior episode. They're just not there. So you're gonna have to have to travel to a big city, probably have to book a bunch of time, probably gonna have to test two or three to find one that works with you. You know what I mean, that you like and and you found genuinely cares to even begin this. But I think the fear is with the, the medicine, how do you know it's working?

0:17:32 - Thomas Ozbolt
You know it's working because you're having less of them. It's preventing their recurrence.

So you can, you can see that. Some of them are very effective. Again, that subset that it doesn't work for, you know you're obviously going to see, hey, it's just not going to work with these people. Good thing though you say, hey, you're gonna have to travel to see you know neurologists in many instances. But one of the really good things that we've talked about before is there are doctors all over the country who are doing incredible things with telemedicine at this point in time. Because when you're dealing with somebody who's suffering neurological symptoms, it's not always necessary for you to be able to touch and feel them, despite what you know the insurance industry wants to tell you is, "Oh, you got to see them in person." No, some of the most important things that can be done can be done over video, because it's looking at how somebody presents themselves physically. Wow and the eyewitness to everything else.

All that can be done telemedicine. The world's changing and that's making you know great health care accessible for everyone, and not just for people who live in a big city or who have millions of dollars to throw around to see whatever doctor.

0:18:35 - Shane Smith
And I think those are two of the key things that we can be most hopeful about. You know telemedicine, you can get treatment, like you say. I can live in rural areas and get a great doctor because they're there. Not that there aren't only great doctors in the city, but there just aren't enough neurologists. Right. So I can see one wherever they are right?

0:18:50 - Thomas Ozbolt
Right. See them in the comfort of your own home and your own environment. Some people, when they go to the doctor's office, their heart, their blood pressure, goes sky high. I have great blood pressure. When I go to the doctor's office, my blood pressure looks like I'm 65 years old and 600 pounds.

0:19:04 - Shane Smith
Yeah, it's bad. Yeah it's bad. So you don't have all those added stressors. The doctor can actually see you in your natural environment how you really are. Right. Which I think is huge, especially for brain injury clients, because they don't need added stress. I would imagine added stressors are more likely to cause a seizure than not having them.

0:19:21 - Thomas Ozbolt
You can see the environment that they live in, how their life is, what things are like around them. Right, it would give a whole picture a lot better, right? Right, because a picture inside of a doctor's office, that has limited value sometimes, I think.

0:19:35 - Shane Smith
All right, Thomas, thanks for being on the show today. I think we've learned a lot between last episode and this episode, talking about seizures and epilepsy and treatments and all the hope out there. For all of our listeners, if this topic is interesting to you, comment down below. Or if there's another topic you would like us to talk about one of our next episodes, please let us know. We'd be glad to delve into that for our listeners. Like and subscribe to see future episodes and remember, if you're in pain, call Shane 980-999-9999. If you've got a question for our concussion brain injury group, just give us a call and we'll get one of our lawyers to answer it. 
 

0:00:09 - Shane Smith Hey, Shane Smith here on Mind Matters: Navigating Head Injuries and Concussions. I'm here with Thomas. He's one of the attorneys in the concussion and brain injury group at Shane Smith Law. Today we're going to talk a little bit about well, I mean, we're always talking about brain injuries, but today we're going to talk specifically about one of the repercussions of some brain injuries you can have. And what is that today Thomas, epilepsy?

0:00:32 - Thomas Ozbolt Epilepsy and seizures. That's one of the cascade effects that can be caused by a traumatic brain injury. You know it sets off a cascade of events within the brain, disrupting its normal functioning. One of the significant concerns that you have is the potential development of seizures and epilepsy.

0:00:47 - Shane Smith And I know to me, well, tons of things that happen from brain injury are scary. But most of those are scary to the person, you know experiencing the forgetfulness. You know most of it's felt by that one individual and it's hard for me just to look at you and know, hey, this is what's going on. But absolutely, in seizures I feel like have a disruptive effect, even more so than everything else, on the family, because everybody can see it right, and I knew somebody who had epilepsy when I was a child and they were terribly embarrassed. Anytime they had epilepsy they were mortified and embarrassed that other people saw it and all of those things. I'm going to guess it's the same and if not worse for our brain injury people.

0:01:22 - Thomas Ozbolt Yeah, when we talk about seizures post brain injury, we're not only referring to those immediate post traumatic seizures but also the potential for epilepsy to develop over time. Now, when you have a traumatic brain injury and the disruption of that normal brain activity that can lead to abnormal electrical discharges within your brain that trigger seizures. Epilepsy is essentially two or more uncontrolled seizures.

0:01:46 - Shane Smith I guess you said two or more, so one's not epilepsy, but if you have two or three, is that automatically determined to be epilepsy?

0:01:53 - Thomas Ozbolt Epilepsy is essentially yeah, two or more uncontrolled seizures. So if you have that first one no, it's not epilepsy, that can happen, but if you have two or more, then they're uncontrollable. I don't know if that's ever controlled.

0:02:06 - Shane Smith I was going to say, what's controllable mean for a seizure? Is it like medication, so you have one and I put you on this medicine and you don't have it again? Is that sort of the controllable aspect of a seizure? Yeah, that is definitely part of it. You know everybody says abnormal electrical charges, but it was really just the brain misfiring right?

0:02:25 - Thomas Ozbolt In a way yeah, and you know one of the most important things in figuring this out is diagnosing a seizure. There's a lot of different types of seizures that can happen or ways that they manifest themselves. And get the diagnosis right when you have that abnormal electrical discharge, that's really crucial.

0:02:44 - Shane Smith How do they diagnose it, what is that?

0:02:44 - Thomas Ozbolt That's a great question. There's several things that are very important to it. Of course you have imaging studies like a CT scan or an MRI. Those will play a crucial kind of high level role in understanding the extent of the injury and identifying potential areas of concern. But of course those are high levels. They don't often get down to a more micro level that you need. Really with incidents like these, eye witness accounts are invaluable and they're crucial in corroborating the occurrence of seizures.

0:03:13 - Shane Smith So I would think the odds of you having a seizure while you're in the CT scan or the MRI are pretty minimal. Pretty minimal. Yes, they have to be just freak timing kind of deal. So most of it is yeah, the CT scan or MRI may show some damage to the brain or some issues, but most of it's eye witness right? People who saw you have this activity.

0:03:30 - Thomas Ozbolt Yeah, and a lot of- there are kind of some what you call kind of triggers or warning signs that a person might experience when they're about to have a seizure. Some of those include having an unusual or a disagreeable odor that they sense, or even having a deja vu experience.

0:03:48 - Shane Smith But the disagreaable odor. There's no real smell there, right. They don't begin to smell. They just, something's triggered, so they smell some weird thing.

0:03:55 - Thomas Ozbolt Yeah, it's called an aura and what that's caused by is the seizure starting in a localized part of your brain. So it's starting in a particular segment of your brain, one that might control smell or might control memory, the seizure's starting there. And a person's actual physical appearance and how those symptoms manifest in terms of what someone's looking at, can give you clues as to the location of the electrically abnormal part of the brain.

0:04:25 - Shane Smith Really? So just, I mean if I had all the training and we're a doctor and all that and I see you having a seizure, I might be like, oh, he's got a brain injury at this one part of his brain just by your behavior. It's that specific?

0:04:36 - Thomas Ozbolt Yeah. And you know, oftentimes eye witness accounts get discounted by, you know, defense attorneys or adjusters. But what a doctor is gonna do is they're gonna talk to family members, they're gonna talk to people who are present on the scene. They're gonna say well, you know, when the seizure started, what did you see on the person? Well, I saw his right arm jerking and the right side of his face twitching. That would tell them more than likely that the seizure focus is in the motor strip of the left frontal lobe of the brain. Now, if you're having a seizure focus in that left frontal lobe of your brain and it's confined to that area, you might not have a loss of consciousness, but most of the time when you have that abnormal electrical activity, it spreads from one particular area of your brain, one particular focus, to the entire brain.

0:05:21 - Shane Smith Really, okay. So you got like a virus, almost right? It's in one spot then all throughout, like or a lightning I don't know the right word but like a lightning storm, or even if I drop food coloring in a pot of water, right? It hits, that's where the seizure starts and then it spreads throughout the- as far as I can go?

0:05:37 - Thomas Ozbolt Yeah, it's like you know, there's the famous saying I don't know who said it, it's when you drop a pebble into a pond, even after the pebble has hit the bottom of the pond, you know, the water still trembles. The same thing applies with your brain, and you know, when you have it spread to the rest of your brain, that seizure is quickly followed by a loss of consciousness and convulsive activity on both sides of your body. So this changes from being, you know, seizure focused in one area to what we call focal seizure with secondary generalization.

0:06:07 - Shane Smith Now we talked a little bit about seizures. What is a seizure right? Because to me the seizure, you know, the only image I have is, you know, the person who falls down on the ground and convulses that I used to see when I was a child, basically. But there are other types of seizures as well you can run into right?

0:06:25 - Thomas Ozbolt Yeah, there are different types of seizures. One of those would be the focal seizure with the impairment of consciousness. This is where you might see you know, you're not always going to see a loss of consciousness with a seizure. You might see an altered state of consciousness where you see someone who's not awake but unresponsive, and they might just be staring or doing automatic repetitive movements like smacking their lips or picking at their clothing.

0:06:53 - Shane Smith But they're not really there.

0:06:54 - Thomas Ozbolt Right, they're in an altered state of consciousness. That's what you would call, it used to be called a petite mal or a complex partial seizure, but that's what you know I kind of referred to a second ago called the focal seizure with the impairment of consciousness. Now there are other types aside from that one as well.

0:07:12 - Shane Smith I mean, how long do these things normally last? Are they all a few brief seconds, or can they last minutes?

0:07:17 - Thomas Ozbolt So it depends on your type. And so, for example, with generalized seizures, these occur with sudden onset over the entire brain at once, without a warning, and they come in different types. When you have these generalized seizures, you can have a tonic clonic seizure. With this type, there's no warning, you know, no aura, but there's a sudden loss of consciousness with multiple rhythmic, convulsive jerks of the arms and outward stiffening of the legs. These will last anywhere, usually from 30 to 120 seconds, so 30 seconds to two minutes. It's often accompanied by frothing at the mouth or losing control of your bladder or bowels and tongue biting. So, like you said, talking about embarrassment, I, you know, I had a friend at our church, you know another young person at our church that would happen and it was always terribly embarrassing. It didn't happen every time, but when it did it's, you keow there was going to be a lot of embarrassment. And then, with that tonic clonic seizure that we talked about, it's usually after you have that loss of control of the bladder is frothing at the mouth, the tongue biting, you know you have to roll the person on their side, the person's unresponsive and there's typically a snoring type of breathing for another 15 to 20 minutes. Oh wow, so it's definitely not quick. And that's called the post tictal state, and so that's just kind of you know, that that's the medical term for that afterwards.

0:08:35 - Shane Smith And I know people who've had this and basically why you could say, well, you're only having seizures. But when you have these major seizures, all the embarrassment, that makes them almost afraid to leave the house because they're afraid to embarrass in front of church or friends or everybody right? It just becomes this closeted, devastating impact right?

0:08:54 - Thomas Ozbolt Right, yeah, so several other downstream effects you know. You think about depression. You think about, you know, loss of friendships. You know, just like you said, just being totally embarrassed. It can even go beyond this in terms of different types of seizures. You got what you call recurrence. When you have recurrence seizures, you know one after the other when you're not gaining consciousness. This is really scary. It's called status epilepticus. Okay. And this is a medical emergency and that must be treated immediately or permanent brain damage can result. The other particularly scary thing about this is in the traumatic brain injury context. This is something that children are much more likely to develop. So you think about how terrifying that is seeing, you know, your young daughter or son having a traumatic brain injury and saying, hey, this is a subset of the population that's more likely to be a risk for status epilepticus.

0:09:43 - Shane Smith And this is sort of the seizure that never ends until medicine comes into play is that it? Yeah, it's, it's, you know, they are just, it's almost, you want to say, being hit by wave after wave of this. And you know that's got to be devastating for the person, devastating for the family member. You probably just assumed they were dying. Yeah, it's, yeah, I mean it- and they can die, or never be the same, I mean without the right medical care. And think about how you're waiting for an ambulance to get there, right?

0:10:08 - Thomas Ozbolt Yeah, and you think in those, those periods, you think about brain damage and how quickly it can happen. It's, you know, the seconds matter, minutes matter, you know loss of brain function. You know you might not die, but you might not ever be- you might be a shell of who you were before or never realize who you were going to be, if you're a kid. So yeah, the description of the seizure, you know an eye witness account that they give at the time of the seizure, that's important in that seizure diagnosis.

0:10:31 - Shane Smith And I never really, I never would have thought, okay, pay super attention if you were to see somebody to everything that's going on, how it started, because that's the key. If they didn't know, if they don't have that diagnosed with the injuries, that's a huge key right for, for everybody? Tells the doctors where to start looking.

0:10:49 - Thomas Ozbolt Right, because you have, you have diagnostic tools, right? We talked about CAT scans, we talked, or CT scans, we talked about MRIs. There's EEGs. But here's the really interesting thing about that. You know they can help determine the nature of the seizure, if you talk about EEG, but about 10% of patients with known epilepsy never in their lives have an abnormal EEG between seizures. Wow. And it's not, you know, you're not ever really gonna be able to catch someone with an EEG right when they have it.

0:11:17 - Shane Smith Yeah, like we say, you'd have to just be sitting in the doctor's office and have crazy timing.

0:11:28 - Thomas Ozbolt And then 50% patients with a first seizure who subsequently develop epilepsy, they have a normal initial EEG.

0:11:31 - Shane Smith So they thought they were okay, they had the brain injury, thought they're okay and then bam, that hits.

0:11:32 - Thomas Ozbolt Nothing about the diagnostic tools that told them that this was gonna be something that they're at risk for, and it's again the eye witness accounts that really tell us.

0:11:48 - Shane Smith So in our- we'll flip to the legal side now. I mean so the fact that somebody had a negative EEG or normal EEG is helpful, but it's certainly not persuasive if 50% of them don't have it or have a normal one, until something happens, until they don't, basically right?

0:11:59 - Thomas Ozbolt Yeah, it's, it's almost, you know, searching for a needle in the haystack if you're, if you're trying to find this on an EEG.

0:12:06 - Shane Smith I think it's important to know Thomas. This is sort of a deeper topic. We're gonna do two podcast episodes on this now. And if- this one we talked a lot about triggers and what happened and what epilepsy was, and all this. In our next episode we're gonna talk about the treatment and how they treat car accident or brain injury types of epilepsy, which is very similar to regular epilepsy. We'll be covering that in next week's episode. So for all of our listeners out there, if you've enjoyed this topic or find it interesting, if you hit like and subscribe so you can see our newest episodes. If you hit the bell you'll see the notification when the new episodes come out and if you have a brain injury or questions or concerns about this issue, or were in an accident and suffer this and would like to talk to one of our attorneys in the concussion and brain injury group, just give us a call at 980-999-9999. And remember if you're in pain, call Shane or go to our website. We've got tons of information there as well. Thanks.

0:00:09 - Shane Smith
Hey, this is Shane Smith, with Mind Matters: Navigating Head Injuries and Concussions. I'm here today with our guest, John Mobley, from the Concussion and Brain Injury Group at Shane Smith Law. Today, we're going to be talking about some of the things you can do, or have others do, to assist you after you've been permanently injured in a car accident. Usually, these are-- we're focusing on serious life changing impacts and things you can do to try to make life a little more enjoyable, a little more livable. Thanks for being with us, John, and I'll let you start off.

0:00:35 - John Mobley
The real goal with our conversation here today is just looking at clients and victims of motor vehicle accidents. Once they have, you know, at some point your treatment is going to conclude. And the doctors are going to say you know, we've done everything that we can do for you. What do you do after that? You know that's kind of the question is, what do you do after the doctor has said you've reached either maximum medical improvement, you're going to have some level of what they call impairment, or you know things like this. We see this a lot with our brain injury department because you know, brain injuries are typically, to some degree, permanent.

There's not necessarily a cure. There's things you can do to make them better, but not a cure. And so what we try and do is arm our clients with this, with good information, so that they can take positive life steps to improve, you know, their quality of life and long-term outlooks.

0:01:28 - Shane Smith
When you said a lot of times you have some type of impairment, what's that mean?

0:01:32 - John Mobley
So sometimes when either a client has received surgery and then post-surgery they still have some degree of pain, or maybe they had shoulder surgeries they still don't have full use of their arm back. A lot of times we will see specialists give them an impairment rating. Basically it says look, you've lost 20% of the use of your arm or 50% of the use of your back or you know, due to your head injury you're just not going to be functioning with the same level of productivity and decision making and focus and attention that you had before your brain injury. We see that a lot with clients involved in- usually are more serious accidents that have to do a lot of medical treatment or surgeries, or are told, you know, they can't get surgery because there's just nothing that the surgery could fix or it's too risky, then they're impaired or receive an impairment rating.

0:02:24 - Shane Smith
Now I'll also say, I tell my clients this when they've got it, if they get something like this early on or it feels like the doctor hasn't done everything he could do or exhaust it. There's nothing wrong with going to seek a second opinion before you reach that point right?

0:02:39 - John Mobley
100%. I mean, if you have the time and the patience and the want-to to do it. A second, even a third opinion cannot hurt, right? You know? At least you're getting multiple eyes on it, on your situation. Sometimes that involves, you know, multiple doctors within the same specialty, just to make sure, like a big decision like surgery.

Maybe you want three orthopedic surgeons to make sure they say that, you know, this is something I need to get done. Or you might want to get the second opinion of a doctor in like an adjacent area. So an orthopedic, a neurologist or a pain management doctor.

0:03:12 - Shane Smith
I mean, yeah, when you talk about specialists, we see that a lot with like ankle and foot and hand things. So let's say general orthopedist, and then they'll narrow it down to a podiatrist or, you know, an orthopedist that just concentrates on the extremities or something like that. So if you've got a permanent injury, nothing at all wrong with seeking a second opinion, certainly if it's in the first six months of the case. You know, we generally recommend it if somebody says you're at maximum medical improvement. But once we're past that point, what are some of the things people should look at where they can make the most impact in their life?

0:03:41 - John Mobley
Yeah. So we have a bunch of different categories that we like to go through with our clients sometimes. One of the first ones, surprisingly enough, is just diet. A lot of the times when we're seeing some of the feedback we get in medical records that we review for our clients, a lot of times we'll see specialists tell our car crash or slip and fall clients, you know, eating better and losing weight will give you better medical outcomes on just a whole variety of things, number one being surgery success and safety. If you are too overweight, sometimes surgery is unsafe to proceed with. We'll see some of our specialists tell certain clients that they need to get their weight down through diet to be a safe candidate for surgery.

And also having a lower body mass index will improve the outcome and the success rate of your surgery.

0:04:28 - Shane Smith
I was going to say, I know anesthesiologists, the folks who put you to sleep, are always very concerned about weight. Once you cross a certain BMI, I guess the risks just go up exponentially, right? Alright. So diet's the first thing. What's another area they can focus on?

0:04:50 - John Mobley
You know, just sticking with kind of the diet. It also helps with the overall amount of stress on your joints. If you've sustained some sort of injury, especially to like an extremity, it doesn't have to be an extremity but like, think about, like knees, the small little you know, joints around your ankle and your foot, also your back. Having, you know, lower weight, better diet is going to improve your long-term outcomes. If you do have like an impaired knee or an impaired ankle, it's just less weight on that area.

0:05:20 - Shane Smith
And we've seen cases before where we've had surgeons say, hey, I can do this, but you need to hit certain criteria before I can go do it, and that's usually focused right on weight.

0:05:29 - John Mobley
Yeah, see it all the time. Another thing that we're surprisingly seeing now is with our brain injury clients, having a specialized diet can actually improve some of the bad symptoms of a brain injury. So we're seeing some of our clients be recommended the keto diet. You got to cross-reference this with your general practitioner and make sure it works for your diet, you know, long term. But we're definitely seeing some neurologists and brain doctors recommend like the keto or certain high protein diets, maybe low in carbs, because they're finding that people that have brain injuries, their symptoms aren't as severe and dramatic with certain dietary changes.

0:06:12 - Shane Smith
Okay, so that's definitely something to talk to your doctor about. If you had a brain injury, would this be appropriate, or even, is it safe for me to try?

0:06:19 - John Mobley
Exactly. Okay, all right. The next one would be exercise. The key walk away here is that more muscle bulk and more muscle mass reduces the risk of potential fractures during falls or trauma. And you may think well, what does this have to do with brain injuries? Well, with brain injuries, you know, we have a lot of clients, one of the key symptoms of brain injury is vertigo, dizziness, trouble with vision. You know, when you think of those three things, you also equate that with all of a sudden, you have more falls, you slip more often. Maybe navigating the shower in the morning when you're half asleep with a brain injury is a little bit tougher.

So being in the healthiest possible state possible from like a muscle mass and working out and exercise and strengthen your body will in fact actually protect you from certain falls that could otherwise break bones when you have more things surrounding that bone.

0:07:19 - Shane Smith
So John, we talked a little bit about exercise. The best types of exercise for this activity would be generally resistance type exercise, right, some kind of physical resistance movement with weights or bands or something right?

0:07:33 - John Mobley
Absolutely. Things that would, you know, hopefully grow, improve muscle.

0:07:37 - Shane Smith
Okay, all right. Sleep, exercise. What's the third one?

0:07:43 - John Mobley
With exercise too, you know another thing just to point out is that weaker muscles can also equate to less agility, which can increase risk for further injury as well. For injured people that have sustained neck whiplash injuries, strengthening the neck safely with neck exercises can be crucial to pain reduction and further injury. And these are usually pretty simple exercises you can do at home that involve, you know, light resistance with bands, like you mentioned earlier, to strengthen that neck area.

0:08:17 - Shane Smith
I think that's, we can dig deep into that in another podcast episode. All the exercises people can do just for neck rehab almost basically? Right. After exercise, what's the next easy one to hit?

0:08:28 - John Mobley
Another one that is, you know, a little bit under the radar is just basic posture, and what I mean by posture I'll have to explain that a little bit is, you know, car accident victims, especially ones that experience whiplash, they may need to make certain lifestyle posture adjustments. That could be things from changing your, you know, your, the pillow that you use, or your sleeping position. More often than not, we're getting feedback- one of the big things that, when we're doing our client interviews to check in with them on their treatment paths and treatment levels is they'll say you know, my sleeping is just so messed up because it's hard to get to sleep, or it's hard to get to sleep and stay asleep. Because you think about it. It's like you know, if your pillow is not at the right height or your sleeping position has changed because of the pain that you're experiencing, then it can truly impact your ability to get a good night's sleep, and that's unfortunately a great foundation for getting better for most people.

0:09:30 - Shane Smith
Yeah that's what I was gonna say is I know, even when I've got a virus, you know, if I can't sleep I'm not gonna get better. And a lot of times, as soon as I can sleep through the night, I start to feel a whole lot better.

0:09:40 - John Mobley
Right, absolutely. I mean, it really all starts with that, and we just hear this from our clients all the time that you know, my sleep has been ruined since the car accident. So sometimes it's as simple as a matter of making adjustments to what you once used. You may now need a thicker pillow, or more pillow support, more head support, so that whatever symptoms you now are, you know, permanently impacted by don't bother you as bad.

0:10:12 - Shane Smith
And I know a lot of chiropractors or orthopedists will have pillows in their office you can actually just buy. You know before I knew any of this, I'm always sort of like eh, what are they doing? Are they just trying to make quick 50 bucks? But the more research you do, the more you look at it, there's actually some justification that it can really help a lot of folks.

0:10:25 - John Mobley
Yeah, definitely in this case.

0:10:27 - Shane Smith
All right sleeping. That's a main area for posture and position. What else along posture?

0:10:32 - John Mobley
So, with posture, another big thing is well, we spend a lot of our life sleeping. What else do we do? We spend a lot of our time at a work desk. So basically making sure you have a great posture at your work desk, and this includes a lot of things. Having a sit-stand desk.

You know a lot of people are saying well, I don't know if I want to stand all day at a work desk, but the other added benefit of that is that it's adjustable, so you don't necessarily have to be standing, but at least you can adjust the sit-stand desk to get that proper alignment where you're not straining your body. You know, if we're straining to look at our dual monitors or we're straining our neck, you might not even realize you have that tension, but if you have sustained a permanent injury to your cervical spine and your neck, that can really compound your symptoms. So it's good to be in a nice aligned position with the monitors at a proper height so that you're not constantly looking up or constantly looking down, and that your elbows are basically aligned with your desk so that your shoulders aren't shrugged, creating additional strain in your neck. It's worth the time for our car accident victims to do that, so that their long-term injuries aren't compounded.

0:11:46 - Shane Smith
And I know standing desks have- the ones that go up and down have really dropped in price over the last two, three years as they become much more popular. Years ago it seemed like they were crazy high and now they're much more reasonable and I don't want to say commonplace, but a lot of employers have them.

0:12:02 - John Mobley
Very affordable now, you're absolutely right. I mean the price has gone down significantly where you can get them under $100, which is nice for people looking to improve kind of their work, alignment and posture. Another area too that I almost forgot about is, for brain injury clients another recommendation that we are seeing from a lot of neurologists across the board is for people with brain injuries to really be aware about limiting their screen time. It's literally usually listed as one of the treatment paths, which is to- that goes for phones, but it can also go for work monitors when you're at work. So it's really important for some of our clients who have experienced brain injury to be aware of the fact that, hey, I've been working for hour and a half, two hours. I need to take a screen break because otherwise it can, it can and does trigger some of those brain injury symptoms like the inability to focus, headaches, sensitivity to light, just because your ability to not get fatigued with a brain injury goes way down.

0:13:08 - Shane Smith
It gets decreased. So even normal stuff like just working all day and then going home and playing on your phone is gonna exacerbate all those brain injury symptoms.

0:13:18 - John Mobley
That's correct. And another thing too, if you have a neck injury, you may really wanna look into also investing into a hands-free headset, because doing this motion all day with a phone pinned between your shoulder is not gonna make your neck better. Yeah, and it's another small purchase that you can make that will really improve your quality of life if you are- you know, do have a neck impairment.

0:13:43 - Shane Smith
I can totally agree with that one, because there've been many days when I spent too much time with my head sideways, and I felt it and I don't have a neck injury. We covered everything with posture, or is there any other areas related to posture?

0:13:55 - John Mobley
Really the only the final thing is just being aware of your posture. Like you said, we've talked about sleep and then at work, but just around the house too, a lot of times people will, you know, melt into the couch after a long day of work. Then you have to ask yourself is the couch giving you proper alignment and posture when you're sitting with your head on the arm of the couch and it's kind of cranked up which I'm sure we've all done once or twice after a long day of work. But where you know that comfy lazy boy chair that is putting you at an angle might not be the best chair for you if you have a- lumbar herniations all up and down your spine that you may need to have a little bit more structured sitting when you're sitting at home.

0:14:37 - Shane Smith
Okay, wow, yeah, and that's something definitely to take a look at, because I know lots of people have lazy boys, or those recliners, and then they get hurt and that's where they still want to go rest and it's just making things worse. Right, we talked about a diet. We talked about exercise. We talked about posture. I mean, everybody spends a bunch of time at work. We talked a little bit about screen breaks. Is there anything else at the work environment that can help out?

0:14:58 - John Mobley
You know we really covered a lot of the main things with work. The only other thing that I could think about with brain injury clients is that you really want to just be cognizant and aware of your break time and taking the adequate kind of steps to maybe walk away from work just a little bit throughout the day, come back, take smaller breaks so that the brain and the body have time to recharge. Because the typical just you know, work all morning, take a lunch break, work the rest of the day. That style of you know time division of your work day does not work for people once they are diagnosed with a brain injury. So sometimes that may involve, you know, speaking with management or your boss to be like, hey, here's my, you know, new reality, new situation, would you be willing to accommodate me?

0:15:48 - Shane Smith
And it's something that it's a legitimate conversation with your boss basically right? Like I've got a brain injury, my doctor says x, y and z. Can we make some arrangements so I can keep working and being productive? But if you force me into this, I'm going to not be productive by the end of the day.

0:16:05 - John Mobley
That's right and you know, I'm sure that can probably- people watching this might be like that'd be a tough or awkward conversation to have with my employer. But you know, bringing you know a doctor's note or an impairment letter from your brain doctor or your brain surgeon explaining, hey, here's what would really benefit, you know, the client and my patient, probably would help facilitate that conversation a little bit so that you can get the accommodations you need to be successful in the workplace.

0:16:32 - Shane Smith
John, I think those are the main areas we discussed about you know, just small lifestyle changes that kind of have a big impact on our clients, certainly the ones after a brain injury, but also after a cervical injury or a lumbar injury as well.

If you're interested in things related to concussions and head injuries, hit like and subscribe down below to see future episodes and hit the bell so you get that notification. If you got questions for John, just email us info, i-n-f-o, at shanesmithlaw.com. And I always remember. If you're in pain, call Shane. 980-999-9999

0:00:08 - Kiley Como
Alright. So if you were with us last week, we were talking about some symptoms, and it's a long list, and so we want to kind of pick up where we left off there. So, John, let's get back into that. Let's talk about some of the symptoms we might see with a pediatric traumatic brain injury.

0:00:22 - John Mobley
Yeah, absolutely Kiley. And just to kind of refresh the viewer, we are going through a very long symptom list because we were discussing how, with pediatric TBIs, you know, some of these young clients can't communicate what's going on, can't communicate their injuries. So we have to go to the next best thing, which is to look at what sort of brain injury symptoms have been manifested or appearing in the child. And that gives us the next best thing to know, did a brain injury occur? Is this something that needs to be followed up on? And it's something that the parents or teachers, families, friends can note in the child. One of the other big categories we see is speech. An important thing that all parents of young children monitor is when the child begins talking and, you know, if it's delayed, then it becomes a cause for concern. Well, unfortunately, one of the symptoms of brain injuries can be an impact on speech, which is a delay in speech or inability to hit certain milestones, which is very important for pediatric development. It can also impact the voice as well. Sometimes we see, you know, hoarseness, strained voice, all these things can be correlated to a brain injury. Another category that is of concern to a lot of parents, anyone that has small children who knows this is, you know, feeding, and feeding safely, and the development of just normal chewing, swallowing. These are very, very big milestones for the development of pediatric children.

Unfortunately, brain injuries can impact that. And what happens is, is, you know, it can cause what's termed oral and pharyngeal dysphagia, which can impact the ability to swallow safely, that basic mechanism to get the food down. Another big thing you know, relating back to how we talked to, you know, a brain injury can impact your cognition and cognitive impairment. If you have, you know, poor memory or limited attention as a small child who's had a brain injury or impulsivity, well, you're not going to be as careful when you're eating, right? You're not paying attention to what you're doing because you have an inability to focus on the task at hand. So when you're not focusing on the task at hand, maybe you breathe down the cheerio or the small piece of steak and it presents just a entire childhood of issues and beyond to the parent who at that point is now, you know, burdened is not the right word, but any parent that knows, you know, raising children it now means it adds an extra layer of complexity to
what could otherwise be a normal task, right? Because now you have to cut the food very small, monitor every single feeding. So it's not just the child that is also, you know, that is impacted sometimes by these brain injuries at a young age. It causes stress, inconvenience, and pain and suffering for the entire family who now becomes, you know, a quasi-caretaker. So these are just some of the things with the symptoms that we see that typically follow up on quite a bit or at least bring to our clients who come to our firm's attention to be like, "Hey, that may not be normal" or "here's the checklist so you can keep an eye out for that." Maybe they're making great advancements in the milestones. You know, every time you go into the, your doctor or pediatrcian, they typically give you this chart to show where the baby lands on the development. A lot of times it looks like a U and if you deviate or go too far from it and you stay deviated too long, then you have to get referred to a specialist to see what's
going on. So that chart in that where the baby falls or the young child, we monitor that closely to see if, "Hey, what was the event?" You know your child was doing great, 50th percentile, right where normal babies nationwide are, and then all of a sudden they start falling off in categories, falling off in weight because they're not eating, because they're afraid to eat, because they have issues swallowing. It's really easy to track that, what was the event and when did the fall off occur? I mean, it's sometimes as clear as night and day that we see a young child fall off. So that's just another thing that we add to make sure that we're getting full, fair compensation and justice for the child and for the family.

One of the other categories that is the big one. It's the big one, is cognition. In that cognition category, it encompasses so much. It's basically, you know, how is the brain working? And it impacts so many different areas, things like attention, and you know listeners at home may think well, what's so bad about, you know, having a decrease in attention? Well, if you want to succeed, or you want to go far in your job, or you want to do well in school and get the grades to get the good job later on, well, attention is a pretty darn big thing. Yeah. And it's hard to put a money value on that. So we have to really lean on the life care planner to say well, you know, that, a lifetime reduction in attention, you're more likely to injure yourself, you're more likely to do dumb things, you're more likely to not succeed in job and school. And when you try and put dollar values on this: astronomical. Astronomical! This is why you know, sometimes when people read the news headlines and they say "Why was that big jury verdict given? It just doesn't make sense, they just hit their head." What they don't see in those big headlines about why was there a $10 million plus verdict is because, you know, they don't understand the full amount of things evolved for the future of that person. And all the lifetime of pain and suffering and complexities and medical visits that that person is now gonna have to do. That's why those verdicts are so big, because I'm sure some of those jurors, when they get put and get called to jury duty and they go in there, they may have, you know, their preconceived notions about people getting big settlements until they start seeing the specialist layout exactly what happened here. And the life care plan is saying, here's the future medical treatment that's gonna be needed and here's how much their life and quality of life is gonna be reduced for the next 70 years as a young child. And that's why these verdicts happen. It's not by luck or it's not by you know one jury. It happens nationwide because of these injuries.

To get back to some of the cognition symptoms is, you know, we see certain deficits with task completion, conversational engagement, that's a big thing for lifetime success. Just an overall reduction in attention span, which can be a huge hurdle for being successful long-term in life. If you can't focus on getting something done, it's gonna impact your relationship with others, your spouse and family and friends. We also, there's another category, which is kind of executive functioning, where, you know, your brain has certain aspects of it that are responsible for, you know, goal setting, judgment, planning, organization, reasoning. These are all things that make a person who they are. And that's why when we see clients that have, you know, impairments, what we call deficits to their executive functioning portion of the brain, these are sometimes the biggest brain injury cases of all. Because while physical impairments can be dealt with with the right specialist care, or therapy, physical things like we
talked about on the last episode, it's much harder to treat cognition and executive functioning problems. It's just, it's who you are now. And that's unfortunate and that's sad for some of these victims is that there's nothing that's gonna potentially cure your inability to not be impulsive, to not make terrible decisions in judgment, because that portion of your brain has sustained permanent damage.

You are just a different person after that, and that is so hard for people to grasp. And we see it with some of our family members of victims that come to us. They're like, I feel like I'm in my house with a stranger, or, I feel like I've got a new person, a new child here now. Completely different. And it gives you kind of cold chills when you think about it. And it gives jurors cold chills too. And that's why we see these large awards, because imagine the person you love most and they're now a different person. Yeah, that's fascinating.

Some of the other symptoms we see too is information processing and just long-term and short-term memory. The memory one is especially difficult for a lot of families to adjust to when they have young children that either have short-term or long-term memory issues, because our memories make us who we are as individuals. You are the total aggregation of your memories that makes who you are as a person. And when you can no longer remember stuff that happened to you as a child because of your brain injury, or if you're already a small child and you just have no short-term memory, then sometimes it can be as simple as, I don't know where I put my keys. Did I put my toys away? Where did I put this? You constantly feel lost when you have severe memory issues, and so those are sometimes some of the really saddest cases. We see it, unfortunately, quite a bit.

0:09:53 - Kiley Como
It's got to be trying on victims, the families. I can't even imagine. I've seen it, but to experience it, it's just got to be terrible. Okay, so we've talked a lot about the signs and symptoms of a traumatic brain injury. Talk to me a little bit about the causes, like how would one sustain a traumatic brain injury?

0:10:13 - John Mobley
So, Kiley, some of the data that we have that tracks nationwide incidences of pediatric TBIs and TBIs in young people-- luckily we have access to this data-- it gives us a great breakdown of what sort of are the causes for young children ages 0 to 14, and what are the causes of those TBIs. The number one cause for brain injuries in young children is going to be falls. And this really comes as no surprise to people that have children, because children are in a constant state of falling down, getting bumps and bruises, getting out in the world and just doing life with no regard to their bodies. So we see a lot of that being falls. And some of that comes to us, some of it doesn't. If there was negligence based, if it was negligence from the bad actions of someone else that caused the fall, then it may come to us, but a lot of those are just falls occurring in sports activities. Beyond that, though, you know, the head injuries are going to be occurring primarily because of being struck, actually events that occur or things like motor vehicle accidents. And then the bottom are going to be assaults and other unknown reasons. So a lot of it is going to be motor vehicle accidents, where we have children and unfortunately even being restrained in a car seat is not always enough to prevent the brain injury. They're going to be better suited to be snug in that car seat but the physics and the whiplash features that cause that forward back, what's called a "contrecoup" forces exerted on the body, it's still going to present issues for that young child. All that energy of 40 miles per hour, cars hitting against each other. That energy has to go somewhere and unfortunately gets transferred to the people that are inside the vehicle and it causes these injuries.

In terms of other big causes, like with falls and assaults, we see just generally that in the age range of very young, shaken baby syndrome is a big thing. When we have, you know, it's a common name for when parents shake the baby, it causes head injuries. We also see young people receiving brain injuries at birth with hypoxic or anoxic injuries when they have some sort of deprivation or complication at birth. That typically is more in the realm of medical malpractice with the claims that we see come to us. We also see injuries a lot that occur with bicycle, motor vehicle accidents, and sports injuries. These occur more often in elementary school children and adolescents.

0:12:57 - Kiley Como
All right, so talking about some causes there. So once we have a traumatic brain injury, who might we meet in our path to taking care of that injury?

0:13:08 - John Mobley
Right. So, unlike adult brain injury victims or clients that come to us, the amount of doctors that you need on your team is gonna be larger with pediatric victims and in young children that sustain TBIs. And the reason for that is because, since they can't tell us their symptoms, like we previously discussed, we need specialists that specialize in the certain areas of the symptom to kind of step in and see if they can't help move along the treatment and identify issues. So that can range from a speech language pathologist, doctors that specialize in speech. If you know, all of a sudden the child's speech milestones have been delayed due to the accident, or they've been able to speak, but then all of a sudden seeing some sort of delay or drop off or new inability to speak, then obviously we now need the, a speech doctor involved. An audiologist as well. So doctors that specialize in hearing are crucial, because the child can't always communicate that their hearing has been reduced or all of a sudden they
can't hear mom or dad or don't respond to the, you know, the nanny or the babysitter's commands like they used to. That's a great reason for us to, you know, get the audiologist involved so maybe further up testing can be done.

Some other specialists that we see very commonly are physicians, the treating podiatrists, where if hopefully they're doing everything that they need to do, they're kind of playing quarterback for the team of doctors and doing good follow up to get those referrals out to the correct doctors, to get them involved sooner rather than later.

Because since the, you know the brain injury is a progressive disease, we want to get those baseline numbers by the specialists early so that if it progresses or gets worse, then you know we can monitor that, that progression of things getting worse. That's why coming soon to us or soon to a doctor to identify this stuff and getting good specialists involved is absolutely crucial. Some other doctors that we see commonly on our pediatric TBI cases are physical therapists, occupational therapists, any sort of rehab, brain injury rehab doctors. These are all people that get involved early and often after the baby has seen, or the child has seen, the neurologist or the brain doctor, because once they identify that brain injury has occurred then they need to get them to the doctor and actually begin therapy, whether that's cognitive rehab, balance rehab, it basically it changes based off what the symptoms the child is experiencing. But luckily there is rehabilitation out there for some of these symptoms.

0:15:52 - Kiley Como
And it's, you mentioned several key points. I think you know oftentimes when we go to our doctor, we think this is our doctor or our pediatrician for our child and they kind of, you said quarterback everything. But in a situation like a traumatic brain injury, that that's a whole different ballgame. I mean, I know we tend to lean a lot on our primary care or pediatricians to take care of that, but we really need to trust them and get those, like you said, those specialists in there, because that's what they- they're highly trained and skilled professionals that know that body part, whether it's the brain or a knee or whatever it is. inside and out that a pediatrician or a primary care physician just isn't trained to do. And so you're absolutely right. I think being able to encourage our clients and to give them that information, to say, this is probably your best course of action to make sure you get the best care and make the best informed decision. I think that's super important.

0:16:39 - John Mobley
Absolutely. We have the utmost respect for our family doctors and pediatricians, but I was, however, at a recent brain injury conference and one of the renowned brain doctors, neurologist specialists said the best primary care physician or pediatric doctor is the one that sends the referral out to the specialist the soonest. So true. And that really is a, you know, that's an important point to make, which is that when we have some of these specialist issues, you want the absolute best doctor on the case, and that is typically the specialist. And then one of the other categories that we see that has a big impact on these cases is the long-term outlook in challenges that are faced by young, our young clients that get diagnosed with these unfortunate injuries.

I know we've gone over attention and executive function. Beyond that, there's also emotional impairments and other challenges that really amount to issues with schooling failures, schooling difficulties and a long-term job outlooks, which are, you know it's way down the road, but we have to look down the road. The reason that these long-term outlooks get jeopardized is because you're playing down a level right. You now have issues and challenges that you didn't have before, and life just gets harder. That's the best way to describe it. Now I've seen some specialists describe it as that life just generally gets a little bit harder because you have deficits that you didn't have previously.

0:18:16 - Kiley Como
I know since my time here with the firm in working with you and other attorneys and the team, what we see so often is treatment fatigue, and that can be extremely dangerous. You're talking especially with a child, and you're talking decades down the road. I mean we could be potentially talking about decades' worth of treatment, right? And so it really is a long haul kind of game and so you need to really get familiar with and comfortable with working with those professionals, I'm sure, as a patient or a victim. Like I'd be really patient. That's something I'm sure you really try to coach up your clients on, to kind of prepare them for that.

0:18:49 - John Mobley
So true. And you know, one of the issues that we run into with that fatigue too is that when someone has a very bad brain injury and they're having all those issues that we talked about organization, impulse control, follow-up, they don't necessarily make great medical treaters. Like, they don't follow up with the care a lot. They miss appointments. And all these challenges and disruptions to their treatment path occur because they don't make the appointments. Yeah. So it's great sometimes when we have parents that are really on board, when we have young children having to go through this long haul of treatment, that they're committed to the process of getting better. It's the best thing you can do as a parent.

0:19:31 - Kiley Como
All right. Well, this is the conclusion of our two-part series. Thanks so much, John. That was fascinating, full of information. And so, everybody, if you wouldn't mind giving us a like, please subscribe to our channel, come back for more great content. And remember, if you're in pain, call Shane. Give us a call at 980-999-9999.

0:00:06 - Kiley Como
Hey everybody, welcome back to another episode of Mind Matters: Navigating Head Injuries and Concussions. As part of our concussion and brain group, we've got today one of our attorneys, John Mobley, with us. My name is Kiley Como. I'm sitting in for Shane Smith today. A little bit about me. My background is a registered nurse. I spent many years at the bedside in area hospitals working in neurological intensive care unit settings, so it's a particular interest to me. But let's get going and talk a little bit more about traumatic brain injuries today, John.

0:00:37 - John Mobley
Yeah, absolutely Kiley, thank you so much. So one of the things we want to kind of go over today is exactly what you mentioned how TBIs affect young children differently than adults. And so just to give kind of some background information, we've done a lot of these series on brain injuries but just to refresh anyone watching, is that you know, TBIs are typically acquired injuries that impact the brain, either from penetrating injuries, car crashes, impacts like that, or even birth injuries. We see that as well with pediatric cases. Hypoxic injuries is what they're called, deprivation of oxygen.

The functional impact of brain injuries on children can be a lot more difficult to diagnose and the reason is, is because when we have brain injury patients, clients, victims, we look a lot at who they were before the accident, what were they capable of before the accident, what their symptoms were before the accident, and then we compare it to what they can no longer do after the accident, any sort of deprivations or reductions in their abilities.

We've discussed this on previous podcasts, but you know the brain injuries can impact your memory, can give you dizziness, vertigo, ringing in the ears, cognition reductions, so your ability to focus, be productive, do work. Well, unfortunately, when we have young children, really young children, we have none of that objective before information. Because they're young babies, you know they don't have a nine to five job. They haven't even made it to grade school yet. We don't know, were they getting straight A's in second grade? We don't know because we're before that. You know they're very, very young. So these things present very unique problems to identify just the severity and the tier of the brain injury. Some of the things that help us to determine and classify with adult brain injuries like mild to moderate to severe, here it becomes a little bit more clouded with very young children and that presents a very unique problem and set of difficulties in these cases.

0:03:01 - Kiley Como
That's an interesting introduction. I think you mentioned something that I think is kind of fascinating and just makes it that much more difficult with children. You know, here you and I are having this conversation about some complex stuff. You know we have the vocabulary to do it, but kids they don't have that right? So it's tough to diagnose and truly understand, lLike you know, how do you get a child to talk about ringing in their ears or how they're feeling at night and that sort of thing? So it can present a challenge to really digging into those kind of symptoms. I'm sure as an attorney you probably have to dig a lot deeper with families, guardians, that sort of thing to really understand that, right?

0:03:35 - John Mobley
That's exactly right. And that's a great point is that, you know, when some of these children are pre-verbal, how do you even get them to tell you what their symptoms are? How much stuff goes undiagnosed? And you know, these are some of our most cherished members of society. Anyone that has kids knows this. So it's really something that keeps you up at night and it's something that keeps us attorneys representing these clients up at night too, because we want to make sure that the correct doctors and correct specialists, like any parent would, gets involved in the case, because you have to go to some extra lenghts when you have a brain injured child who can't communicate what's going on. And, as we know with some kids, you know they just tough it out or they don't even know that something's wrong with them because they can't articulate that. They can't communicate that, and it's really heartbreaking.

0:04:26 - Kiley Como
So how frequently do you see this sort of thing then?

0:04:28 - John Mobley
The data on TBIs in car crashes is astonishing. There's some studies that put it as high as 30 to 40 percent of all motor vehicle accidents result in some degree of brain injury. That can range from concussion to post-concussion syndrome, mild TBI, which is a mild traumatic brain injury. And don't be confused, the word mild brain injury is not mild at all, and it means that person has a huge, huge impact and huge difficulties that they're going to be experiencing in the future. To moderate brain injury, which is the more severe, and then a severe brain injury and up to death. So these things are very common. In terms of prevalence, you know, in the United States some studies have that, you know, children in the 0 to 4 year range had the highest annual rates of TBI related emergency room visits, a large number out of every 100,000 reported. And then after that, adolescents aged, you know, 15 to 19 were kind of the next big group or demographic that reported brain injuries.

And you know, you- all these numbers you have to take with a grain of salt because they are vastly underreported, vastly underreported. And that is widely, widely accepted in the medical community that some people just don't understand that they've sustained a brain injury and that's why you know, really, us kind of sometimes doing these podcasts and just getting the information out there is so crucial so that people can really identify the injury and know that, hey, it's not that just something's all of a sudden not wrong with your body, it's that you had trauma to your head and now you know you are a different person or you are- these symptoms you're experiencing have a root cause, which is the brain being injured.

0:06:20 - Kiley Como
Yeah, amen, it's a complicated landscape, for sure, traumatic brain injury. Sometimes you don't even see it right away, right? I mean these things creep up on us after weeks, days, weeks, even months sometimes. So it's really a waiting game with some of that, I'm sure.

0:06:33 - John Mobley
That's exactly right. And you know that's a key point to brain injury and just having a better understanding of it, is that it is not a one and done event. It's not like you bumped your head or that car rear ended you and you hit the steering wheel and then hit your head and then you know that was the injury, like you know if you broke your arm. It is actually a chronic and progressive disease. That's a better way to kind of understand brain injuries and that you hit your head and now, as testing and in medical studies and knowledge have really evolved in the past few decades, we see that having a brain injury just affects all sorts of things. Hormonal changes, changes in, that we didn't previously understand, in brain chemistry, changes in, in what we talked about before, some of the symptoms. And these things, if they last beyond six months, it's unfortunate, but the studies also show that that can be permanent changes. So we're talking about a lifetime of difficulty. And to bring it full circle to what
we're talking about here today about pediatric TBIs is these are young folks that just started life.

Yeah right, it's, it's, and that's the heartbreaking nature of it, is that they just started life and we don't even know what was, what they could have been, or what was taken away from them. Right? And then we find out that you know they may have to, if they lived to the, you know, government-predicted age of mid-80s or you know, high 70s, then they're gonna have 70 to 80 more years dealing with, you know, the potential symptoms or the reduction of who they could have been. And it, it's- this is why, when we get these cases, they're are some of the most serious cases we take on as a firm, because, and, and jurors resonate with this as well, and it's just, they're very tough cases. So we take them very seriously here at the firm.

0:08:35 - Kiley Como
Alright, so now let's kind of dig down into the meat and potatoes of, let's talk about some signs and symptoms of traumatic brain injury, especially with with pediatrics. So what might we see?

0:08:44 - John Mobley
There's a long list of pediatric symptoms that we kind of use to decode if the injury has occurred. Now, this is typically paired with testing that can be done and we've spoken about that on previous podcast, about just some of the amazing, amazing technological advancements in the medical community that we've made in recent years through diffusion tensor imaging, which is very, very high-powered imaging that can literally trace the flow of water through the brain, where we can identify exactly which portion of the brain was injured. There's huge advancements being made in blood tests, or we might be able to see if there's, as we previously spoke about, there's hormonal changes that occur when the brain is injured and that can be reflected in the blood. So those are some of the tests too, in addition to like a CT scan, which is only going to pick up really bad brain injuries and then it'll be clear anyways. So if the test is not available for whatever reason, or it's not ordered, then we go to the next best
thing, which is looking at the symptoms, okay? Because when you injure your brain, typically it manifests in the body in other ways.

So you know, we will see with children commonly a large list of things. They could experience changes in their bowel and bladder function, changes in their level of consciousness, ranging from, you know, a brief loss of consciousness to a full coma or worse, dizziness. So if anyone's ever had a very small child, sometimes- I personally have a small child as well, they may appear dizzy, so it's hard to really identify that symptom, but there are special tests that are done that can identify levels of dizziness, balance and things of that nature. A little bit harder in a small child, though. Another thing that we see is, that can impact it, is fatigue, so if the child had previously high energy levels and now seems kind of withdrawn out of it, disassociated, these are all things that really a good support structure and parent can identify so that they can report back to the medical professional. And that goes for any of the symptoms we'll discuss here today is, you know, we always encourage our brain injury
clients or their support staff, so that's a spouse, parent, cousin, even a good friend or significant other that you're living with, to help us by, and help the client, by keeping a journal of these things and identifying symptoms and seeing what the person is like on the day-to-day basis, especially if they knew them before the accident. In the context of speaking with small children, of course the parent's going to know the child best. So really they're the first line of being the great historian to communicate that information both to us, the lawyer, and to the doctor. And what that means is that we can just get the best possible care and identify all that stuff.

You know, another thing to point out is that some of these children may not present with immediate effects of the TBI, and that's the big kind of scary thing here is that it may show up later and you see the challenges that this child would not otherwise had.

And it doesn't show up until later development. And particularly we see where maybe that brain injury is causing issues years down the road, once they reach some of the more rigorous demands made by, in the academic setting. So like school. Maybe they seemed okay as a small child when they were just around the house doing baby things or young child things, but then once they have to start doing reading, comprehension, math, then that lack of cognition really starts to show itself and we don't see it until years later. So a lot of times with our very young pediatric clients, if we have any sort of academic history, that's a great way to see who they were before and who they are after. And if they're too young to even be in an academic setting, then we just don't have that and we have to really look at other things in order to know the severity of the brain injury.

Some of the other difficulties, Kiley, that also will present themselves is, you know they'll see issues, and we spoke about educational issues, but also vocational, it'll, the brain injury young will also affect their vocational outcome later on in life. It will have social issues, like you know, their ability to make and maintain friendships, participation in, you know, home, school and community overall. So it really, we will see a huge reduction in all the things that what we would deem the quality of life. And that's why these are some of the biggest verdicts out there. The biggest settlements that a lot of firms do is brain injuries, but even more so pediatric brain injuries, because a lot of times when we're valuing a case we're not looking at just hey, what sort of you know bills, and medical bills and costs and expenses has the client incurred to date, but we would also be presenting to a jury future damages, future needs. Depending on the severity of brain injury, I've had life care planners with
some of my clients say, "This brain injury is so bad, they're eventually going to need an in-home assistant." $80,000, $100,000 a year. A YEAR. So, and that's just one portion of it. And then you know, additional follow-ups, your hearing and vision can go if you have a brain injury. So you think about a young child who then has, you know, potentially over a hundred lifetime visits to an audiologist or an eye doctor, and we've got to include all those things. So we really, really, really lean heavily on certified life care planners in these types of cases and situations to fully map that out. And you know, this is just one of those things where you have to be so thorough and document everything and make sure that the right medical treatment is occurring, because anything missed could, you know, really be leaving something on the table for, you know, the potential recovery for the young child. And these are all decisions that parents have to make. To get back to some of the symptoms, we also see impaired
movements, impaired balance, impaired coordination. And that might not sound like much on paper, but you talk about being what they deem a fall risk. Think about it. I mean, how much does it cost if you fall and break your hip? A lot, and if you now have bad balance for the rest of your life, bad movement, can participate in sports? Are you going to fall down more than if you had not? These are very, you know, hard things to make seem tangible to people. So it's our job as the attorneys to explain just what that means on a day in, day out basis for someone, both from a future pain and suffering standpoint to a potential medical risk. These are scary things when you actually start thinking about the day to day implication of it.

Another thing that we see sometimes in pediatric TBIs is nausea. You know a lot of our clients, when they get into a motor vehicle accident they will sometimes vomit or be nauseous on the scene, literally vomit, and they don't know what's happening. Well, that is a clear sign that you hit your head and had some sort of brain injury. A very, very common thing. It means you not only sustained a brain injury but a somewhat serious one, so that's a great way to tell. We hear a lot of some of our pediatric clients involved in accidents that they, you know, were nauseous or threw up and that might be the only symptom we have. But that's an immediate red alert that we need to make sure that they get screened for a brain injury.

Pain is another one. Headaches is one of the most common things, and that's a hard thing for a young child to explain, they have a headache. In a very young pediatric victim or client it might just present as crying. You know, we don't know. They can't communicate that they have a headache. It can also- some of the other physical symptoms we've seen are seizures in very serious cases.

Another category that gets impacted is what's called the sensory perceptual category. And that can be things like dizziness, vertigo, imbalance, hypersensitivity to sounds or light. One of the classic brain injury symptoms is hypersensitivity to light. We see a young client squinting or having trouble adjusting. We know that that may be a symptom that needs to be recorded by the parent or whoever is taking care of the victim and then immediately communicated to the specialist, which is typically a neurologist, but it can vary.

Another thing that we see is tinnitus. Tinnitus, tinnitus. Pronunciation is up for dispute in the medical world, but it's a big word that basically means ringing in the ear and what it can do is impact your ability to pick up sounds. So people, a lot of people that have worked, we see it a lot with some of our older clients actually, who have spent long careers, you know, on the railroad or loud sounds, or construction, and or you know some of, unfortunately, some of our military veterans will have reduced hearing in tinnitus. And what it does is that, you know, if you've ever had someone you know that is afflicted by this, they have trouble picking up small nuances and conversations when they're out in a noisy restaurant. It just, they can't pick up certain sounds.

It also impacts your sleep. And they say is- leads to depression, because when you have the constant ringing that's described as this just nonstop, incessant cicada sound in your ear, or ringing that it's- it really can impact your quality of life. And luckily there's, there are now some objective tests for that, which is just wonderful for small pediatric clients who have sustained a brain injury, because you know, of course, they couldn't communicate or even understand what ringing in the ears is. So to be able to test it is a very exciting advancement in our ability to diagnose TBI symptoms in young clients. Because you know, until they can become verbal and communicate what's happening to them, you know they may not be able to explain that, hey, I'm having this tinnitus or tinnitus. Another category that we see impacting our young clients is the visual category. What that means is that some clients, when they sustain brain injuries of a certain degree, will have changes in their vision, or what we call
disruptions, and what that can mean is, is that you may see double vision in very bad cases.

And anyone's ever had double vision, know that that is enough enough to make you impaired or get an impairment rating that can impact your ability to do anything, let alone just live. Another thing would be blurred vision, or seeing spots. What they say sometimes, when you have a, what's deemed an abnormal nystagmus, is basically you know you can see fluttering or your ability to focus on an object, tt's impacted. This is a very hard thing to identify in young, very young clients, pediatric clients.

So what we typically do, a doctor that we like to have quote, quote, quarterback, a pediatric case is there's not only ophthalmologists, but also neuro-ophthalmologists, which is a doctor that specializes in, you know, vision issues after you sustain a brain injury. And getting to the right doctor is imperative. Sometimes you know we'll have clients that come to us late in the game and you know they will have been seen just a normal eye doctor because they're, like my vision's messed up. And sometimes they even forget to tell that they're in a motor vehicle accident and we're like, unfortunately, these vision symptoms started after your accident and that really needs to be what needs to be focused in on. And you might not even be at the right type of eye doctor.

You might need to be at a neuro-ophthalmologist, which is someone, like we mentioned, specializes in, you know, vision changes after a brain injury. So this is the type of doctor that can be included on a pediatric brain injury as well.

0:21:32 - Kiley Como
And that's a lot to look for. I think you know, in my experience as a bedside clinical nurse in the neuro setting, one of the things that always struck me over the years was how brain injuries are so insidious in that you don't see it a lot of times. If it's an open head injury, obviously, but those closed head injuries, you just don't see it. They can, a patient or a client can be sitting right in front of you and you'd never know they had a massive brain injury. And like you've been saying, with children, even more complicated. So it's just being acutely aware and alert all the time. You mentioned having, you know the parents, guardians, you know teachers, you know just everybody on the lookout and just be bold and not let anything slide. I loved your idea about the journal, great idea to keep those little thoughts in because there may be many, and they last, for you know, like you said, months, years potentially. So what a complex landscape that is.

0:22:24 - John Mobley
So you made a great point there and the key takeaway just to build on that a little bit, is that it really takes a village to identify these symptoms, the potential for the injury, and, to you know, get the child the appropriate care they need, because you know you're going to need everyone looking out for some of these symptoms. It's a huge list, and it's one of the things that we really urge clients, if they're on the fence about getting an attorney or not, there's no question. In a pediatric TBI case, you need to consult attorney because the landscape is just so complex, so in depth, that we want to make sure we're not missing anything.

And the parents not missing anything, because no one wants their child to, you know, be beginning life starting off on a wrong foot or difficult in, in these TBIs that impact them can cause that to happen. But they can be mitigated and they can be improved upon, and with the right treatment and therapy, the symptoms can decrease, hopefully. So getting in sooner rather than later is always the name of the game.

0:23:29 - Kiley Como
All right, John, thanks so much. That's all the time we have for this episode. There is so much more we want to talk about, so make sure you come back for our next one when we dig in a little bit deeper on pediatric traumatic brain injury. So if you just wouldn't mind, hit like, subscribe to our channel, come back next time and just remember: if you're in pain, call Shane, 980-999-9999.

Transcribed by https://podium.page

0:00:07 - Shane Smith
Hey, I'm Shane from Shane Smith Law. I'm here today on Mind Matters: Navigating Head Injuries and Concussions, and I'm here with John, one of the attorneys at Shane Smith Law with the Concussion and Brain Injury Group, and we're going to be talking about a particular case he had where, basically, the client had a TBI and the impact it had on the case overall. John, how did this accident occur?

0:00:30 - John Mobley
So, Shane, this accident involving our client was a very serious accident where the defendant was not paying attention and ended up rear-ending our client at a high rate of speed, about 40 miles per hour. Created some very serious property damage, mainly actually to the defendant's car, which was shredded and totaled, and, believe it or not, our client's car sustained very minimal damage, so the car kind of did its job to protect them. The bumper absorbed a lot of the energy, but what we'll talk about too is that just because there was not a lot of property damage, it doesn't mean that a lot of forces weren't then exerted on our client and caused a lot of injuries.

0:01:09 - Shane Smith
Yeah, because I know sometimes some of the force analysis. People too will say you know, when a bumper doesn't collapse, when the car doesn't collapse and it remains stiff, all that force ends up going in- it's got to go somewhere. It either goes in whipping the car forward or it goes into the person or whatever, whereas the ones that collapse actually absorb more damage. And it sounds like a lot of this force went into this client.

0:01:35 - John Mobley
Absolutely, and you know the injuries were immediate and apparent, both injuries to some orthopedic injuries and as well as brain injury.

0:01:44 - Shane Smith
What were the brain injuries that were immediately there? Was he knocked out? Was he dizzy? How was it at the scene?

0:01:50 - John Mobley
Yeah, so at the scene, and some of the telltale initial brain injury symptoms we saw here, which was the dizziness, the nausea, the brief loss of consciousness all of these things are the first signs of a brain injury or some sort of energy transfer to the brain. And that's what we saw here with this client.

0:02:12 - Shane Smith
And when we say brief loss of consciousness, what does that mean? Because you know, when I talk to folks, some people think it's, you know, just a second. Some people think it's like 10 minutes. How long, do we know how long this client was out, or did they just think it was just a minute or a little bit?

0:02:26 - John Mobley
So this is always a very hard thing to go back and check because a lot of times the person who sustains the brain injury is not the best historian. So they don't even know? Exactly. It could feel like a minute to some people is actually 10 seconds, or they are out for an hour, and that's the hard part is that you don't always know the exact timeline. So when I'm talking to my clients who we suspect have a brain injury, I'm usually phrasing it more along the lines of you know, is there a portion of the accident you don't remember? And a lot of times we can piece it together that way where you know they'll hear screeching breaks and the next thing they'll remember is when EMS or a witness or bystander is knocking on their window waking them up.

0:03:07 - Shane Smith
So that is clearly something happened.

0:03:09 - John Mobley
Yeah, the light switch got turned off at that point, unfortunately, when you have these long blackout periods. And sometimes there's, when you injure your brain too, there's a period where you're kind of in like almost like a drunken, disoriented stupor is the best way that my clients explain it where you're half with it, but you're definitely disoriented.

0:03:31 - Shane Smith
So you're not normal.

0:03:32 - John Mobley
Not normal, not making sense. And when we see our clients that have friends and family in the car that didn't have a head injury, they usually explain, like you know, mom or dad, something wasn't right.

0:03:44 - Shane Smith
So any, I mean, is it fair to say anytime somebody is like hey, I'm missing part of the accident or, you know, right after the accident I felt like I was drunk or everything was blurry, is it reasonable to say then they most likely hit their head or suffered some kind of impact to the brain?

0:04:01 - John Mobley
I think that is the safest place to start as the default, because what else would explain that? You know you don't typically walk around fumbling your words. Being disoriented, having nausea, blurry vision, those are clear head injury symptoms, and with what we know from the statistics of there being almost 40% of all motor vehicle accidents result in some degree of head injury, I think it's safe to start at that point and then piece together the facts. If we have any EMS, sometimes the EMS notes will notate if they think the head injury occurred or they're showing brain injury symptoms. If we're lucky enough to have bystander witnesses or family members in the car, that really helps us tell the full story.

0:04:41 - Shane Smith
Now is EMS- how reliable is it if they don't put something about a head injury in their notes?

0:04:46 - John Mobley
It doesn't mean anything. And the thing is it can vary based off of how busy the EMS personnel making the notes is that day or how thorough they are on the notes. So much stuff gets left off. We only get lucky when they actually put it on there and do a very thorough brain injury investigation.

0:05:06 - Shane Smith
So that's not taking anything away from the EMS. They just may have five other calls or a gunshot. Then they just have something else where they're like, oh, you're okay, and okay meaning you're not gonna die, put you in and go because we've got another thing going on, right?

0:05:20 - John Mobley
You nailed it. So like if two cars are flipped over and on fire, that's mass mayhem and they're probably not focused on: "Well, let me make sure I get every single note down to the T" and if they were slurring their words correctly, they're probably more worried about getting the client to the hospital so they're alive.

0:05:36 - Shane Smith
That's their primary job is to get you to the hospital so they can fix you right, stabilize you and get you there and, like we've discussed, a concussion is not likely to kill you at the scene or once you're awake you're unlikely to expire in the next hour probably? Correct. Okay. So if it's not there, that's not anything. The most reliable thing is probably the person, if they say they're missing time? That's correct. Yeah, absolutely. Alright, this client was you said, I mean you said it was readily apparent. What happened after that? In the context of the head injury stuff.

0:06:08 - John Mobley
Certainly so, you know, with it being such traumatic brain injury symptoms already showing up immediately, the client did the right thing, which was get to get urgent, immediate care. And you know, the unfortunate worst was then confirmed, which is that the first medical doctors who started to see the client confirmed that, yes, there was definitely a concussion and there was post concussion symptoms and as well as headaches.

0:06:36 - Shane Smith
So, in your opinion, anytime somebody's missing time or thinks they got knocked out, they definitely need to go to the ER? 100%. Even if I feel okay, but if I don't remember the accident, that, there's a problem?

0:06:51 - John Mobley
100%. If you think a loss of consciousness or you don't remember if you did or didn't hit your head, it's always out of abundance of caution, get to a medical specialist so they can just be sure. Because, as we've spoken about on prior podcasts, you know the unfortunate consequence if you have something serious going on or a brain bleed, you can potentially die, and these are things that do happen. You know, if you have bleeding on the brain that goes untreated, you may fall asleep and never wake up. You may experience severe, severe complications that would aggravate and worsen your long-term kind of outlook.

0:07:26 - Shane Smith
And is that kind of you know that old, I'm not gonna say old, the old advice people you see on TV shows: somebody's got a concussion, it's, you gotta wake them up every hour, every two hours? Is that cause we're worried about that brain bleed? So if I hit it, even though I might feel totally fine if I go home and I'm tired and sleepy, that could be it. I mean, it's probably not, but it could be.

0:07:46 - John Mobley
Yeah, that old advice is actually still kind of good advice, honestly, because- and the main thing that that advice was kind of getting at is that you don't just wanna go home and try and sleep it off where no one's monitoring you or watching you. Then you could find yourself in trouble and becoming incapacitated and then it gets worse and worse. So, yes, that advice still holds up, but really the main underlying goal of it is get to the doctor and let them figure it out. Let them tell you you are okay.

0:08:12 - Shane Smith
So, John, this client had visible symptoms at the scene and they took him to the emergency room. What happened there?

0:08:21 - John Mobley
So typically at the emergency room they'll go through an entire process of determining the severity of the injury and this can be accomplished through interviewing the patient, getting an idea of what exactly happened in the accident. So a lot of times we'll see in medical records they'll notate the severity of the accident based off of whatever the patient's seeing them tells them.

0:08:42 - Shane Smith
That seems a little unreliable if they've suffered a hand injury. It is. Okay.

0:08:47 - John Mobley
It is. So you can see how a lot of stuff can kind of get lost in the madness here when you're trying to explain what happened but you're also very disoriented. So that's why these medical professionals are trained to trust but verify as to what happened. If they suspect an accident was worse, then they'll order the appropriate scans, typically a CT scan. However, if they aren't kind of conveyed how serious the accident was, we unfortunately see a lot of our brain injury clients get discharged from the hospital without the proper stuff occurring, and that means the proper imaging or being held for long enough. So that's why the follow-up with the neurologist is always crucial to your treatment in a case.

0:09:31 - Shane Smith
If there is one of these. So I was gonna say, are they great at screening for concussions and stuff at the emergency room? Or does that need some work, or does it just vary greatly depending on where you're at?

0:09:40 - John Mobley
It varies greatly depending on where you're at, how stressed the hospital system is. We all know post-pandemic the kind of stresses that our healthcare system goes through in trying to provide the best care. And then the triage patients accordingly. Ideally they would do an MRI, but we find out more and more that an MRI takes too long and they're very expensive.

So typically a CT scan is ordered, even though an MRI has little to no radiation like a CT scan does.

Constantly they order the CT scan when in fact the MRI would tell us more about the brain injury.

That's why follow-up care and doing the neurologist follow-up is so, so important so you can get the appropriate clinical correlation of your brain injury, and get the proper, the actual, better diagnostic image which is the MRI. Way stronger than a CT scan. What's clinical correlation? That means that if they were to do an MRI and saw that maybe there was a bruise or injury to the brain, that alone probably isn't gonna be able to confirm the brain injury. But if the neurologist then does evaluate the client clinically and says oh, here's all your symptoms, so you've hurt this part of your brain that controls vision and memory, and I'm seeing here, when I'm examining you that you're complaining that you don't know directions to your house anymore when you're driving and your vision's blurry. Well, we've just correlated with the imaging and showing us that, hey, these symptoms of that brain injury area are showing up when I'm talking to you, and sometimes they'll do things like brain check tests where they'll examine your cognitive abilities. These things are how they correlate.

0:11:24 - Shane Smith
So they're matching the tests with what you're telling them basically, or what they're seeing.

0:11:32 - John Mobley
Exactly, and that's exactly what happened here. When this client got in with an neurologist, thankfully quickly, they immediately suspected brain injury based off of the client's symptoms, and then they ordered something called a VNG, a brain check and a balance test.

0:11:48 - Shane Smith
Okay, let's go through those. What are they?

0:11:49 - John Mobley
So there's specific tests that can analyze- one, the VNG will analyze vestibular function, and the vestibular portion and region of your brain control things like, you know, it would have, if it was injured it would impact things like dizziness, nausea, potentially some of your vision, a little bit of your hearing, memory, and it's part of a greater brain injury kind of.

0:12:10 - Shane Smith
So the dizziness, nausea, those are huge signs you got an issue with that? Huge signs. Okay.

0:12:20 - John Mobley
And this test that the client had was positive. So the finding there was that they did in fact suffer brain injury. The balance issue when you, sometimes, when you injure your brain, believe it or not, your brain controls balance and how well you can steady yourself. This client was, unfortunately and very sadly, just barely able to walk down a hallway in his house. Felt like he was kind of on like a cruise ship feeling, and that's a terrifying feeling because as you get older and you're having that cruise ship balance issue feeling, you're more prone to falls.

0:12:49 - Shane Smith
Okay, yeah, which are huge for older people in particular, but good for everybody.

0:12:54 - John Mobley
Absolutely everybody. You fall and break your hip. That's a life changing incident. You're constantly falling, you're constantly injuring yourself, you know, not even to mention the fact that it makes you kind of feel queasy and sick, and these are symptoms that this client experienced.

0:13:08 - Shane Smith
And I'm guessing that varies as well, right, depending on the severity of the injury. So it could be just I'm a little dizzy to, like this client, I can barely walk down the hall.

0:13:16 - John Mobley
Absolutely. There's so many different shades of the severity of the injury and tears to the point where some people they're just completely disabled. They couldn't even look at a computer screen to do work because their vision and balance is just so discombobulated that they're not gonna be able to function. Luckily our client was in between there, so you know, still very functional, but quality of life just went so so far down for this client and that equates to a lot of pain and suffering and just like a very hard life.

0:13:54 - Shane Smith
Because life changed for this client and that's one of the reasons why we want to always ask before and after questions right, how is it before, how is it changed? Because just having the injury doesn't always equate to a large PI settlement if you can't explain what the impact to your life was. And this client, it sounds like, was great at explaining the impact, to friends and family, I guess.

0:14:06 - John Mobley
Absolutely. And the before and after kind of accounts and stories and witnesses that we collect on cases like this. They're arguably just as important as the medical documentation, because they show what the person was and then what the accident caused them to lose, and that loss is what we put money value in. If your life is forever changed in a worse way, then that's how we help value your claim. So in this case our client lost quite a bit, and so we realized we needed to get every possible penny out there for this client.

0:14:39 - Shane Smith
Now, before we get to that, now you said there were three tests they did, they did the VNG. What were the other two tests, and let's talk about those.

0:14:49 - John Mobley
One was a balance test, and this test is, you know, I haven't seen one done personally, but I've read about kind of what they do. They literally check your balance and will take you through a battery of tests where they can check to see if you're stabilizing properly or sometimes if you're leaning or losing your balance, and it varies. But they do a lot of different tests to kind of check and see if you're having issues with that, and if you test positive, which this client did, you get labeled a high fall risk. Okay. You may have heard that term in the hospital, some hospitals use it, nursing homes use it a lot. As we age, our you know, the, the elder members of our society become high fall risk and it really creates an additional burden on someone else, whether it's a caretaker, a family member. So now our client, unfortunately, is gonna have to have the support of family members, friends, who knows, maybe down the road. Nurses are personal kind of care assistants, because they're a fall risk, so they need someone to kind of monitor them.

0:15:50 - Shane Smith
And just being labeled that I know has an impact on your quality of life. It even- I've seen people in the hospital. The high fall risk person is told: "Don't get out of the bed without hitting the nursing button, don't go do anything by yourself without an aid." And just, I mean even just in that limited environment I've seen an impact I can't imagine in a nursing home or in a, in some other scenario the loss of ability you would have, just by being labeled a fall risk, because they they restrict you from doing everything. Right. And for good reasons.

I mean you know, I mean there's a valid reason, but it's still gonna impact you tremendously.

0:16:18 - John Mobley
Right. And if we were presenting this to a jury, we would definitely frame it as a loss of independence. Right? And that's a huge thing, and everyone can relate to that, because it's so nice. You know I'm hungry, I want to go grab some lunch, I'm gonna hop on the car and I'm gonna run down to get my favorite meal, come back home, enjoy myself. You lose all that when you lose your independence, and everyone can relate to that, because no one wants to be a burden on someone else. No one wants to have someone else take care of them. So in these types of cases, that's what we present to the jurors. We say you know, this is a loss of independence and this person needs to be compensated for that huge life change.

0:17:01 - Shane Smith
Yeah, no, now that I think about it, I mean even just getting out of your favorite chair and going in the kitchen and making a sandwich. It has increased risk, right? What about people who live in two-story homes?

0:17:11 - John Mobley
Oh, it's a nightmare. Some of these clients that I have with these symptoms, they would have to completely overhaul their life. If they lived in a two-story house, that becomes a obstacle course. They probably need to downsize or even consider moving, and chances are that probably is what happens on a lot of cases.

0:17:28 - Shane Smith
That's a huge impact, obviously, because you have to sell, realtor fees, the hassle, find a place that works, leave your home which, for some people, they've lived in the same home for 10, 15, 20 years, and you wipe all that away and you move into a new place where maybe you didn't raise your kids anymore, which for some people isn't a big deal and for other people it's a huge deal, depending on how your lifestyle has been. Yeah. And I can just imagine in today's environment, everything would be much more limited to finding a one story home that would work financially. Absolutely. So that's the second test. What was the last test, John?

0:18:04 - John Mobley
The last test was the brain check and that is a cognitive battery. And when we say cognitive battery, that basically means that it tests things like recall, basic facts, your ability to remember things. This client performed very poorly, and what they do is they compare how you performed to the rest of basically the general public so they can actually give you a percentile result. It's kind of like taking the SATs a little bit. Yeah, you don't study for this test, but it is a test, and when you score very, very, very, very poorly, it's typically indicative, when matched up with other symptoms, it helps support the fact that the brain was injured and now it's having issues recalling things, memory. And these are important tasks when you think about jobs, managing your own life, organization skills, planning your day out, executive functions. And if you can't do that, then guess what? Life just got a whole lot harder.

0:19:04 - Shane Smith
Things we don't even think about really. We think they're normal stuff. Just plan, what do I gotta do today, this, this and this? Go to the store, go to work, get gas and my car, all those things. And they lose the ability to do that or it becomes much harder. Is that right?

0:19:15 - John Mobley
Absolutely, and you know when you can't do these things, then people tend to get frustrated. Makes life harder. You see decreasing job performance, maybe you get terminated from your job, maybe you can't find a new job. So it's a huge disruptor to life.

0:19:32 - Shane Smith
Wow, all right. So those are the three big tests. Our client had some injuries. What happened on this?

0:19:38 - John Mobley
So after we reached kind of a, what we call a stabilized point, we had to stick with the treatment for a long time because, you know, if the symptoms don't get better at the six month, 12 month range, then they're unfortunately typically permanent, which we've talked about in the past. So it's gonna take, you know, 12 months to figure out where you're at.

Yeah, we never rush these cases. We like them to just evolve organically so we can see exactly where the client has started, where they're going to. In this case, that is exactly what happened, where the symptoms basically stabilized and we were able to move the case forward, kind of generally knowing that nothing else was gonna occur symptom-wise. And then, once we were able to do that, we submitted a demand to, there were numerous insurance companies involved in this case, so we had a bunch of negotiation ahead of time.

0:20:30 - Shane Smith
How do you end up with bunches of insurance companies?

0:20:34 - John Mobley
So one of our goals as the attorney is to identify any and all monies and covers that may be out there, and a lot of times we see you can have the defendants vehicle, the owner sometimes. If someone else is driving the owner's car, you have the owner's insurance, and then the defendant driver's insurance.

You can go after those too. After those are exhausted, then you have your own insurance, any work insurance if you're in a work vehicle. In North Carolina, it has some great laws called resident relative, where if anyone who you are married to are related to by blood, and that goes way far out, it can be a second cousin, is living with you, then you can use their insurance as well.

0:21:17 - Shane Smith
All right, so that's part of your job as well as helping the client is to do some digging, basically, and in this case it sounds like you dug around and you guys found multiple insurance companies to try to help this client out.

0:21:30 - John Mobley
We did. And there was such a good job done by the medical doctors to document the file that, at least for the first two insurance companies, we got them to give us all their money very, very quickly.

The last two were a fight.

And when we have pushback from the insurance providers, when we know what has happened to our client, we know the severity of the injuries, the medical documents are clear, then I realize it becomes a point and a goal for me that I'm gonna need to educate the adjuster on just how bad this is. If you're not in, you know, someone that deals with brain injuries a lot, one of these insurance adjusters, then you might not know just how life changing they are. And that's when we come in and we use those before and after letters. We use the diagnosis that the neurologist gave us and we show that at every single medical provider symptoms of the brain injury were present, and then we just explain basic things like you know, you can't remember how to drive home.

After having some serious negotiations and providing them with supplemental information, we were able to get the third insurance company to give us all the money, and then we got very, very low offers from the final insurance company. We went through the same kind of rotation of education, educating the adjuster, providing more supplemental information, and then we were able to get all the money after, you know, a long negotiation battle.

0:22:52 - Shane Smith
What's the outlook for our client? How is he doing at the end of this? Has life gotten manageable?

0:22:57 - John Mobley
It's manageable. And the thing with these brain injuries is that it's a new normal, never going to have, be completely healed. This stuff is permanent. So that is the unfortunate aspect of it. But you know, getting a very large six figure plus settlement can help with some of the costs associated with this new normal. That would be things like helping with the fall risk and helping with the memory issues, being- having, now having money to potentially get treatment like cognitive therapy. We talked about the cognitive brain check you can do, at home mental exercises to try and stay sharp, improve any areas that were injured in your brain and kind of regrow that brain area. So it really helps our client when we can get a good settlement so that they have a lot of options moving forward.

0:23:48 - Shane Smith
And that's really what it does, right? It provides options to make life more manageable? Correct. Okay. John, I mean it sounds like we just had a client in a bad situation and by your digging and making sure they got the best medical care they could, and digging into all the policies and finding all the money, we were able to make a difficult situation more manageable. What advice would you give to anybody listening who's been in an accident like this? What one piece of advice would you tell them?

0:24:14 - John Mobley
I think that the first thing you need to do immediately is seek medical care from an emergency medical situation, go into the ER, and then your next phone call should be to an attorney. Yeah, brain injury cases are too tough to navigate by yourself, especially if you are the person with the brain injury, if you're the person who had the brain injury right.

You need help not only from family and friends, but you need help from an attorney to navigate this process, because they are some of the most life-changing injuries that you can sustain in a motor vehicle accident.

0:24:46 - Shane Smith
It sounds like even in this particular case, I mean, you had to do a ton of educating to the adjusters for these second and third and fourth insurance policies to get them to understand the severity of injury, or at least to acknowledge the severity of it and then pay up.

0:25:01 - John Mobley
Correct. It's complicated science, it's complicated studies, it's a lot of anatomy and physiology and so, unless you are doing these cases day in, day out, it can be tough to understand everything, and this is why education is such a big part of educating these adjusters so that they properly value the cases.

0:25:21 - Shane Smith
All right, good deal with John. Thanks for being on the show today. We appreciate it. For anybody listening: if you liked what you heard or are trying to get more information on brain injuries and concussions, hit like and subscribe down below, hit the bell for notifications. And remember if you're in pain, call Shane 980-999-9999. And if you've got a question for John that you'd like him to answer to, if you'll submit that to info at shanesmithlawcom, we'll try to get an answer for you right away. In pain, so I call Shane 980-999-9999. In pain, call Shane.

0:00:08 - Shane Smith

The NFL Concussion Protocol. Last episode we talked about what they do on the sideline survey. This episode we're going to dig into how they get to come back. I'm Shane from Mind Matters: Navigating Head Injuries and Concussions. I'm here today with Thomas, one of the attorneys at the Concussion and Brain Injury Group here at Shane Smith Law. This is the Mind Matters Protocol. This is part two of our NFL Concussion Protocol series where we talk about once the player has been diagnosed with a concussion, taken off the field, taken in the locker room, basically sent back to the hospital for treatment how they get back to playing, which is what everybody cares about the most. Thomas, so let's briefly, briefly, sideline survey what gets covered in that.

0:00:48 - Thomas Ozbolt

Got the Maddox Questions, quick questions to see if the players are oriented to where they are, who they're playing, what the score is, and neurological exam for the sideline survey. All of this inside the blue tent.

0:01:12 - Thomas Ozbolt

0:01:35 - Shane Smith

Alright. And that can be a thumbs up or thumbs down. If it's thumbs up, I could get back out to the field to play this game. They say, all right, you're good. Thumbs down, I'm out and on my way to the hospital, I assume.

0:01:45 - Thomas Ozbolt

Right, yeah, you're out of the game and then you're placed into- tt's all called, when you see it on TV, they call everything the concussion protocol. But the NFL has a more formal name for the process where you get back onto the field and that's hey, you've been yanked from the game, have signs and symptoms of a concussion, and to get back on the field, you have the return to participation protocol. So you don't go back into the game until you've walked through this protocol. All right, what does that look like? What's step one? All right, yeah, let's use Josh Allen, Buffalo Bills quarterback, as an example for this to start off with. The may or may not be eliminated by the time this podcast airs, but he's a useful case study. And so anybody who knows Josh Allen, let's assume he's scrambling, you know, big boy, 240 pounds, breaks the pocket, barrels ahead for at first down and does the wise thing for once in his career, decides to slide. Not a fake slide like he tried to pull against the Steelers in the wild card round, but a real legit slide.

0:02:45 - Shane Smith

Clearly, Thomas, you didn't watch that game or have any feelings about it. None at all. So all right, he gets hit. Bam. Sideline survey. Thumbs down. Go back to locker room, thumbs down. Nope, you're out of the game. How's he return? How does he get?

0:03:01 - Thomas Ozbolt Yeah, so, assuming they make it onto the next round, they pull off a miraculous win with the backup quarterback and get to the Super Bowl. He's been diagnosed with concussion. How does he get back on the field? There's a five step process where he has to be clear to fully practice or play after concussion diagnosis. This process of return to participation protocol, it's a process the NFL has come up with and it's based on what they call. And that's their characterization. I don't want to defend the NFL on all of this. These are internationally accepted guidelines to ensure that each player receives consistent treatment.

0:03:39 - Shane Smith

And the players league also had some weigh in on when they were seting all this up right.

0:03:43 - Thomas Ozbolt

Yeah, they definitely got to have a voice in all of it through the collective bargaining agreement and have some input into it. Yeah, so they definitely had some say in this.

0:03:52 - Shane Smith

This makes me think about one of those things where, when I'm making rules, I'm like this is what we should all do for everybody. And then it happens to me. I'm like well, that's a stupid rule. I want to get back out there with that. I don't want to jump through all these hoops anymore, but now they're stuck with it for their own good, basically right? Basically, yeah.

0:04:07 - Thomas Ozbolt

So the first part of all this is phase one. All right, and this is symptom limited activity. So here in our example, you know Josh Allen, he'd be prescribed rest, limiting or if necessary avoiding activities. Then that's both physical or cognitive, which would increase or aggravate the symptoms.

0:04:25 - Shane Smith

All right, so I'm just resting and not doing anything that's going to make any of my symptoms worse.

0:04:29 - Thomas Ozbolt

Right, and this would just include activities of daily living and under athletic training staff supervision only, there would be or could be limited stretching, balanced training that can be introduced which would eventually progress to light aerobic exercise, and all of these only as, you know, Josh Allen would be able to tolerate them. And phase one if any additional medical issues popped up, the Bills' team doctor, Buffalo Bills team doctor, they should consider external consultation or additional diagnostics. So in phase one, if there's no increase in symptoms and, you know, Josh doesn't develop signs of concussion on the neurological exam, he could be cleared onto the next phase.

0:05:11 - Shane Smith

And how long, is there a certain timeline? Most of these phases have to take place or do take place, or is it just all up to the individual how quickly they heal?

0:05:19 - Thomas Ozbolt

Yeah, it's all up to the individual and how quickly they heal. And you know, a lot of times they're trying to see if someone can progress, you know, through the phases in the course of a week. You know that's kind of the goal. It's like, hey, I want to get you back on the field. They want to get back on the field, they want to play. So a lot of times you'll see, you know guys be able to clear the protocol in a week. Sometimes if it's a worse type of injury, you'll see, you know, a couple of weeks, you know, maybe even three or four weeks. Last year, Tua Tagovailoa, basically they pulled him out for the season or he pulled himself out for the season. They thought it just wasn't a good idea for him to be in there taking those types of hits.

0:05:53 - Shane Smith

He couldn't complete the return to game protocol, basically?

0:05:57 - Thomas Ozbolt

Right. It was, you know, it was pretty concerning. He had back to back concussions. I don't know that it was back to back weeks, but it was in pretty, pretty close frequency and time.

0:06:00 - Shane Smith

And as we've discussed in prior episodes, I mean, once you have one concussion, you have another one. It's that much worse. It's not like you're starting from ground zero, it's just the symptoms are going to be magnified more. 0:06:17 - Thomas Ozbolt Yeah, you can have a compounding effect and you know, like in the 90s, Steve Young, his career was largely cut short due to, you know, having a few too many concussions. I think he could have played a couple more years, but he got a few too many hard hits and decided it was best for him and his family if he walked away from the game.

0:06:34 - Shane Smith

All right, so round one is over. What's round two?

0:06:37 - Thomas Ozbolt

Phase two is aerobic exercise. So here, it's Josh Allen again, he would be getting graduated cardio exercise, cardiovascular exercise, and that would be under the direct oversight of the Bills' medical staff, and this might be something like a Peloton, exercise bike, treadmill. You would see him engaging in dynamic stretching and balance training and this would involve a gradual increase in the duration and intensity of all these activities, as long as there's no increase or aggravation of signs or symptoms by the player while he's performing the activity, and not only while he's performing, for a reasonable period afterward.

0:07:13 - Shane Smith

Okay, so if I go to run for 30 minutes or do the Peloton for 30 minutes, they're gonna watch, so legitimately, they're gonna watch me and make sure I don't relapse, basically.

0:07:24 - Thomas Ozbolt

Right, yeah, they're watching you for your own good in a way. It's like, hey, you know, he says he's good, but let's just keep an eye on him, see if he's squinting from light sensitivity. And then, you know, the checking back with you later on. You know you go home, you're eating some, you know you're having a protein shake and you're getting a splitting headache. That that would say, hey, maybe it's not time to continue progressing here.

0:07:45 - Shane Smith

And you hang out here at phase two, or you can go back to phase one, right? Yeah, because you can go up and down in the phases, right? If symptoms come up, they could pull you back and say you aren't ready to go to phase two.

0:07:55 - Thomas Ozbolt

I don't know if you go back to phase one. I don't think I've seen that. But I've definitely seen someone linger in a phase for a while. Or they say, hey, he's not ready to progress to the next phase, so he's going to stay here for a little while. I'll leave you there. I haven't seen him go up and down on it. It's not to say it can't happen, but I just I haven't-

0:08:09 - Shane Smith

Usually the advice is "We're just going to hold you here for a little while."

0:08:15 - Thomas Ozbolt Yeah, we'll keep you here. We'll stop these activities. We'll still let you attend, you know, regular team meetings engage in film study, but as long as there's not an increase or aggravation of signs or symptoms while they're engaged in cardiovascular activity, player's basically ready to move on to the next phase. What's phase three? Phase three is football specific exercise. And in this instance Josh would continue with supervised cardiovascular exercises that are increased, and they might mimic sport specific activities. And also, supervised strength training is introduced here. Josh Allen in this instance would also be allowed to practice with the rest of the Bills and sport specific exercise for 30 minutes or less, and that's with careful and ongoing monitoring.

0:09:00 - Shane Smith Okay, so I figure they're watching him like a hawk in that 30 minutes.

0:09:02 - Thomas Ozbolt

Yeah, and there's some discretion in between, in phase two and phase three for neurocognitive testing to be administered. You know this is where, you know, you're going back and you're testing to see if the players kind of return to baseline and seeing where they're at. And if the player hasn't returned to kind of baseline in this instance and this testing in phase two or three, you would repeat that test again in 48 hours. That's why you hear sometimes oh, he's still in phase two, he's still in phase three, is because they're testing to get the baseline but something's still off. There's still some sort of sign or symptom of neurocognitive ability that's just not back to where catching up baseline. But you could also look at it to, if they find that there's a non concussion related cause, yeah, that's determined to be the cause. That then that can, that can be considered and will move or let them keep progressing, because this is causing the issue. Right, yeah, maybe there's a headache or something for, for some other reason.

0:09:58 - Shane Smith

Or they're having balance issues, but they also have a twisted ankle. Right. Exactly. 0:10:02 - Thomas Ozbolt I think that's a perfect example. In these instances here, it's the Bills' team doctor who ultimately makes the decision on when the player gets to return to contact activities. Is it, what phases contact? In phase three, when there's a demonstrated ability for Josh Allen to do cardio and supervised strength training without an increase or aggravation of signs or symptoms, he can move on to the next phase. And what's phase four? Phase four is club-based non-contact training drills. So here Josh Allen after his concussion, he's going to continue cardiovascular, strength, balance training, team based sport specific exercise and participation in non contact football activities, which would include throwing, catching, running or other position specific activities.

0:10:49 - Shane Smith

So what's the difference in phase three and phase four? Is it supervised strength training and sport specific exercises? Is that right?

0:10:57 - Thomas Ozbolt

Yeah, sports specific exercises, but not necessarily training drills. Like so, one of the examples, you know, you could, you know maybe, having players running routes and you know Allen's throwing corner route to him or in cutting routes, different things like that, but not anything where he's gonna be, of course he's not gonna be tackling anyway, but there's no hitting. There's no players allowed to hit him. He's wearing the red jersey. There's no tackling, there's no running through tackling dummies like you see, hold the ball, run through with the tackling, dummy at the gauntlet or pushing a sled or anything like that. It's just kind of a slow and gradual increase in what you're able to do. So maybe a sport specific activity and doing some running or running with the ball, but then you're moving on. It's just a slow and gradual increase. Ramp up.

0:11:44 - Shane Smith

All right. So phase four is non-contact team drills and stuff right?

0:11:48 - Thomas Ozbolt

Yeah, non-contact football specific activities. And here to what they're looking at too is, you have to have all signs, symptoms and a neurological examination, including neurocognitive testing and balance testing. All these have to return to baseline status before you can return to full football activity and clearance. Is that phase five? That is phase five. There is one except- or just kind of an exception here to phase four, and these are ones that can happen on a case-by-case basis, because you have some players who have documented ADHD or learning disabilities and for something like that, if hey, you're showing you're not remembering much, you may not have remembered things much anyway, right?

0:12:28 - Shane Smith

So that's why that baseline is so critical and that's, I guess, why they lean on the team doctor. The team doctor should know these things.

0:12:36 - Thomas Ozbolt

Well, yeah, he should know his patients, he should know those who are under his care. So he's ultimately the one who can make that determination. With the neurocognitive testing and the balance testing of baseline, these have to be completed no later than the end of phase, phase four, with the results interpreted as back to baseline.

0:12:55 - Shane Smith

All right, so hit phase four. Everybody says I'm back to baseline. What's phase five? Yeah, that's full football activity or clearance. All right, so I'm good to go once I finish four. Phase five is basically I'm living life back to what I did before.

0:13:07 - Thomas Ozbolt

Yeah. There's kind of a final component to that, though, is you've been cleared to move on to phase five. You've established your ability to participate in non-contact football activity, which will include team meetings, conditioning at the cardio, non-contact practice. This is all without recurring signs and symptoms and your neurocognitive testing is back to normal. But here the club doctor would clear Josh Allen for full football activity involving contact and then he would be examined by the independent neurological consultant that's assigned to the Bills. So this is somebody who's kind of separate from the Bills organization, and in these instances, the team doctor, he has to give that INC, the independent neurological consultant, just give him a copy of all relevant reports and tests, which would include the sideline and booth reports, the booth athletic trainer spotter report, where they initially see it, team injury report. You know that's to give a daily update on what the injury is, and also be given access to video of the injury where that's applicable, where there's actual angle of it, and they also get the player's neurocognitive test results and interpretation. So if independent neurological consultant concurs with the Bills team doctor that the player's concussion has resolved, then in this instance Josh Allen could play in the Super Bowl.

0:14:27 - Shane Smith

Then he's cleared, phase five is over, and now it's back to normal.

0:14:31 - Thomas Ozbolt

Back to normal. And you know, hopefully this is just hypothetical example. Nobody gets hurt, and hopefully the Bills lose to the Chiefs.

0:14:39 - Shane Smith

So one question, that independent neurologist at the end we were talking about that's gonna give me the thumbs up or thumbs down and get out of phase five, is that likely to be the same independent neurologist we had at the game that said, hey, I think I see something here. It would seem to me they're probably different people because I might be in a away game, so that neurologist not gonna be the team neurologist, it's gonna be somebody else.

0:15:02 - Thomas Ozbolt

Yeah, it is a different one. It's actually you have the INC and an UNC. Oh really? In terms of acronyms, and I'm not quite sure the difference between them. The first one is the one that's in the booth, the unaffiliated neurological consultant, and then you have an independent neurological consultant who's assigned to, so it's gonna be a different person, and he would have access to the unaffiliated. I think the unaffiliated part goes in, hey, this is one unaffiliated neurological consultant for both teams who's watching the game. He's not affiliated with the Bills or the Chiefs, he's affiliated with that game. But then, when you bring it down more to a micro level, each team has their own independent neurological consultant who's tied to and assigned, so he's an independent, meaning he's not a team employee, but he's probably a neurologist who works with this team. Or with the NFL, or is a local affiliated with some hospital, guy who comes in on the weekends and has a, you know, other gig in addition to his hospital duties.

0:16:03 - Shane Smith

And I think it's great to know what's going on behind the scenes. I wonder when I see it, sometimes like hey, what is going on? So I'm glad we could dig into this. How effective do we think these protocols are in protecting players? Obviously they're all fairly new-ish, but how do we think they're doing so far?

0:16:18 - Thomas Ozbolt

Yeah, I think there's a significant step in the right direction. They're putting measures into place that are protecting player safety. Of course, as we discover and learn more about the brain like we're always talking about, there's learning more every day there's going to be room for improvement, different ways of testing these things, especially as we learn about concussions and their long-term effects and ways they might present themselves, or different diagnostics that may be available on the field.

0:16:42 - Shane Smith

I was going to say it makes me think of Star Trek when they run that thing over you and it tells you everything that's injured you know. I mean I can see that at some point, that'll be the tension right? Boom. But until then, in our work, hope to God, I can't imagine every team would have say an MRI or something you know, right on the side that sounds crazy. Yeah. From a legal perspective, how do these protocols impact like personal injury cases related to sports concussions?

0:17:05 - Thomas Ozbolt

Yeah, I think you can look at these protocols and see them as a standard of care in the sports context. So if the team or the league fails to follow these protocols, it could potentially lead to liability for injuries sustained by the player or long-term consequences, like we've seen in some of the lawsuits that have been brought against the NFL.

0:17:24 - Shane Smith

I have enjoyed us digging into part two of the NFL concussion protocol. I think the NFL is probably in the forefront of this area because of all the lawsuits that used to happen, but I think we'll see it something similar in other sports, I guess, especially other contact sports as it moves along, and maybe digging into those on some on some of our other episodes, or digging into the trickle-down effect of now that the NFL is doing this, how does it impact our college games and our high school games and other sports for football games I guess. If you've enjoyed this episode of Mind Matters, hit like and subscribe down below and hit the bell for notifications. Catch future episodes where we discuss concussions and everything related to TBIs and brain injuries and concussions, and everybody remember, if you're in pain, call Shane 980-999-9999. In pain. So I call Shane 980-999-9999. In pain. Call Shane.

0:00:08 - Shane Smith
I'm Shane Smith here with Mind Matters: Navigating Head Injuries and Concussions. I'm here with Thomas, one of the attorneys here at Shane Smith Law in the concussion and brain injury group. Thomas, today we're going to be talking about the NFL concussion protocol and basically the return to participation protocol. Right? What you have to do, so you can get back on the field, back to playing.

0:00:27 - Thomas Ozbolt
Yeah, as you know, it's the best time of year for the football fans out there. It's the NFL playoffs. We're into the final rounds, and any NFL fan by now is acquainted with the phrase the concussion protocol. Right, what is that? Yeah, few people really know what it means. They just hear, you know, Tony Romo would go "Oh, concussion protocol jail," but that's what we're here to talk about today. The concussion protocol, the NFL has a specific protocol that they run through, and that's a set of procedures and guidelines that are used to assess and manage concussions that are suffered by NFL players during the games. Designed, and of course, above all things to ensure player safety.

0:01:07 - Shane Smith
All right. So what happens when they suspect a concussion, or a player has a concussion?

0:01:13 - Thomas Ozbolt
Yeah, there are two things that can trigger a player being pulled off the field, and you might notice these. You might notice at least one of them. First, player has an impact to the head, and they exhibit or report symptoms or signs that are suggestive of a concussion or a stinger. That's the first thing that can happen. So you have impact to the head, symptoms exhibited or reported, concussion or stinger. Or, you have these independent certified athletic trainer, booth athletic trainer, team physician, NFL official, coach, teammate, or the unaffiliated neurotrauma consultant notices something from whatever part of the field they're on. So you have a booth person, you have a coach, you have a player, a teammate. They notice these and they initiate the protocol.

0:01:59 - Shane Smith
So even a teammate can do it.

0:02:01 - Thomas Ozbolt Right, yeah, it can be triggered by, you know, say, you know, I guess, we're past the time, Dak Prescott. But, you know, let's say Patrick Mahomes takes a shot, and he gets up and he starts talking like it's 2020, Travis Kelce can say, "Hey, you got to get Pat off the field. There's something wrong here."

0:02:18 - Shane Smith And I know, like I watch a lot of USC and those fighters a lot of times, you know they want to keep fighting. They don't want to be pulled out of the ring, for instance. My guess is NFL players are exactly the same way.

0:02:29 - Thomas Ozbolt
Exactly the same. You saw it a couple of years ago. I think it was 2021. You know, Mahomes took a shot, got knocked unconscious when he was getting drugged down by a Cleveland Browns player. He didn't want to leave the field but they wouldn't let him back on. He was immediately removed from the game and that was it for that game for him. And luckily won.

0:02:49 - Shane Smith
Now once they're removed, what does that remove phrase mean? Are they off the field in the locker room, to the hospital? What's that mean?

0:03:33 - Shane Smith
ALl right. And what are the Maddox Questions and what's the sideline survey? What is that? Yeah it's a quick- so they know these questions in advance. Can I prepare for them?

0:03:42 - Thomas Ozbolt
Oh, you could, but you would have to be in the moment to really be able to answer. The way that they're designed, they're kind of cheat proof. So sideline survey is quick. It's crucial, though. And when we talk about Maddox Questions, those are designed to evaluate the player's orientation and their memory. So, for example, they might be asked what stadium are you in? Alright. Or they might say what's the score, or who are you playing, to check their cognitive function.

0:04:09 - Shane Smith
So those are the Maddox Questions. So those are just normal questions every player is going to know the answer to, as long as they're in the right frame of mind.

0:04:18 - Thomas Ozbolt
Exactly. If everything is going the right way with cognition, they're going to know the answer to that question. They're not going to say they're playing the Braves or something.

0:04:28 - Shane Smith
Well, I know, like, I've seen it in UFC, where they talked about one guy who was, you know, he'd already had a concussion, he'd been knocked out, and they're asking him a question. He goes, "I can't talk to you, I got to get ready for a fight." And they're like, no, fight's over. These are kind of the responses they get on those Maddox Questions, I guess.

0:05:14 - Shane Smith Because those would be the biggest issues, right, "I can't remember where I'm at or who I'm playing or what the score is." I mean, I imagine every NFL player knows the score constantly.

0:05:25 - Thomas Ozbolt Constantly.

0:05:26 - Shane Smith
Yeah, so they don't know any of that. That's a huge sign and it's easy and quick, easy diagnosis for them, I guess.

0:05:34 - Thomas Ozbolt
Yeah, it helps them move on to the next part of that, which would be, you know, it's an indicator this could be a concussion that we're talking about here. So that takes you on to the next step here.

0:05:43 - Shane Smith All right, and what is the next step?

0:05:46 - Thomas Ozbolt
Next step is the neurological exam. This is something a little bit more detailed.

0:05:48 - Shane Smith
Is this the sideline survey? Is that what it is?

0:05:51 - Thomas Ozbolt
Still part of the sideline survey All right.

0:05:53 - Shane Smith
So the whole thing, the whole umbrella is the sideline survey. Yeah. Everything in that blue tent is sideline survey. Yeah. And inside of it, Maddox Questions first. Second question is neurological.

0:06:04 - Thomas Ozbolt
Neurological exam. That's when they're looking at things like balance, coordination, reflexes, maybe, you know, the light in front of their eyes, checking the nystagmus, you know, standing on one foot. They're checking for signs of concussion, like headaches, dizziness, confusion. And again, that all takes place inside the blue tent. So blue tent: "Hey, where are you? What's the score? Who are we playing? And then, all right, let's- did that go well? Let's move on to the next step and see how you're doing neurologically.

0:06:29 - Shane Smith
All right, now is the neurological, is it mostly physical, like the field sobriety tests, if somebody gets pulled over on the side, is it like stand on one leg and walk, you know, walk in a straight line? Or what kind of tests go into that? Or is it the flashlight kind of deal?

0:06:46 - Thomas Ozbolt
Yeah, I think, I think it's- I don't know that there's a specific checklist that they'll go through. A lot of this is guided by the team physician and they do have some latitude in this process. And as we'll see later, they ultimately get to make some of the decisions in conjunction with, you know, the independent neurological or the unaffiliated neurological consultant. But the neurological exam we're talking about is crucial because it helps identify subtle symptoms, and doing this in a thorough way might identify some issues that might not be immediately apparent. Because of course you wouldn't know anything about balance if you're just asking a few questions. It's like, let's get you up on your feet, let's see how you're doing. You know, let's close one eye. There's a variety of different things that they could do.

0:07:28 - Shane Smith
Okay, I guess how crucial is the exam to the whole process?

0:07:32 - Thomas Ozbolt
It is vital to the player getting back on the field or moving on to the next step of this.

0:07:38 - Shane Smith
Because if they couldn't do the neurological here they'd probably have to pull them and send them all to the hospital, I guess a physician or the ER to do it. But they're able to do it here with all the concussion protocols and all the doctors and everything there.

0:07:49 - Thomas Ozbolt
Yeah, if they pass, you know, if they nailed the Maddox Questions, if they get through the neurological exam without any signs or symptoms, they may return to play. But if any element of those surveys, if they're positive or they're inconclusive, they're taken back to the locker room and back there you've got a more detailed examination that goes on.

0:08:09 - Shane Smith
So it's no longer sideline survey, now it's, "You're failing, get to the locker room."

0:08:13 - Thomas Ozbolt Yeah, bad sign if you're a fan of that team. You're like, "Oh no, he's going to the locker room. They might not be coming back at this point."

0:08:19 - Shane Smith
So what happens in the locker room? Well, one. How long does the sideline survey normally take?

0:08:24 - Thomas Ozbolt
I don't know if there's exact number that you can put on it. A lot of times, you see, with concussions when someone goes in there, it happens pretty quick. You know it's, these things show up pretty fast. When you're dealing with a knee injury or, you know, an ankle, that might be a little bit longer. But these, you know, you usually see it pretty quick. You hear the announcers talk about it pretty fast. "Oh yeah, he's got a concussion, Jim."

0:08:44 - Shane Smith
So they know the answer pretty fast?

0:08:52 - Shane Smith
And if they're going to be back out to the field, they're out there pretty quick.

0:08:59 - Thomas Ozbolt
Exactly, yeah. It's got beefed up. You know there were some controversial player returns over the last couple of years that led to a lot of scrutiny being placed on the process. So they've beefed this up more over the years and made revisions and added in requirements, the unaffiliated neurological consultants. But yeah, the next part of the process is then getting back into the locker room. I think that's one of the things that was added in.

0:09:23 - Shane Smith
And what happens back in the locker room?

0:09:25 - Thomas Ozbolt
Yeah, the medical team performs a complete what's called an NFL SCAT, and SCAT stands for Sports Concussion Assessment Tool. And then they do a thorough neurological exam, and if there's any abnormal signs in this instance, they are not allowed to return to play.

0:09:40 - Shane Smith
So what are the chances of my player going back into the locker room and getting to come back out and finish that game?

0:09:45 - Thomas Ozbolt
Yeah, it depends on if they can get through the NFL SCAT standardized tool. They can get through that and they can show that they've been evaluated for symptoms and there's, you know, clear on symptoms. If they've had a cognitive assessment done and everything seems to be working well with their thinking. If there's the neurological screening and balance testing that are done, then that can say, hey, you might be able to get back on the field. This is evaluation of the symptoms here for the SCAT test that involves checking for concussion related symptoms that are reported by the athlete. Cognitive assessment, that's going to test memory, concentration, and orientation, so maybe a more detailed Maddox Questions. The neurological screening that's checking for signs like headache, dizziness, confusion. And then balance testing, obviously testing the athlete's ability to maintain balance, that can be affected by concussion. And then from there they're making a determination about readiness to return to play.

0:10:44 - Shane Smith
And the people saying thumbs up and thumbs down. Are they tied to any one team or are they to the league overall?

0:10:50 - Thomas Ozbolt
I think the ultimate decision is made by the team physician, but there is some interplay with the unaffiliated neurological consultant as well as anybody who's in the booth, and what we've seen in recent years is them erring on the side of caution, because, you know, couple years ago, Tua Tagovailoa took a really bad hit, that head bounced off the turf, and didn't get taken out of the game. And then the following week it happened again, and there were really concerns about what, if he was going to be able to continue his career or it's gonna be too (inaudible).

0:11:40 - Thomas Ozbolt
Yeah. And, and you could see that in this past, you know, in the past wild card round of the playoffs. The Rams were playing the Lions, Matthew Stafford took a hit midsection, falling down, got hit on the head by an oncoming player. And you saw his eyes just roll in the back of his head staring straight up at the ceiling. Obviously didn't know where he was, but he was out there the next play, maybe a play or two later. It's like, well, yeah, it's a playoff, maybe that gets relaxed a little bit and to some extent you got to trust the player to just, you know, make a decision.

0:12:13 - Shane Smith
To be like, "Whoa, yeah, I don't feel good, guys." Yeah, all right. So, from a legal standpoint, how important are these exams?

0:12:21 - Thomas Ozbolt
Yeah, the thoroughness, they're extremely, extremely important. First, because the thoroughness of these exams can impact the accuracy and diagnosis and consequently, the player's health and safety, for the accuracy of the diagnosis and consequently the player's health and safety. From a legal perspective, that affects, it shows the diligence and the standard of care that's been provided by the team's medical staff.

0:12:44 - Shane Smith
I was going to say, my guess is, and you know there were all the concussion lawsuits awhile back, where NFL players are like, "Yeah, gosh, y'all didn't treat us right." My guess is, all of this is going to make it difficult to sue the NFL for future players because they're like, look, we're doing all the things we can do. We've got this sideline survey, we've got the locker room SCAT test. You know, we've got all these things to make sure you don't have a concussion. Now they all depend on you. So if you lied to us, we're not going to know. I mean, but it seems like it makes it tough to sue the NFL about this stuff now, because as far as I know they're pretty cutting edge with all this stuff.

0:13:25 - Thomas Ozbolt
It's definitely been affected and taken into consideration, international standards and guidelines on these. And you also have the input of the NFL Players Association and the collective bargaining agreement, where it's hey, it's not just NFL teams are going to do whatever they want. This is a process that has been agreed to by the players.

0:13:43 - Shane Smith
By the players league too right?

0:13:45 - Thomas Ozbolt
Yeah. So it's, it definitely insulates them from some of the liability. At least you have to think.

0:13:52 - Shane Smith
At least it seemed, as far as we know it looks like it would I guess. Right. When can a player who's removed from the game for a suspected concussion get back?

0:13:59 - Thomas Ozbolt
Yeah, the players can only return to play in a future game after they've been cleared by the team's medical staff and an independent neurological consultant. So I think I may have said before, it's a large degree of discretion in the team's medical staff and they make the ultimate decision. But this does take into consideration an independent neurological consult. So it's not just the player, the player's team that has a financial interest in the outcome and might, you know, be willing to fudge this. You have an independent neurological consultant who has to kind of sign off on it.

0:14:40 - Shane Smith
And I think that's a critical part of the whole process is the independent part, because I know players want to play, coaches want good players to play, and obviously nobody wants somebody to get hurt, but still pretty tough if they're your star player and they want to play, to say no.

0:14:43 - Thomas Ozbolt
Yeah. And you know, they know their body better than anyone and know well, you gotta at least think they know what they're capable of and know the risks. So, yeah, it would be hard to keep them off the field if they were itching, itching to get back out there.

0:00:08 - Kiley Como Welcome to another episode of Mind Matters: Navigating Head Injuries and Concussions eveyone. My name is Kiley Como. I am the firm's treatment coordinator. My background is I'm a registered nurse specializing in neurological intensive care unit bedside nursing. And so today we're with our brain and concussion group attorney Thomas.

0:00:36 - Thomas Ozbolt Establishing a clear link between the traumatic brain injury that happened in, you know, whatever crash and or incident and having subsequent movement disorders. That's crucial, and it involves thorough medical documentation, expert testimony, eyewitness testimony and a deep understanding of how the law recognizes and compensates for these interconnected health issues. Now, talking about movement disorders specifically, these are defined as abnormal, uncontrollable movements of the body that are characterized by either excessive activity, which is called hyperkinesia, or slowed, hypokinesia, activity of the limbs, trunk and or head. So you have excessive activity, hyperkinesia, slowed activity, hypokinesia. Traumatic brain injury can produce either type as well as movement abnormalities that might be difficult to categorize.

0:01:18 - Kiley Como Okay, so that's interesting. So let's get a little more specific. Tell me about some specific movement disorders.

0:01:22 - Thomas Ozbolt Yeah, the most common ones that are seen in TBI are tremor, dystonia, and Parkinson's disease, believe it or not.

0:01:30 - Kiley Como Okay, so what do you mean by tremors or dystonia?

Right, yeah, tremor you know, kind of has an association maybe with some of us of the older generation of those little creatures in the movie Tremors. But a tremor is a rhythmic oscillation of an extremity or the head, which can one: either occur while the limb or head is not moving. It's called a resting tremor. Number two, while the body part is being used, like if you're eating or drinking it's a kinetic tremor. Or, number three, while it's held in a certain position, you know, while your body's held in a certain position. That's what you call a postural tremor.

Tremor is the most common, most traumatic movement disorder and usually only affects the upper extremities, so your arms. It typically occurs following a motor vehicle accident where you have a rapid deceleration force. So you know, sudden stop, you know you're driving, maybe a head on collision, sudden stop. Or you know you're running into the back of somebody. So in most of our cases it would likely be a head on collision. With these more severe TBI, tremor can first manifest as long as a month to a year following head trauma. It can cause difficulty obviously eating, drinking, doing a lot of everyday things due to the shaking that happens in your body.

0:02:45 - Kiley Como All right, yeah, so that sounds pretty serious. So how do we go about treating this?

0:02:48 - Thomas Ozbolt Medication can help to improve it and there's been some success with neurosurgical intervention. That happens either by destroying or through ablation, or stimulating, through deep brain stimulation or DBS, certain brain structures through the precise stereotactic placement of electrodes. It's actually placing, you know, an electrode inside your brain to affect deep brain stimulation, which just sounds like something from the future. Yeah, it can be effective to an extent.

0:03:20 - Kiley Como Yeah, so that's interesting. I've actually taken care of many patients over the years that have had those same types of procedures that you're talking about, and you're right, it does look like something from the future. It's very, very intricate, patients are very sick, but it's just some fascinating technology that we have these days to take care of patients that are suffering from TBI.

Have you seen it actually be put in? I have, yeah. What does that look like?

0:03:44 - Kiley Como It's very detailed, it takes a lot of time. There's a lot of work in preparation that goes involved, goes along with that, not just the surgeon but, you know, nursing staff standing by, I mean respiratory therapy. A lot of times these patients are on ventilators or, you know, really critically ill otherwise, because, as you mentioned, the brain controls everything, right. Yeah, so when you've got that deep level brain injury, you're talking about some pretty massive overall injuries to the rest of the body.

0:04:13 - Thomas Ozbolt That probably involves a massive team in terms of medical professionals involved in that, probably some highly trained people. Absolutely, and days, weeks in the ICU, yeah, pretty easily.

0:04:24 - Kiley Como Is there any information on, like these success rates of these types of interventions?

0:04:28 - Thomas Ozbolt Yeah. So one long-term study of post-traumatic tremors reported that 65% of the patients had complete resolution or marked reduction of the tremor following the surgery. At the same time, for those folks, post-operation complications and adverse response rates kind of complicate that, because those are showing up in 50 to 90% of the cases. So it's really mixed. You know it's kind of a coin flip on, you know, if you're going to have something significant happen as a complication as a result of that from what one study tells us right now.

0:05:03 - Kiley Como Yeah, you're right. I think a lot of that takes a really patient person, support people around that person who suffered that injury. It's not just the care you get right away but, as you just mentioned, the recovery time it takes. You really got to be in it for the long haul and you've got to be a strong type of person to get through that sort of thing.

0:05:21 - Thomas Ozbolt I'm sure their families are probably in the same situation. Being there by the bedside, so that's not just affecting this person, it's also having a massive impact on the people around.

0:05:31 - Kiley Como Matter of fact, most of their work comes in after the hospitalization because, you know, in the hospital the nursing team, the doctors, are taking care of that patient. But once that patient goes home or to rehab, that's where the family really has to step up, because they're really the major support at that point. When you talk about rehab, it's like how long can that last?

Months. Months, yeah. And that's hard. Even say years in some instances? It could be. I mean there could be some permanent disability, absolutely. But yeah, certainly several weeks of intensive rehab, inpatient, and then you know outpatient rehab, for you know many weeks to months of that, if not into, you know, over a year of that sort of thing. And that's not just physical rehab, you're talking cognitive rehab, speech therapy, I mean, depending on the injury, could be head to toe.

0:06:14 - Thomas Ozbolt So when we talk about the impact of what a crash and what it takes from a person, that's really what we're looking to bring justice to the situation. It's like to have that taken from you as a human being, your ability to function for months on end, and just you know the movement disorders that go along with it. That's, I mean, what would you give up, you know, what would you accept to have that happen in your life? Let's talk about dystonia. Tell me a little bit more about that. Yeah, dystonia.

So, unlike tremor, dystonia is a slow movement that's characterized by involuntary, sustained muscle contraction. This often happens with repetitive twisting movements or abnormal postures. So in some instances, dystonic movement can be accompanied by tremor or rapid jerking movements. And this, you know, is one of those things that can also happen in the general population with something called torticollis or you know another name for that's rye neck, or task specific forms like writer's cramp. If you think about kind of, you know, how, how that can show up in people. Maybe you might know something about torticollis or rye neck, because I sure don't. I know I've seen it before, I've heard it talked about as abnormal posture, but do you know what I'm talking about?

0:07:24 - Kiley Como Yeah, yeah, it's just turns into kind of a muscular disorder at that point more or less, if you want to put it that way. But that's more that kind of a long term and that you know some of the therapies that a person can go through afterwards can help avoid some of that. You know, when the muscles are held in one position, if for any length of time they tend to stiffen up, tighten up, kind of you've heard a foot drop, something like that, similar situation where those muscles just kind of, and tendons just kind of tighten up and you know it's hard to kind of get them free and mobile again.

0:07:53 - Thomas Ozbolt So, first and foremost, post-traumatic dystonias. Typically they don't resolve on their own. So if you're waiting for it to just go away on your own, it's not a great idea. You need to go to the doctor. Now, medical treatment, you know, usually doesn't work either, with the exception of botulinum toxin or Botox injections believe it or not. These are most effective for focal dystonia, for the neck or hand. But just like a tremor, you have precise neurosurgical procedures involving ablation or stimulation of specific brain structures, like that deep brain stimulation we've talked about. That's been done, but it's also had less effective outcomes. So there's just not a lot there right now in terms of medical treatment for this, unfortunately.

0:08:39 - Kiley Como Let's talk a little bit about Parkinson's disease. You mentioned that that's one of those types of movement disorders you might come across when dealing with TBI.

0:08:45 - Thomas Ozbolt Yeah, Parkinson's disease. You know, first thing I think about when I hear that, it's not traumatic brain injury, but it is an example of a hypokinetic movement disorder that's characterized by what's called bradykinesia. That's defined as a slowness or poverty of movement. So you've got bradykinesia, postural instability and a resting tremor. There's often, but not always, a resting tremor in one or both hands. Later there's a progressive difficulty in standing, initiating steps, walking, handwriting, speech and balance control over a matter of several years. And as the disease worsens, dementia may become prominent, leading to required assistant living or assistance with your living.

0:09:29 - Kiley Como So you're not saying that TBI always or even only causes Parkinson's right?

0:09:35 - Thomas Ozbolt Right. Nobody's coming out and saying that, that's definitely important, but because the exact cause of this it's not known, but evidence points to a combination of factors that includes environmental factors such as exposure to pesticides and herbicides, well water consumption believe it or not certain medication, and multiple head trauma. It can occur in the general population spontaneously, as early as 40 to 50 years old usually. But what Parkinson's does is, it destroys the neural pathways in the brain that utilize the neurotransmitter dopamine. So when you have treatment with this, it's focused on replacing that dopamine with various medications, but there's no cure.

0:10:17 - Kiley Como So that makes me think of Muhammad Ali. So we all know Muhammad Ali. Now we're seeing a lot of Michael J Fox when we're talking about this type of movement disorder. What does that mean?

0:10:26 - Thomas Ozbolt Yeah, definitely the most prominent individuals that you associate with this and did a lot to advance treatment options and bring awareness and research money into this. But when you think about this, it's believed that Parkinson's, it doesn't arise from a single incident of head trauma. So it's not the sort of thing where we're saying, hey, you know, 30 year old, you know John Smith, driving down the road, gets crushed by a tractor trailer and has a TBI as a result of that has Parkinson's disease. But it's more a result of repeated head injuries, which does raise a host of concerns for young football, soccer players, young athletes or any other person who's involved in contact sports who then suffers a traumatic brain injury in a motor vehicle, for example.

0:11:52 - Kiley Como Yeah, it's such a mysterious disease, such a mysterious organ in the brain. I know we've been going at it for decades and still I feel like barely scratching the surface there.

0:12:01 - Thomas Ozbolt Yeah, I think we talk about it a lot, but it's kind of like the ocean. You know, we know just a little sliver of what's underneath the waters that make up most of our earth, you know 5% of those, and what we know about the brain is largely the same. It's a really interesting comparison. It's depths are unchartered.

0:12:21 - Kiley Como Yeah, but I am really liking seeing the push toward understanding it more. Like you mentioned football and you know CTE or chronic traumatic encephalopathy and the role that repeated impacts play. So football, boxing, all that sort of thing, it's brought a lot of awareness to the disease in general. So you know it's a good thing to see.

0:12:40 - Thomas Ozbolt Yeah, those tools being, you know, brought to everyday people rather than, you know, just kind of high profile, that's going to change the landscape and really, I think, help our clients and people who we serve to get the tools they need to get over these, you know, tremendous life altering injuries.

0:12:57 - Kiley Como All right, so that's going to do it for us. If you need help with any of this, you can always call us at 980-999-9999. Remember to hit like and subscribe, remember to hit the bell for notifications and if you're in pain, call Shane.

0:00:08 - Shane Smith
Hey, Shane here from Shane Smith Law. I'm here today on Mind Matters: Navigating Head Injuries and Concussions, our podcast, and Thomas is here with us. He's one of the attorneys from the concussion and brain injury group at Shane Smith Law, and today we're going to be talking about traumatic brain injuries, but a specific part of that and how it impacts sleep disturbances. So, Thomas, before we dig into all of that, what is a traumatic brain injury?

0:00:29 - Thomas Ozbolt
Yeah, a traumatic brain injury occurs when there's a direct bump, blow, or jolt to the head, or when there's blunt force or a hit to the body that causes the head or brain to move quickly back and forth or just quickly back, quickly forth. This causes the brain to bounce around or even twist inside of the skull and also causes chemical changes in the brain and stretching or damaging brain cells.

0:00:55 - Shane Smith
So it sounds to me like you know, when I was a kid I had one of those balls and inside of it was another ball and you could hit it against the wall and obviously that's an impact, but you could also just shake the thing and you could hear the ball inside bouncing around. Same thing with brain?

0:01:08 - Thomas Ozbolt
Similar concept with skull and the brain inside. Yeah, and you know, when you do that, when you shake that ball, or when you know that skull gets shaked around, that can lead to changes in the brain which leads to symptoms that might affect how you think, learn, act, feel, smell or even sleep.

0:01:28 - Shane Smith
Wow, all right. So, and sleep's what we're going to talk about today, and sleep is not really something I think about when I'm talking about injuries, you know, and what's going on in life. Rarely, since I don't do brain injuries all the time, do I think, okay, tell me about your sleep? Not like, I know you hurt your back and you're pain, it can be hard to sleep, but how does how does having a TBI affect sleep normally?

0:01:49 - Thomas Ozbolt
Yeah, that's a great question. They become a crucial part of the narrative and you know the true story that we tell about what's happened to our clients. These are things, you know, when we talk about sleep disturbances, they not only impact your daily life, as anybody who has ever had any difficulty getting sleep can tell you. You know the importance of a good night's sleep, like a new mom, for instance?

Right yeah, a new mom, new dad, any of those things. You know sleep, it's crucial, and if you can establish a clear connection between the TBI and those sleep disturbances, you've established a pivotal step in building a strong case.

0:02:26 - Shane Smith
What does sleep disturbances mean, right? Is that like I wake up all the time? Is that I never get into deep sleep? Is it, I can't fall asleep? What is sleep disturbances in the context of a TBI?

0:02:36 - Thomas Ozbolt
Yeah, so sleep disturbance, it falls under, they've kind of got several different categories underneath it. This is something you commonly see in TBIs. They're caused by multiple different reasons, though, so you need some kind of correlations, clinical correlation.

0:02:50 - Shane Smith
Now, if I get a concussion, does that mean I'm going to have a sleep issue? Is that what you're saying is pretty common?

0:02:54 - Thomas Ozbolt
It's pretty common. It's not necessarily going to be the case, but when you have a TBI, some of the related sleep disturbances that you might have. They include insomnia, obstructive sleep apnea, excessive sleepiness that's called hypersomnia, 50 cent word there, that's what my dad used to say, and narcolepsy.

0:03:14 - Shane Smith
Now, Thomas, before we go into what each of these types of sleep disturbances are, how common are they? Because we've talked a little bit about before, it's pretty common. But what does that mean? Like you know, am I like 90% likely to have a sleep disturbance? Is it like 10%? What, what does that mean?

0:03:30 - Thomas Ozbolt
Yeah, that's a great question. So there's been a lot of different studies done on these. One, in one of these studies, of 100 different patients one year after TBI, 50% of them continue to have difficulty with sleep, even after a year, and 64% of that 50% reported waking up too soon. 25% of them reported prolonged sleep and 45% of that reported difficulty with falling asleep.

0:03:58 - Shane Smith
Okay so, a little mix of everything basically right your sleepers nightmare kind of deal.

0:04:03 - Thomas Ozbolt
Yeah, and you know we talked about hey one year, even one year, in another study three years after the TBI 67% of individuals reported persistent sleep disturbance. That's even worse, even worse, and of those 27% had difficulty with excessive sleep. So you know, oversleeping their alarm going way too long, disrupting their life and work. 12% had excessive daytime sleepiness and 10% had insomnia. Okay now, the scary fact about this at least for me, I value my sleep is that insomnia occurs in 30 to 50 percent of TBI cases and might not appear until weeks to months after the injury.

0:04:49 - Shane Smith
So you may, if you're not knowledgeable in TBIs, you might not even associate it with it because it didn't appear for for several weeks right?

0:04:58 - Thomas Ozbolt
Right, and you know you can obviously see where that can create difficulties in speaking with an adjuster who has very limited experience on on some things, probably brain injuries in particular you know, and it's like, hey, you know, this didn't, this might not have shown up until a month after the crash, but that doesn't mean it's not related. There are different causes that are responsible for insomnia, you know, that's something certainly to acknowledge, but one of those causes is damage to the brain structure.

0:05:27 - Shane Smith
Let me ask you this too. So if I have one type of sleep disturbance, am I not gonna have the others, or these all mixed together, like if I've got insomnia, it would seem to me when I think about it, I could also have the sleepiness during the day because I didn't sleep right, or hyper-sleepiness. So do people have insomnia then the next week they're so tired they oversleep and do all this? It impacts, you can have all types of them?

0:05:50 - Thomas Ozbolt
Yeah, I think you could have a mix, certainly have a mix. You know we talked about insomnia being present in 30 to 50 percent. Sleep apnea, that was found in 30 to 40 percent of TBI patients who experience daytime sleepiness. So you see a lot of crossover. It's not just like you're gonna have sleep apnea, you're gonna have insomnia. You can definitely see that mix over. Whether there's been specific studies that will go beyond isolating one, I'm not exactly sure of that. But there's a multitude of studies that look at these kind of in isolation, you know, studying for one factor, controlling for one factor.

0:06:24 - Shane Smith
Yeah, I know the effects of messed up sleep compound. Yeah, day after day after day, it just keeps getting worse and worse and worse. I mean it can make everything difficult, right?

0:06:34 - Thomas Ozbolt
Right. Sleep, we're finding more and more out, is just one of the most crucial parts of your life. You know your sleep, your diet, your physical activity. These are essentially the building blocks to having a healthy lifestyle and healthy well-being. If one of those goes off here, sleep disturbance being one of the things that's affected by TBI you can disrupt your entire life. You know the healing of your body, your metabolism. Scary fact that you know, learned and researching this issue is that TBI can essentially cause a flip-flopping of your waking and sleeping cycle. So if you think about, wow, daylight savings time and how that throws havoc on you and that's just one hour.

Yeah, this can flip flop your entire days and nights, where you're awake at night and asleep during the day. That's called circadian rhythm sleep disorder. That can happen with TBI.

0:07:25 - Shane Smith
And I, I've seen the effects that can have on somebody who works night shift for a long time. It starts bleeding over into everything, it's not uncommon for it to impact their metabolism, their weight, their emotional aspect, I mean their moods, everything. And that's something, I don't want to say you can control, but you know you have a little bit of control there, whereas this you've got no control.

0:07:44 - Thomas Ozbolt
Yeah, it's like being forced into a third shift lifestyle, which studies have shown it's really harmful to your body, is working that type of lifestyle. So if that is forced upon you by the negligence of someone else and causing you a traumatic brain injury, that's a life-changing sort of incident.

0:08:00 - Shane Smith
Yeah, because most higher paying jobs for one are daytime jobs. I mean, I'm not gonna say they're no great nighttime jobs, but the vast majority of the high-income jobs are daytime. A lot of times the nighttime jobs are there but they don't pay as well, right.

0:08:15 - Thomas Ozbolt
Yeah, and you think about kind of being an attorney or being a doctor or being somebody who runs a restaurant or or any of these things where you do what you have to do during the day, because that's when your clientele is out and about. If you have something like that happen for someone like that, or a teacher, you know even a mother, you know a full-time mom staying at home watching the kids.

Kids are up there the day right? Kids are up during the day and you're, you can't get off the couch. Like that's terrible.

0:08:40 - Shane Smith
I mean even even non economically, but just socially. Yeah, I mean interacting with everybody would be so much harder as well, because while everybody else is up moving around, you're asleep and while everybody I mean, and they want to wind down at 9 o'clock, they're settling in for bed and you're like it's 8 in the morning. It has a ripple effect on your social life and your psychological health, and just everything that makes us human beings. What evidence do we need for the, for this right? I mean, how do I prove I've got sleep disturbances?

0:09:07 - Thomas Ozbolt
Yeah, so, as in any case, documentation is key. We're looking for medical records, we're seeking expert opinions, and we might even involve sleep specialists to provide a comprehensive picture. One of the goals that we have is is showing to a jury how TBI has directly led to those observed sleep disturbances, and strengthening our case in that process. There's some diagnostic measures that you can use for this. Some of these involve self reporting, others involve you know what you call objective testing those, those self reporting mechanisms. You could use a sleep diary just to report your sleep night by night. There's questionnaires, one of those called the Pittsburgh sleep quality index. There's an insomnia, insomnia severity index and the Epworth sleepiness scale. Sleepiness scale, yeah, not exactly sure what that looks like, but it is a clinical way that they use to assess the degree and the severity of sleep disturbances.

0:10:03 - Shane Smith
And I'm sure, I mean, you know, we sort of joke when you talk about a sleep journal or whatever. You know, wake up in the morning, how was your sleep? But I'm sure it's more detailed than that. I mean they ask some questions that you know, they get more detailed.

So it is a little more objective than just hey, I slept great or I slept bad. Yeah and nowadays with technology I think your phones and your watches and all that can't they tell you how many times you woke up and they could start measuring the quality of your sleep, and I'm sure that would be evidence we could use to prove that you woke up 47 times in the night.

0:10:34 - Thomas Ozbolt
Right, yeah, I've got one on right now it's called a Whoop. Plug for Whoop right now.

0:10:43 - Shane Smith
You know, but we laugh, but but that would be a great way to measure your sleep disturbances, because they're- it tracks, it records that for weeks, I think right?

0:10:52 - Thomas Ozbolt
Right, for months. I have a six month picture of what it looks like and it provided a report for me to show to the doctor what the, that sleep study we refer to. It's called a nighttime polysomnography. That measures a lot of the same information that the Whoop will capture. That would include you go into a sleep laboratory. They're assessing your brainwave activity while you sleep, eye movements, muscle movements, heart rate, your respiratory rate, your blood oxygen content and your limb movements. Now Whoop only covers your heart rate, respiratory rate, blood oxygen content and heart rate variability. But those are all things you can see a change, like you could look at that information.

If you have a sleep study done, you can kind of see how that evolves over time to show that it's happening.

0:11:34 - Shane Smith
And I like the, the home method of the Whoop and, and maybe some of the other stuff, just because I know people who've went and had sleep studies and they're like, look, this is not an accurate reflection. I sleep because who has a lot of fun going to a place sleeping with all these things, tape all over your body, and sometimes the lights are on or they come in and check on you and then you know, I mean ever, yeah, I think a lot of jurors to look at that and go, well, maybe it's probably not that bad, because I've had those and it's, nobody can sleep there. Right, whereas the Whoop, that's just on your arm and your home right?

0:12:04 - Thomas Ozbolt
Yeah, it's charging, or it's recording what is your, your baseline, so you have a picture of what it looks like and so if something happened to me, you could look at my data and see the impact that it had over time. Now, not everybody has that, but it is a measure.

0:12:13 - Shane Smith
Even if I put it on today and mine was crazy, you could certainly say this is atypical, doesn't fit the norm, right? And Whoop then would tell you, hey, you're, you've got a lot of stuff going on. You need to relax or you need to do whatever.

0:12:26 - Thomas Ozbolt
Yeah, it measures your kind of stress level and it told me that my body temperature was a little over last night. It was a little bit warm in our house. So it'll, it'll let you know those factors that will affect your sleep.

0:12:37 - Shane Smith
Obviously, sleep issues leads to tiredness, fatigue, just not being your hundred percent self. How's that intersect with with TBI? Or is TBI directly linked to the fatigue? Or is the insomnia linked to the fatigue? How's all that work?

0:12:53 - Thomas Ozbolt
Yeah. So I think, starting by defining fatigue in terms of how they do it medically, it's the state of chronically feeling tired and exhausted. Now, to be clear, I mean there are a lot of things that cause fatigue. It's a common symptom, you know. Anything from being out of shape to significant medical problems like anemia, multiple sclerosis or cancer could cause fatigue. But post traumatic fatigue affects at least 50% of individuals with TBI. Wow. And in those cases it's often debilitating. There's been long longitudinal studies that have been done on TBI patients, and in those studies fatigue was present in 68% percent after the first post trauma week, 38% after the third month and 34% after even the six month of that longitudinal study.

0:13:40 - Shane Smith
So it seems to get, once you cross the six month mark, you're, I don't want to say stuck with this in your life, but I mean it's very difficult to overcome those sleep issues and the insomnia and the fatigue and everything wrapped into place if you're still having it six months out.

0:13:53 - Thomas Ozbolt
Yeah, you know it can definitely be there even after half a year. And if it's there after half a year, you know you, you got to assume that's gonna continue to some extent, or you might be able to assume that's gonna continue to some extent.

0:14:09 - Shane Smith
And I think it's important to realize there's no break. Frequently, you know, you have a mom with a new baby or dad who's taking care of a new baby.

You know they go for five days on, which is difficult and challenging, but then dad may be at home or mom may be at home for the weekend, so they get that break. Or even grandma comes into town and takes care of the baby for a night, sort of give a reset, you know what I mean? Yeah. A lot of people talk about that, right, like my mom came into town, took the baby for a weekend, finally got eight good hours asleep. Or I went on vacation and got, I went to bed early on Saturday and woke up super late on Sunday, so I'm sort of recharged pretty good, but there's no break for these guys, right?

0:14:41 - Thomas Ozbolt
Yeah, it's when you're, all those examples you're talking about, that's something external that's causing the fatigue. In these instances, where it's traumatic, post traumatic fatigue, it's caused by something inside of you, you, that you can't control. You know many, in many cases there's, there's different ways to treat this, but it's, it's something that affects an injured person's daily life and there's really no escape from it. It affects their ability to work, engage in activities, be a mom or dad, maintain a certain quality of life and, you know, establishing that connection between the TBI and the fatigue and sorting out, hey, it's not all these other confounding variables, it's the TBI that's causing it. That's crucial.

And you know, post traumatic fatigue is caused by a lot of different factors. What are some of the factors that cause it? So there's, you know, at least six different kind of factors that will cause it. There's anatomical, there's behavioral, there's biochemical, there's endocrine factors, there's medications and there's sleep disruption, as we just kind of talked about. Now for anatomical, traumatic injury to specific structures within your brain, like the brain stem, the basal ganglia, that can affect your a level of alertness as well as your drive and motivation.

0:15:53 - Shane Smith
So that's gonna, that's when the brain, there's an actual injury to that part of the brain, boom. That's what's causing the issue, the injury itself.

0:15:59 - Thomas Ozbolt
Yeah, it's, it's, it's creating, you know it's, it's causing the fatigue in the way, by affecting your level of alertness as well as your drive and motivation, you know, triggering those, you know, internal effects upon you. And then you've got behavioral, you know, depression, which is something that's particularly prevalent with TBI. That can also be related to fatigue development. When you're under that stress of just feeling like the world is ending or just life is terrible and that's maybe oversimplifying depression, that can develop fatigue in your-

0:16:32 - Shane Smith
So the TBI caused me to have depression, and the depression is what's creating the fatigue issue.

0:16:39 - Thomas Ozbolt
Right, it leads to fatigue. So all these things kind of, it's a web.

0:16:42 - Shane Smith
So it's a path together.

0:16:44 - Thomas Ozbolt
Okay, then you've got biochemical changes, like, traumatic injury to the brain can cause alteration in your amino acids that are produced that can affect the production of neurotransmitters within your brain, the signals that are being sent for your body to act and react to certain stimuli. So the chemicals are off inside? Right, yeah, okay, much simpler. Endocrine dysfunction, particularly related to pituitary gland injury. This can cause fatigue due to deficiencies in your growth hormones, your thyroid, your cortisol, all the things that make you go, the things that build your muscle, the things that control your stress level. Injury to the pituitary gland, that's the endocrine we'll talk about there. Wow. And then medications, these have fatigue as a side effect. In a lot of cases, medications are prescribed to deal with TBI, and then sleep disruption and all.

0:17:37 - Shane Smith
So the medication, that's one of those things where everybody's evaluating is a cure worse than the disease kind of thing. You've got some injury, some traumatic brain injury issue you're trying to treat. You take the medication, but the medication, like one of the side effects is weight gain. So it makes you gain a bunch of weight, or it just makes you overly fatigued, or it makes it so you can't sleep, right.

0:17:55 - Thomas Ozbolt
Yeah, it gives you weight gain, which gives you depression, which gives you fatigue, which makes you have drugs to, you know, deal with that, but it's not like you can just not take the medicine, right, that's not a choice for a client. And there's rarely other alternatives. With a lot of these sorts of injuries to the brain, there's limited ways we have to deal with them, right now at least.

0:18:16 - Shane Smith
So it's not like Tylenol, where there's a whole bunch of different types of Tylenol out there. There may only be one type of medication for this specific injury to your brain, or two right, of which both may have the side effect fatigue, right?

0:18:27 - Thomas Ozbolt
Right yeah. And at that point you're locked in. You know, do I deal with this debilitating issue or do I have the secondary, you know also debilitating fatigue, that comes with it. Right, and that's catch, I don't know, that's catch 22.

0:18:42 - Shane Smith
So yeah, catch everything I mean kind of deal. And it makes, and you know, when we look at fatigue as a symptom, you know, I know personally, like when I'm super tired I'm not myself.

0:18:53 - Thomas Ozbolt
Right.

0:18:55 - Shane Smith
You know, I don't want to, if I've had a super hard day at work or two super hard days at work, I'm not going home and being as active and doing all the things I'm doing. That's just two days yeah.

Right, and that assumes I can get sleep. I mean part our clients and other people who suffer from the fatigue symptom or the insomnia. It just compounds and compounds, I mean. So, like we said, it totally takes over your life because dad's still, dad's too tired to do anything, or mom's too tired to do anything right, which, if you look at mom was a homemaker and she can no longer get up and clean the house and do all those things. That's going to fall apart, her relationship with her husband's gonna fall apart.

Probably affects the resent you know, I mean spouses begin to resent, now they got another kid right, instead of their partner. How much people lose for this? And part of our job is as on the, now we'll switch the legal aspect of it. Part of our job is to say I mean almost basically say what would you give up, what would you pay to have this part of your life taken away? Right?

0:19:48 - Thomas Ozbolt
Yeah, and you know we don't live in a time where you know, you go take away what was taken from you. It's not an eye for an eye anymore.

We live in a world and a constitutional system that says the mechanism that we have by law to give you justice is to give you compensation. So we're not asking for someone to just be given money.

0:20:08 - Shane Smith
If I had to do a study and I put up there and said, hey, we're running this study, we're running this contest. Here's what's going to happen to you. You're going to get hit in the head and you're not going to be able to sleep for two, more than you know, for two weeks at a time. Who would sign up for that study? Right, and if I said, your sleep is going to be messed up for six months, who's going to sign up for that? And how much would I have to pay to get volunteers to come in and do this? Or we talk about the circadian rhythm flipping. How much would I have to pay for somebody to say, hey, I'll take that job. Yeah, and that's probably the right amount. I mean, because that's what I would have to pay for somebody to voluntarily do it, is at least equivalent to somebody who didn't have a choice, right?

0:20:49 - Thomas Ozbolt
Right, so what's the value of what was taken from you? And it's like, if you can't sleep anymore, if you can't function well with your family anymore, it's like what are those relationships worth to you? I don't see how anybody would give that up for anything really, but I mean you gotta start in the millions of dollars.

0:21:06 - Shane Smith
And I was gonna say, and that's what we gotta talk about, right, and that's part of the difficult part of our job is what is that worth, right? What's the question for that? And off the cuff, like you say, you say a million dollars. Sounds like a huge amount of money, but if you've got a 30 year old man who's now, he sleeps all during the day and is up all night and you can't have the accountant or a doctor, now he can't do that anymore. Now he's gonna have to take a night shift job at a fact, you know what I mean or where the income is in half, or he's not gonna be able to see his kids at the family picnic anymore.

You know what I mean, cause I remember when I knew people who worked night shift, they, when they had to come to do stuff during the day, they were there cause it's a family event, but a lot of times they were barely there. You know what I mean. They're in the corner, propped up against the wall, trying to be awake, but they're also asleep because they just worked an eight hour shift and they got two hours of sleep in their back. I think about years ago when I had two children, you know, and my wife taking care of them during the day. You know, by the end of the week she was pretty wiped out.

0:22:05 - Thomas Ozbolt
I had a client describe it to me one time. You know he had suffered a traumatic brain injury. He said I feel like I'm a ghost caught between two worlds and he said I wish God would just take me to the next one. It's like that's how bad it had gotten for him. He just felt like he wasn't here in either world.

0:22:18 - Shane Smith
Wow, and that's one of the things we're gonna talk about on a topic later on is at one of our other episodes we're gonna talk about the impact of traumatic brain injuries on suicide and early you know, early death, where people just feel like there's no options and they're hopeless. Another topic we wanna talk about is we wanna go a little bit deeper into these sleep disturbances and talk about you know what exactly each one means, right, and some of them are pretty self-explanatory.

Insomnia everybody knows that means you can't sleep, but what really does that mean, right? Does that mean I can't sleep one or two nights, or does that mean forever, or you know? So we're gonna delve into those topics. So, for our listeners, if this is a topic that interests you, please hit like and subscribe down below and remember the bell well, lets you know when a new episode of Mind Matters comes out. We should be getting an episode out every single week, so just stay tuned and get regular updates and find out what's going on and always remember if you got a TBI or some kind of injury like that from an accident and you wanna talk to one of our attorneys Thomas, who's here, or one of the other attorneys in the Brain Injury and Concussion Group, please give us a call at 980-999-9999. And remember if you're in pain, call Shane.

0:00:10 - Shane Smith
Hey, I'm Shane from Shane Smith Law. This is an episode of Mind Matters: Navigating Head Injuries and Concussions. I'm here with John, one of the brain injury and concussion attorneys here at Shane Smith Law. For all of our listeners and if you can like and subscribe to see future episodes of Mind Matters, we'd appreciate it. John, what are we talking about today here?

0:00:29 - John Mobley
Hello, Shane, thank you for the introduction. We're going to be talking about some of the long-term effects that we see our clients diagnosed with brain injuries experience and suffer, and you know it's really a focus on how TBIs can lead to long-term hurdles and cognitive impairments.

0:00:49 - Shane Smith
So what's the timeline we're looking at here? When does sort of long-term begin and when is short-term?

0:00:55 - John Mobley
So the latest and greatest studies from some of the specialists that we see present that you know are kind of the nation's leaders in brain injuries say that you know after about six months if those brain injury symptoms have not gone away, unfortunately they are probably permanent.

0:01:12 - Shane Smith
So you're stuck with it. So six months is a pretty clear marker. If you're not better by six months, you got problems.

0:01:18 - John Mobley
You have problems and they are, to be clear, not curable. Brain injuries and brain injury symptoms that pass that marker are not curable. They are treatable. They can go up and down in terms of improvement or getting worse, but they will typically be there.

0:01:36 - Shane Smith
So I was going to say what's treatable mean versus curable. I mean curable makes me think it goes away totally. What's treatable mean? What's that going to do for me?

0:01:45 - John Mobley
Treatable means that you engage in cognitive therapy. Sometimes it can be vestibular therapy. You may see a specialist or a neuropsych that specializes in this area of the body and they may give you some memory exercises. It really depends on which part of the brain you injure and what executive function they call it the brain is responsible for. So if you injure the part of your brain that is associated with memory, the therapist or neurologist may give you honestly we see, honestly see where our clients are given puzzles to do.

Sometimes, if it's also your memory we see our clients will place post-it notes all over their house to be, like you know, turn off the burner. Remember your sister's phone number is this phone number and it's almost like occupational therapy where it helps you, give you the tools you need to succeed in an already hard world that just got harder for the person with a brain injury.

0:02:49 - Shane Smith
So treatable means they're going to give me stuff to help help deal with it, and sometimes it may be worse, sometimes it may be better. I mean, is that medicine? Does that come into play too? Can they give you some medicine? Or is it all just these tips and techniques, or maybe some physical therapy?

0:03:03 - John Mobley
It can absolutely be medicine too, and that ranges the entire spectrum. That way, see some things that help. Sometimes we see anti-seizure medication. In addition to that, there's hyperbaric oxygen chamber treatment, even seeing magnets being used now, which we don't see a lot, but there is definitely a lot of additional treatment that you can seek in the form of therapy to treat the disease.

0:03:31 - Shane Smith
So the short, short, I guess, to the point answer is if I'm outside of six months and I've got stuff still going on, I don't need to just accept that. I can get some kind of treatment to help me deal with it better.

0:03:42 - John Mobley
Absolutely, and that's really what's encouraged by all the specialists, because you really can improve your symptoms with active, good follow-up care. There's therapy for everything. Some of our brain injury clients have injuries to their inner ear or suffering from ringing in the ear, tinnitus, and there's therapy for that as well. Sound therapy, using noise canceling or white noise machines to help them sleep, because some of our brain injury clients say it's a deafening cicada or cricket sound in their ear that impacts their ability to sleep, so their doctors will prescribe them white noise machines. Simple solutions.

0:04:23 - Shane Smith
I was going to say, it makes me laugh, just because my wife and kid like white noise and have for years, but to think that I can get a prescription for one. But if you don't know, though, and nobody tells you, hey, do this coping mechanism, you don't know, unless you're just trying to figure it out yourself.

0:04:40 - John Mobley
Absolutely, and figuring stuff out on your own with a brain injury is very difficult because your organizational skills are sometimes reduced, your memory is reduced, you miss appointments. A lot of people, and this is the saddest part Shane honestly about brain injuries, is that they don't always make the best patients or therapy candidates because they either forget about appointments or don't want to do the appointments, or they're suffering from depression, from the brain injury, so it's hard to get out of bed to go do the appointments. So compliance is a real issue and unfortunately, all that does is make their life even harder because they're not doing the therapy.

So this is where we beg family and friends and spouses to really step up to the plate and help them if they are lucky enough to have that sort of safety net.

0:05:27 - Shane Smith
I was going to say, I personally have known clients with a brain injury and it affected their emotional aspect. And I talked to a doctor who's not a brain injury doctor, he was a regular doctor trying to help this person. He said I don't want to see him anymore, he's a psycho. He yells and screams at my staff. He does all this kind of stuff. Because he didn't used to be this way. But, like you say, one of the issues of dealing with brain injury people right, they're very emotional sometimes.

0:05:51 - John Mobley
Absolutely. If you want to work and thrive in this space and help people, patience has got to be your best friend, because for that exact story that you just shared.

Anyone that works in this space has just as many stories to share about how difficult it can be sometimes. Because from the perspective of a brain injured client, they don't understand why stuff is not the same. And that's so often why we have to reach out to family and friends and really get to know our clients so that we can kind of see how they were before the accident and how they were after the accident. And sometimes the client who has the brain injury cannot tell us that directly, or is not what we call a reliable narrator of their own condition or stories. So we have to reach out to the spouse to understand just how different they are.

0:06:41 - Shane Smith
And I know that's one of the things we've done for a long time and when we suspected brain injury is send one of our forms to the client, but then we try to send another one to a family member or friend to see what they say, because, like you say, sometimes they don't know or they get mad and just throw it, You know, wad it up and throw it away, they don't want to cooperate or it makes them sad to think about how things are different I guess.

0:07:01 - John Mobley
Absolutely yeah, because you, sending the forms to multiple people. It's really the only way sometimes we can get the full picture.

0:07:10 - Shane Smith
And I can't tell you the number of times where we're talking to somebody and I say, well, my spouse wants to talk to you, and the spouse can tell a totally different story of what's going on with the person.

0:07:22 - John Mobley
Right, absolutely. I've seen that so many times throughout my career dealing with these types of cases. It's like a night and day situation when you talk to someone close to them versus their account of what's happening.

0:07:34 - Shane Smith
So what are some of the other long term symptoms we should be looking for?

0:07:37 - John Mobley
Absolutely. So we see, besides the memory issues, we're also now seeing issues with attention deficits, general cognitive impairment. Also, there's quite a few, and this is kind of the scary one, quite a few studies out there now showing and pretty reliable too on a sample size showing that if you have sustained a concussion or a brain injury, you are two to four times more likely to develop early onset Alzheimer's and dementia. So you know, when we ask for very large amounts of money to compensate our clients, it's because we have to keep all these things in mind. It's not just their medical bills, it's what they're gonna face in the future. I mean, can you put a price on losing your consciousness and your memories and everything, all the terrible things that come with dementia and Alzheimer's, which is a lot of people's worst fear, can you put a price tag on that? Or what would it be like to lose six years because you have early onset Alzheimer's? I mean, it's hard to put a price on those things and that's kind of what our responsibility as attorneys is to do.

0:08:46 - Shane Smith
And I mean yeah, I mean because and you asked a spouse, right?

What's it gonna be like? I mean everything I know about it, when somebody has Alzheimer's, it gets, one if you just take out the emotional aspect of it, right, that the spouse just lost a person who can't even remember them anymore. What about the care and feed- you know, medical care and feeding and handling and helping of that person gets exorbitantly expensive, right, I mean, it's-

0:09:22 - John Mobley
Absolutely, that's why we really enlist really good what's called life care planners, because all those intangible and tangible things need to be itemized. Because you know, sometimes these people that sustain brain injuries, you know their impairments are so severe that they need an assistant, a medical assistant. They need someone to help them just organize their lives and say we really have to do due diligence to kind of know how their future earning potentials are gonna be impacted. Maybe they were a high-performing CEO who can only work half the hours a week, you know. So we have to be able to itemize all these things so we truly can get full justice for our clients.

0:09:55 - Shane Smith
What about when family you know when we're talking to our clients about that and you talk about the medical assistant or the nurse or somebody to help take care of this. What about the family member who says, well, I'm just gonna take care of my spouse, that's what I'm supposed to do, and how does that impact a settlement? Or what you do with the insurance company?

0:10:10 - John Mobley
Right, absolutely. So you know there's types of claims called loss of consortium claims, and we see them a lot with TBI clients because, you know, essentially the only victims are not just the people that sustained a brain injury. All of a sudden, unfortunately, they become somewhat of, in some instances, a burden to a spouse. Now the spouse is not only juggling four kids and trying to work a job or a part-time job, but they now have an additional role to fulfill in the house because they're making up for their spouse's loss of contribution to the household, loss of maintaining the house.

They've become a medical assistant, they've become a secretary, because they're keeping up with the person's you know appointments and treatments and therapy and everything else. So it's a tremendous loss for the entire family unit and that's certainly something that we as attorneys take very seriously when we're trying to itemize and figure out how to make someone whole again is, you gotta look at the whole picture.

0:11:10 - Shane Smith
So what would you tell our listeners that they should be looking out for after that six month mark? What are the key things they'll be looking out for?

0:11:17 - John Mobley
Absolutely, so I mentioned kind of attention deficit disorders. You know there's now studies where they looked at about 12,000 plus minor children who had sustained brain injuries and saw a huge uptick in the development of ADHD from a brain injury. So that's one thing. Minor TBIs are harder sometimes to document and know the extent of, but at least in minors you can look for things like inattentiveness and ADHD. And then, of course, dealing with that from a medical standpoint is going to be the appropriate path there. Also, another big thing is the emotional changes that we see, we've had, we've seen where spouses of brain injured clients say that it's like they're now married to a stranger. Wow, and you just think about that and it kind of gives you chills. It's devastating to think that the person you married is not the same person.

0:12:18 - Shane Smith
Yeah, I think that's my wife's nightmare, right? Something happens, and for her it's memory that I would just forget everything. But also your personality changes. You're a different person, right? I mean you go from a smart, caring, loving husband to an angry person or a depressed person, or now you're not a self-starter anymore. I mean, all these things can happen, right.

0:12:39 - John Mobley
Absolutely, and we've seen you mention angry, we've literally, and these were some hard conversations with our clients, where you know the person who sustained the brain injury before the accident was kind of mild mannered, soft-spoken, very kind and patient and then post brain injury would snap at the smallest thing would yell at the children, would yell at the spouse.

It has a transformative effect, and sometimes not in a good way. No, and you think, how does this impact the spouse, the family, the person? The sad truth is that it affects a lot of relationships and probably increases the likelihood that that relationship fails eventually.

0:13:23 - Shane Smith
Well, anything else in the long-term effects should we tell our listeners to be looking out for or be ready for.

0:13:29 - John Mobley
You know those are the big ones, honestly, that we see a lot of besides, just the typical ones like continued headaches and sensitivity to light, but those are pretty straightforward that the neurologist can identify long-term. But the ones we discussed here today are the main ones that you know, it really helps for family and friends to keep an eye on past that six months mark.

0:13:56 - Shane Smith
So if I'm still sensitive to light at six months, definitely should be, I mean, you would have told me to be seeing a neurologist already, but I should certainly, somebody needs to take me to the doctor, without question. Okay, John, thanks for being on the show today. I think it's important to talk to our listeners about the long-term effects, right, and some of those triggers that say you got a serious problem, and the fact that once you cross the six-month mark, I mean that you're stuck with it. You know it's, we can manage it, but it's probably not going to go away. It's awful to hear, but also important information, I would say, for our listeners. For our listeners out there. If you like navigating head injuries and concussions, hit like and subscribe down below, hit the bell for notifications for our next podcast update and remember, if you're in pain, call Shane 980-999-9999. And if you've got a head injury question or you've been in car accident, you suffered a head injury, John would love to talk to you and see if he can help.

0:00:08 - Shane Smith Hey, I'm Shane from Shane Smith Law. I'm here today with Thomas for this episode of Mind Matters: Navigating Head Injuries and Concussions. Thomas is one of the brain and concussion attorneys here at Shane Smith Law, and Thomas we're talking about what today? Retrograde amnesia?

0:00:23 - Thomas Ozbolt Yeah, retrograde amnesia that's a term that's often used in psychology and neurology to describe a specific type of memory impairment.

0:00:32 - Shane Smith Amnesia is what everybody thinks about- you, you get hit in the head and you forget everything. It makes me think of there was an old movie Overboard with Goldie- is it Goldie Hawn who fell overboard and hit her head and forgot everything for a little while but she could still do normal stuff, but she had no memories for months. Is that retrograde amnesia? What are we talking about here?

0:00:54 - Thomas Ozbolt It's similar. There's different types and different categories of it. Retrograde talks about where someone's unable to recall past memories, experiences or events. You can have amnesia of a specific event, like if you're involved in a car accident, let's say massive impact. You might not remember even the beginning of that impact. It might be wiped out. Retrograde, I think, refers back to a varying duration of time, from weeks, even years back, depending on the severity.

0:01:21 - Shane Smith So you're losing stuff. Now does it come back or is it gone?

0:01:24 - Thomas Ozbolt I think it depends on the severity. It potentially could come back because you have neuroplasticity of the brain and its ability to regenerate itself over time. But in terms of this specific feature in retrograde amnesia, that's where more recent memories are more difficult to access than older ones.

0:01:45 - Shane Smith Okay, so the more like a week or two before the event. So I can remember all my childhood stuff, but I can't remember the last six months or the last three months or what I did the day of the accident.

0:01:58 - Thomas Ozbolt Exactly, and they talk about this in terms of a temporal gradient. Things kind of go along this spectrum. You know, if it's something that's more recent, you may have difficulty recalling it from the last few weeks, but if it's going back to a birthday party with your parents or your friends and you're probably not going to have as much difficulty with that, with this specific.

0:02:23 - Shane Smith I would imagine that causes a lot of distress in the individuals who have it, because they know things happen, they just can't remember what it is or even how they got there right? This is the thing where you wake up in the hospital and they're like how did I even get here?

0:02:30 - Thomas Ozbolt Yeah, yeah, just incredibly alarming. And you know we have more than a few clients like that. They just they wake up and they're surrounded, or they're kind of bolted down to a bed or they've got IVs running from them and they're like how did I get here? What's going on? Where has my life gone? So you know that's, I think one of the most alarming things about it is that you just it's a lack of a sense of control that goes on with it. And how do they calm those folks down?

I guess there's lots of different ways. Having friends and family around I think can be one of the best things, because you know it's much better to hear from somebody who's close to you than you know a doctor you've never seen before was just trying to explain to you what's happened to you. I mean, I'm sure there's different types of medications and things like that, you know, but I think definitely being around family and friends is going to be the best way to come, you know, to get it the best possible way.

0:03:21 - Shane Smith To get the best, just sort of acceptance, I guess. Yeah, bring yourself back. My guess is some of them probably go through almost like the grieving period. You know they continue on the grieving period where finally there's acceptance at the end and not denial and anger. I'm sure there's a ton of that associated with losing large chunks of time.

0:03:38 - Thomas Ozbolt Yeah, you got to. I mean, I feel like sometimes when I sit around, I think that would be one of my worst nightmares is not being able to remember, you know, my daughter's birthday party a couple weeks ago and not being, I know you're a father too, just not being able to remember those core memories or

those things that are just incredibly special to you. It just feel you know that's a loss that you can't ever quantify in terms of a dollar value.

0:03:59 - Shane Smith Yeah, because what is that worth, right? What if it was an event and that person's no longer with us? Or somebody who was happily married and then ended up getting divorced, but all their happy memories are gone, or some of them are gone anyway?

0:04:12 - Thomas Ozbolt Yeah, you have something taken away from you that just forms a key part of your relationship with a person.

0:04:18 - Shane Smith Yeah, that sounds bad. I mean, it sounds terrible. What else would you tell us about retrograde amnesia?

0:04:25 - Thomas Ozbolt Yeah, I mean one of the things that I think is maybe the silver lining of it we don't know yet that it steals away from you something in terms of your procedural memory. You know your ability to do certain tasks, skills that you learn before the onset of the amnesia. And even if somebody doesn't, you know maybe they forgot hey, I forgot how jump shot. Or you know hitting a baseball. I forgot how I learned to do that, but I still know how to do it. You still know how to do it. Procedural memory is there.

0:04:53 - Shane Smith You just don't remember, like you say, how you learned it. Right. So this is sort of the thing where people start to do something that, like holy cow, I can do this.

0:05:01 - Thomas Ozbolt Right. Yeah, I just kind of you don't know how you got there, but you know that you can still do it and I guess that's one of the good things about it.

0:05:11 - Shane Smith Ok, because a different part of the brain remembers that part, basically? Right. How often does this happen in car wreck cases?

0:05:19 - Thomas Ozbolt Yeah, I think it's hard to put a number on it and I think the big reason for that is because we're really at the infancy of learning about TBI in the context of anything. Diagnostic tools that we have today are light years beyond what they were three or four years ago, and we're coming out with more and more ways of detecting what's going on. In terms of our clients, we see it pretty frequently, in terms of forgetting things or having memory concentration problems. Just certain memories or people's names is a big thing. I mean, it also comes up in the context of neurodegenerative diseases. You might think about Alzheimer's or another disease like that. This TBI can help make well, not help, but TBI can contribute to making those things worse or bringing them about when they weren't ever really going to come about. Maybe you had an early trigger for those things.

0:06:11 - Shane Smith So you didn't have it. And then boom, you're in the car, wreck, you get a TBI and now suddenly you go from you know, limited retrograde amnesia now into full blown Alzheimer's, or at least that slippery slope of dementia.

0:06:24 - Thomas Ozbolt Yeah, could bring about or trigger that happening before it was ever going to happen or much earlier than what was going to happen.

0:06:35 - Shane Smith And it's a question along those same lines: the elasticity of the brain, is that impacted a lot by your age and how old you are?

0:06:41 - Thomas Ozbolt I think we're still learning that. I think definitely a younger brain, healthier body can definitely bring about the ability to rehab from a brain injury. But I think that's still one of those things that we're learning a lot about. But it would be hard to imagine that somebody younger wouldn't be able to rebound from something like this versus a 30-year-old, versus a 75-year-old.

0:07:08 - Shane Smith Yeah, ok, and I just think in an older person you steal those memories, sometimes that's all they have left, right?

0:07:22 - Thomas Ozbolt Yeah, those precious memories, or memories of things with your family. That's, I know even for me now, that's something that I treasure, and I just can't imagine what it would be like to be older, and almost in the twilight of your life, you might say, and not having those treasures to hold onto.

0:07:36 - Shane Smith So what else are they talking to us about retrograde amnesia about?

0:07:39 - Thomas Ozbolt So retrograde amnesia, individuals with that, they might struggle with remembering what's happened in the past, but they can still function in their daily lives, so it might look for them like they're just going on. Nothing has happened in terms of not having a real impact on their lives. They're involved in a significant car accident that causes TBI, but this can definitely affect things that they've had in the past. It can affect memories, can affect again these treasured moments that we talked about.

0:08:06 - Shane Smith Well, let me ask you this: if you have retrograde amnesia, is it normally like, ok, I lost this time period here, but now that I'm here and I'm awake, all the new stuff is building on, or do I continue to lose time basically?

0:08:20 - Thomas Ozbolt That gets into a different category, which is what we call interograde amnesia. That can be something that can happen in a collision as well, or through traumatic brain injury, and that's where a more debilitating disorder. Yeah, because that impairs your ability to learn new information and that's obviously essential for day-to-day activities. So you could have one or the other, you could have both. I don't think there's anything that, having one limits having the other being caused by TBI.

0:08:50 - Shane Smith Okay, so you could be unlucky and have both. But retrograde is a specific type. Just for some time you lost in the past.

0:08:59 - Thomas Ozbolt Yes.

0:09:00 - Shane Smith But it's not going to continue to impact you. That's something else.

0:09:03 - Thomas Ozbolt Yeah, yeah, you might have that as well. They might go along with each other, but you know that's definitely its own specific category. And then you have an anterograde which is looking forward.

0:09:15 - Shane Smith So what, I mean, we talked a little about car wrecks. What causes retrograde amnesia?

0:09:20 - Thomas Ozbolt Yeah, I think it can be, you know, as we talked about, a number of different things. Genetics, you know different neurodegenerative disorders, but traumatic brain injury and to any significant impact in terms of direct blow to your head or those acceleration deceleration forces that you know basically cause your brain to smash against the hardest thing in your body, the inside of your skull.

0:09:41 - Shane Smith So car wrecks definitely can cause it. That's where we see it the most in our, in our act, you know, in our cases. But it makes me think about it like sports, the football. Has it happened in football, or I know, boxers a lot of times have issues. I watch UFC and I've seen multiple of those people talk about you know, when they get knocked out, they'll wake up and they lose the whole fight. Yeah, and that's what we're talking about here retrograde amnesia, right, that's, they've got it.

It's just confined to a very short window when they're talking about not, not remembering the fight at all.

0:10:09 - Thomas Ozbolt Exactly. And sometimes, like you hear, with football players: I don't remember, you know, from the second quarter on, you know, I just took that big hit, went down and, you know, woke up in the hospital and just completely wiped out.

0:10:27 - Shane Smith So for our purposes that would be pretty limited, retrograde amnesia, you know, short impact, but I guess that would also be then, you know, those people who you know they've been in a car wreck. They're sitting on the curb, which happens sometimes. You know they get out of the car and then you know, when the EMT gets there, they're like what happened? Like I don't know. You know, they just don't remember anything. They don't remember passing out, they don't remember getting out of the car.

You know they just find them on the side of the road right?

0:10:50 - Thomas Ozbolt Yeah, one of the interesting things that can happen too is, you know, I've had clients where I've talked to them a couple days after a car accident and they remember, you know somewhat what happened. But as we get farther away and we talk about it some more, so that memory has kind of been faded or wiped. So it degrades and it's gone.

Yeah, because when you have that concussion that you know disrupts the function of your brain and disrupts how signals are being sent different, you know, hormones, responses throughout your body that can take some time to unfold in terms of how you know things, that kind of going to degenerate in terms of your system.

0:11:24 - Shane Smith So you know, I've always heard, you know, back injuries get worse over the first three to five days. Right, you know, if you feel it the first day, it's going to be terrible by day three. That's one reason why we say, if you aren't in a lot of pain, you go right to the ER, because it's going to get worse. So these are the same way, they get worse over a shorter time period afterwards, I guess the head injury stuff just comes to light, basically, is that what it is?

0:11:46 - Thomas Ozbolt Yeah, well, I think one of the important ways to think about it and conceptualize it is, it's not an event, right? It's not, I got in a car accident, boom, I had a traumatic brain injury. It's an ongoing disease process. It's something that unfolds over time and can still be unfolding, you know, years after the fact, really, and it might even be the lesser traumatic brain injury, a mild traumatic brain injury, not one where you're getting your skull stoved in, but one where you've, you know, got some pretty bad headaches for a couple weeks after. That can be the one that lingers with somebody longest, and why? We don't really know. But you know the brain's kind of like the ocean. You know we're just kind of scraping the surface.

0:12:25 - Shane Smith Figuring stuff out as we go. I know, you know it's been exciting for me to see the evolution of this over my career. You know, because when I first took it on brain injuries, we didn't have any of this science stuff. There were no DTIs, there was no blood tests to show it. I mean, it was really just almost all visual. Or the old MRIs that really are not great at showing brain injury. They show blood but not an injury to the brain. That was really about all we had.

And now in the last five years it's just accelerated. We have so much more medical information and knowledge.

0:13:01 - Thomas Ozbolt Yeah, I think it's a field that's exploding, and when we're talking to the doctors and the scientists that are involved with this, they're just incredibly excited. Which makes me excited because they're saying, hey, we're just in the infancy of this. They're working with the Department of Defense, they're working with different federal agencies to figure out how we can bring this to the public and kind of expand what we know about how traumatic brain injuries are affecting people and that can do tremendous things for our clients, which I'm really excited about.

0:13:39 - Shane Smith I was going to say in a lot of the work we have to do on the case is, once we get the diagnosis of the brain injury, then it's, how does it impact that client right? And what are some ways we dig into that, or people, even somebody watching it, could dig into it a little bit and be able to explain it to their family members.

0:13:45 - Thomas Ozbolt Yeah, I think some of the tools that we can use with that, it's a videonystagmus test, which is going in and evaluating this balance and posture test in terms of how your eye will respond to a stimuli and what that tells us about what's going on inside your inner ear and inside your brain and the areas of your brain that are responsible for the balance and the movement of your eye. So that's something that can give us evidence, can tell you, look, if you're going to be at elevated fall risk over time, if you're going to have cognitive issues. There's also diffusion tensor imaging, which lights up your brain like a Christmas tree in terms of the way that you can look at it and see, hey, that bulb isn't working there. Maybe this particular chain of white and gray matter is what has been affected here in this accidnet. That's what you're lost. And blood tests that's kind of the new frontier is, you know, blood tests can tell you what part of your brain or how your brain has been injured.

0:14:38 - Shane Smith And that's something we're going to get into in another episode, because that sounds crazy, cool, exciting, and one part of it is like I don't see even how they can do that. The other part of it is like well, of course, they can see changes in everything, so we're going to dig into that on another episode of Mind Matters. So if that's something you're interested in, watch out for that episode as me and Thomas dig into that. So how do they explain the amnesia to their friend and family members?

Is it just like hey, I don't remember that, or is there anything else that can sort of help with that? Because, to be quite honest, I know we've run into clients and family members where when somebody's suffered a head injury, they're like I just don't remember anything. But a little while people are like, yeah, come on, really? What? You know, why can't you remember it? You know? Does that make sense? How do you deal with that?

0:15:20 - Thomas Ozbolt Yeah, I think you know, another way to think about it is, you know, it's not just them explaining it to their friends and family members. A lot of times they're alerted to it by their friends and family members. It's like hey, bro, we just did this the other day, you don't remember?

0:15:39 - Shane Smith So it's the opposite of what I was talking about, that friends and family members notice it and the person themselves does not.

0:15:44 - Thomas Ozbolt Yeah, and that's why you know, having community, friends and family around you in these cases, that's some of the most valuable, it's the most valuable network you can have to really help you find out what's going on, get you to the doctors that you need to go to and then help you get back to yourself. There's different therapies, different neuro rehabilitation therapies that are out there, cognitive behavioral therapies that are recommended, and then some other really kind of neat stuff that I'm sure we could talk about on a different one, because I don't know about it now.

0:16:17 - Shane Smith What I would, you know, what I take from that is you know it's so important to listen to those people you know, your friends and family, when they raise one of those issues and tell your doctors or tell your lawyer so we can dig into it and, like you say, try to get you the right doctor, the right specialist to figure it out, because you may not know yourself. And if you minimize that, oh it's nothing, it's nothing, it's nothing. You know you're not going to get the treatment you need, for certain, and obviously you're not going to get that involved, that part of a case, but more importantly, you're not going to get the treatment you need. So it's going to continue to be a problem.

0:16:53 - Thomas Ozbolt Yeah, I think you know being able to talk with your lawyer about it and get, have them, get you connected to somebody, because if you look at it in a way, we're kind of like almost like a general contractor. We have a pretty broad base of knowledge and information and we work with a lot of doctors over, you know, years and years and you know, we know, you know, we know what types of doctors that we can send people to, and a lot of times if you're just a regular person going to the hospital, going to your doctor, you just feel like you're not heard, like you're not listened to, and I think that's really one of the most valuable things that an attorney can do.

It's like hey, we know we're trying to help you. We're not burdened by the constraints of having, you know, 9,000 people in the waiting room and, you know, having to worry about billing and all the Medicaid, Medicare and all those things that are going on is, we can listen to you and we can help you with information that you might never have and you might never be given by, you know, your set of doctors or your insurance company.

0:17:50 - Shane Smith All right. Thomas I think we've learned a lot. We've talked about a lot today For a lot of listeners. If you're interested in Mind Matters or injuries and concussions, like and subscribe and hit the bell for notifications and also remember if you're in pain, call Shane 980-999-9999. If you've had a brain injury or concussion in your car accident case and have questions and concerns, feel free to call our office and ask for Thomas or the brain injury group.

0:00:06 - Shane Smith Hey, I'm Shane from Shane Smith Law. I'm here today with John, one of the attorneys here at Shane Smith Law, in the Brain and Concussion Injury Group here. This is an episode of Mind Matters Navigating Head Injuries and Concussions. If you like this kind of podcast, please hit the bell for notifications and like and subscribe. John, today we're going to talk about symptoms and injuries right after a car accident, right? Specifically those injuries as they relate to the head. What's the most common injury? What comes up the most?

0:00:31 - John Mobley Absolutely, Shane. So you know that's going to be our discussion today about the immediate concussion symptoms. A lot of times we see dizziness, we see nausea, just the client not understanding what's going on, where they are. These are some of the main ones that we see.

0:00:48 - Shane Smith So, John, when I think of a concussion in a car accident, I'm always thinking about the person who blacks out, who hits their head and is totally unconscious. Is that all that common, or are there other stuff that happens a whole lot as well?

0:01:00 - John Mobley You know that is one of the possible outcomes, Shane, but it is, it's actually a more rare outcome. There are so many different shades of gray, if you will, and different types of brain injuries along the spectrum, but the more common ones we see, or is typically where the client appears almost disoriented, drunk sometimes is how their family and friends describe their loved one who sustained some degree of a concussion, and just being kind of all over the place. There's, of course, the Glasgow Coma Scale, where you know if you are completely blacked out and non-responsive, that's typically very bad, but there's a whole other level and the vast majority of these head injuries usually result in lesser kind of outcomes than a full blackout. Not being non-responsive, usually it's more like they're disoriented, and even sometimes they may even be talking to the EMS personnel or first responders and then days later just not even remember that they were having conversations. Really.

0:02:00 - Shane Smith So I was going to say so let's break those down a little bit. So to me, when I, when you tell me somebody who's disoriented so much they appear drunk, that seems frightening that they hit their head hard enough that I guess things are all jumbled up right, how can friends and family sort of identify that what would tip, tip the hat, that, hey, they're probably not drunk, they probably hit their head or something else. I mean, is there anything that would key them into that?

0:02:22 - John Mobley Yeah, absolutely, and that's why the range of outcomes vary so much. When someone initially gets into the accident I mean if they're with a family member that knows them well, that family member is going to say, you know, wow, something's off here. Yeah, you know you're saying and doing things you don't normally do. But if you're in the car, maybe in the backseat and you get rear-ended of an Uber, the Uber driver might not know if that's you or if that's someone else. So same goes with the first responders. Sometimes they don't adequately assess the degree of the head injury because as well as maybe a family member could, knowing that they were in an accident, that where they hit their head, and that's just simply because it can be very nuanced and and the person's change in their personality is only something that a close friend or family member would recognize.

0:03:12 - Shane Smith So we would certainly say if you've been in a car accident, certainly a serious car accident, but a car accident, and friends and family afterwards are like, hey, this seems a little odd, even if they've been checked out by a first responder. What should they do? Would they take them to the hospital? Would they take them to their doctor, what, what, what should they do if it seems weird?

0:03:31 - John Mobley Absolutely. If you suspect any degree of a concussion or head injury, you absolutely need to at the very least, go and see some level of a medical professional, whether that's an urgent care or a ER, so that you can do the followup diagnostic tests and be cleared by a true specialist.

0:03:53 - Shane Smith So the fact that a first responder shined the light in your face and moved on, that's not a good indicator that there was no head injury at all, is there?

0:04:01 - John Mobley No, the only real assessment, unless it's completely evident to the EMS like you have a skull fracture, the only real assessment they're doing is usually the Glasgow Coma Scale, which is going to assess the injured person's responsiveness level so that they can gauge how bad is this. But the real kind of specific diagnosis are gonna occur later at the medical facility and that's gonna be done by an ER doctor or a neurologist through things like the clinical evaluation of the client, a CT scan, later maybe a brain MRI or having an actual neurologist come in.

0:04:38 - Shane Smith What is sort of the- when we talk about immediate injuries, right, what is sort of that time period when friends and family would notice something is off a little bit? Is that like right after the accident? Is it like two, three days? Is it like a week? What's the most common area in where I'm looking for immediate symptoms?

0:04:56 - John Mobley Absolutely so. It's usually directly following the impact. Okay, and when that brain either hits the steering wheel or the inside of your own skull or the back of the headrest, when you're coming back in that hard whiplash fashion, that can be so fast and so immediate that sometimes people don't even know they hit their head.

0:05:18 - Shane Smith So they're not looking for the cracked windshield kind of deal, or the cracked side glass, I guess. I mean, there's so many things in the car you can hit your head on. Yeah, absolutely, and that headrest is not gonna be soft enough to fix the issue.

0:05:26 - John Mobley Unfortunately not. The technology is not yet there that, that head hitting the back of that soft cushion seat is enough to still cause a concussion and a mild brain injury.

0:05:37 - Shane Smith And when you talk about headrest, you know behind, you're actually supposed to put those a certain specific way as well for them to be effective. And I don't know, when I'm getting in cars I don't generally move the headrest around for myself, I just get in and ride.

0:05:51 - John Mobley Right, I do the same thing.

0:05:54 - Shane Smith So that's clearly another issue that exacerbates this problem. What I wanted to ask is you said sometimes you know the EMTs, first responders, they're checking them out and they think the person's totally fine, and is that just because they don't know the person? Is that what it is, or is it because that gap in memory and stuff just hasn't shown up yet, or what's going on with the person?

0:06:13 - John Mobley Right, that's not like a full brain injury assessment that's occurring immediately at the scene. It's really just to assess is this person living or potentially on the way to not be not living? It's really kind of a more of emergency triage type thing. And so that's why it's so important to get to a doctor. And you asked previously you know what can you do in that initial phase. There's gonna be some big indicators. Sometimes we see our clients talking about nausea. Some actually vomit at the scene. That's a classic brain injury symptom.

0:06:44 - Shane Smith So if that happens, definitely.

0:06:46 - John Mobley Clear as day. You need to go to the doctor immediately, probably to the ER, and those symptoms that family members can pick up on you know those will last, sometimes for minutes to hours, and then, depending on the severity of the brain injury, they will resolve. So that's why it's so important to kind of, we find out what happened at the scene. A lot of times, as an attorney, we'll look at the EMS record, because they're the first people there. And you know if we don't have any witnesses, that's sometimes the best information we have, and we'll see that a lot of times. The EMS personnel will give great notes as to what they noticed. Was the person not making sense? Were they not able to answer questions? You know like what day is it? Who's our president? You see these questions a lot by EMS. Right yeah, like just the basic stuff. Those are such valuable, valuable notes, because sometimes that stuff improves quickly with a client and then we just may never know that they did sustain a head injury until later it comes up. You know, maybe weeks later they still have the sensitivity to light, they still have the headaches, they still have irritability and are forgetting things. And we don't necessarily see it because of their either no witnesses or it wasn't documented by the EMS.

0:07:56 - Shane Smith Because of the fact that I had nausea or dizziness at the time, but it got better by the time, say, my wife got to the scene two hours later. That doesn't mean there was no head injury.

0:08:12 - John Mobley Right. It can happen that quickly, sometimes, where the symptoms improve, and sometimes, depending if it's a bad injury, then it can go on for days and days.

0:08:20 - Shane Smith But just because it gets better it doesn't mean I'm all better really.

0:08:24 - John Mobley Absolutely not. Unfortunately, once a brain injury has occurred, the studies are pretty clear on the fact that there is no cure, unfortunately. There's treatment, there's rehabilitation, there's ways that you can change your life, but if you in fact did sustain a brain injury, it can develop into a progressive disease, neurodegeneration, usually not good. Now there's of course, various degrees of them, from mild to severe, but once they occur, they're there. And is a concussion the same as a brain injury? Yes, a concussion is a form of a brain injury.

0:08:58 - Shane Smith So that's just so, if they say you have a concussion, you've had a brain injury of some type, correct, it's just where is it on the spectrum?

0:09:04 - John Mobley Exactly a concussion, and the later post concussion, post concussion syndrome, you know a brain injury from mild to moderate, to severe or traumatic. It's just kind of how they classify the progression of the brain injury disease.

0:09:21 - Shane Smith I mean, but the severe and traumatic, those are the ones we see on TV kind of deal, but we don't see a lot of people talking about the mild and the moderate kind of deal. It can still impact your life significantly right?

0:09:33 - John Mobley Just as much of an impact, yeah. And the movies and TV and Hollywood, a lot of times it's a person has hit their head catastrophic and they're in a coma or need to learn how to walk again. We certainly see those. But there is a whole nother world of brain injury out there where it is just as long of a battle and lifetime challenge for our clients who have sustained some of these mild and moderate brain injuries.

0:09:56 - Shane Smith And one of the things I've seen with the mild and moderate people is they've got the symptomology. You know that stuff happened in the beginning. They have symptomology that continues on and they start to doubt whether it's real or not or whether it's them it's all in their head, kind of deal. Is there anything that can help with that?

0:10:11 - John Mobley Absolutely so. You know we've come such a long way with how we diagnose and assess these things. We're now seeing blood tests, where some of brain injury breakdowns and the hormonal stuff go on actually produces what's called markers in the blood that can be tested through blood tests. Brain imaging has come and advanced, you know, light years since just being able to get a CT scan back in the day. Now we have other things called DTIs, which can really map the flow of water in the brain to see where the injury occurred and create a 3D model. We've also seen improvements with a neuropsychologist and how they assess brain injuries through very rigorous battery of cognitive testing.

0:10:54 - Shane Smith Yeah, you mentioned a blood test. Can my primary care doctor just order that?

0:10:59 - John Mobley You would have to check. I'm not sure. It's relatively new. It's the newer of all the big brain tests, so we're kind of seeing of how wide scale the usage is of it. But it's proven to be very reliable.

0:11:10 - Shane Smith If I think my family members showing symptoms of this, some kind of brain injury. What do I need to do?

0:11:16 - John Mobley You absolutely need to encourage them to go and see a doctor at the very least, and to follow up with a specialist too. Because we have to remember, just like the EMS's main job is to get you alive to the doctor, the ER's job is really to triage people that are in severe, severe, experiencing severe issues. So, sometimes the ER will miss certain brain injury markers as well. They'll just do a CT scan and then recommend you follow up to your neurologist. It's usually way down at the sheet they give you that says go see the neurologist, please, please. I stress to anyone listening out there if you're told to go and see a neurologist, please do it.

0:11:55 - Shane Smith Go see the neurologist, go see your family doctor, get in to see the specialist, right?

0:11:59 - John Mobley I would say it's almost five to six times out of 10 with our clients, we see where they were told, given what they thought was a pretty clean bill of health from the ER, and then we get them with the neurologist, and the neurologist is like you are nowhere near from being out of the woods yet. Unfortunately, we have a bunch of other tests to do and they suspect a brain injury did in fact occur. And you also mentioned what family members can do. You know, on the problem side is there was, you know, recently comedian from Full House, Bob Saget they're now suspecting sustained a fall in his hotel and went to bed instead of seeking treatment, and they think that is- you know this is it's still being investigated, but that is the current leading theory as to how he passed away, cause he went to sleep instead of seeking care at an urgent care or an ER. And you know that can happen. That's why the doctors will always recommend if you suspect a brain injury, please get checked out.

0:12:53 - Shane Smith And I've seen stuff in movies where somebody has a concussion like don't let them sleep or check on every 30 minutes. Is that kind of what they're worried about?

0:13:00 - John Mobley Yeah, that's the standard thing. If you have a slow to moderate brain bleed or hematoma, it can progress fast and you can be in trouble fast.

0:13:11 - Shane Smith All right, John, I want to thank you for coming on Mind Matters. I know you work on a lot of brain injury and concussion clients and help them out and I think your knowledge is always helpful to them and make sure they get the right care they need. For our listeners, if you're interested in concussions and brain injuries, hit like and subscribe and remember to hit the bell for notifications and remember if you're in pain, call Shane at 980-999-9999. If you think a family member has a brain injury or a concussion from an accident, John would be a great person to help you.

0:00:05 - Shane Smith Hey, I'm Shane Smith. I'm here with Thomas and we're here on an episode of Mind Matters: Navigating Head Injuries and Concussions. Thomas is one of the attorneys of the Concussion and Brain Injury Group here at Shane Smith Law. Thomas, we're going to talk today about impacts of a concussion. What specifically are we talking about?

0:00:23 - Thomas Ozbolt Chronic Traumatic Encephalopathy.

0:00:26 - Shane Smith Now that's a whole mouthful, obviously. Is that, and I know they abbreviated CTE, and now I know why because that sounds difficult to say and probably difficult to understand. What is that? What is CTE?

0:00:41 - Thomas Ozbolt Yeah, it's something that's kind of come to light through different sports and different studies that we've had that have resulted from some incidents in sports. Jovan Belcher from the Kansas City Chiefs that was a big incident that happened. Some time ago, he ended up suffering from CTE and killing himself, killing his family, and raised a lot of questions about what the heck is going on with these different athletes and sports where these seemingly bizarre things are happening because there is no history with him. CTE is a degenerative brain disease and it's associated with repeated head traumas.

0:01:20 - Shane Smith So degenerative means it's going to get worse over time, right?

0:01:24 - Thomas Ozbolt Yeah, you know, a couple impacts. Over time they add up, create this cumulative effect where you're rapidly degenerating in brain function.

0:01:33 - Shane Smith Now I've always heard that once you've had one concussion you're more likely to get another one, just because I guess your brain is more fragile. So the multiple concussions is definitely what leads to this, or makes it much more likely to occur.

0:01:48 - Thomas Ozbolt Yeah, just repeated head trauma having that cumulative effect that a couple years down the road you've aged in terms of your brain health by decades, years.

0:02:00 - Shane Smith So boxers, football players or just some of those unlucky people. I mean, I know a guy who honestly had been in, I think, 15 car wrecks by the time he was like 25. He was like, yeah, three concussions, two broken arms. He was just a train wreck for car accidents. But those multiple concussions, they don't have to be close in time together, I guess is what we're talking about.

0:02:18 - Thomas Ozbolt Right, yeah, they don't have to be close in time to each other and you know they might not even show up on someone's radar as being a concussion. I know, you know, the NFL specifically, you're seeing it in offensive linemen and you know offensive linemen aren't getting tackled. They're having that, you know ball gets snapped, they're popping up and they're having a collision with somebody, but they're not getting popped in the head. That's a penalty. They're just getting a big acceleration, deceleration force and over time, you know these guys are, you know, turning 50 and everyone around them, you know, thinks they're 70 or 80 years old.

0:02:58 - Shane Smith So it can be the mild concussions, or even the mildest of concussions can lead to this if you have it time after time after time.

0:03:05 - Thomas Ozbolt Yeah, yeah, it can definitely add up. It doesn't have to be a big impact, it can be something smaller. You can even call it the silent killer. And that's because the symptoms of this, the CTE, they don't you know usually appear until years or even decades, really, after the initial injuries happened.

0:03:22 - Shane Smith So what exactly is CTE? What happens and what's it cost? Or what did this- Let's go down to: What are the symptoms of what happens when I've got CTE years later? Right? What is the killer? What's triggering? What's going on?

0:03:37 - Thomas Ozbolt One of the things that might put it on your radar that someone might be suffering from CTE could be memory loss, confusion, impaired judgment. There might be impulse control problems.

0:03:48 - Shane Smith So is that like today, or is that like 20 years from now, when that stuff will all kick in?

0:03:53 - Thomas Ozbolt Yeah, it could all kind of kick in 20 years down the road. It could be years from the time that somebody was playing a sport or being involved in car accidents. You know, it's one of those things. We're just scratching the surface of this.

0:04:08 - Shane Smith So that sounds horrible, I mean horrifying, honestly. I mean you could think you're fine and then 20 years later, bam and find out it's from something years prior. I guess the only thing you can look out for is if you have multiple concussions, you know, make sure you're thoroughly checked out and everything is tested, and just know there's gonna be some symptoms, to know you can't just shake off your third or fourth concussion.

0:04:30 - Thomas Ozbolt Right, yeah, and you know making sure that your coaches or you know different people around you, friends and family are kind of monitoring those things, and you know, in any contact sport these days, this is something that can be a risk. You know, we think about football, we think about UFC, MMA, you know different things like that, but I mean even a sport as low contact as soccer. You know these guys are jumping up and whacking the ball with their heads and you know that can cause, and that's enough. Yeah, it could definitely do it.

0:05:02 - Shane Smith You know, the more we talk about concussions and brain injuries and stuff, the more frightening it is to me, honestly. You know, when we talk about the massive head injuries, okay, and then when we step, take a step back from that and we go to these quote minor head injuries, you know, and we learn about the symptoms and all the stuff that can happen for that minor head injury, it's frightening to me because those aren't, those aren't the things you think about. You know, when I hear somebody had a head injury initially I'm thinking the guy who went to the hospital who's got to do rehab, all that stuff. They're not the person who goes, maybe this is their third concussion, you know, because they had one playing football and one playing soccer, or they fell once and now they're in a car wreck. All relatively mild, and now they've got all these symptoms right and we're worried about things like CTE or other stuff. What else would you tell us about CTE?

0:05:53 - Thomas Ozbolt Yeah, I think you know, again, we're scratching the surface of it and there's lots of studies that are out there, a lot of it, you know it's going to come to light, you know, over the next few years and maybe decades, as we continue to find different ways to evaluate what's happening to our brains just through everyday living and contact sports, different things like that. You know, having the right protective equipment, you know, if there's any parents out there, people are like, oh man, I don't want to have my children involved in anything. You know, yeah, because you know, put them in a bubble and hey, let's just, you know, sit at home and look at screens all day. You know, I don't know that that's the right answer. I know that's not the right answer, but there's definitely new equipment that's out there that teams, different sports, are using to help minimize these risks. Now, if you're an NFL fan and you're watching any of the training camp stuff, you're wondering why the football players look like Marvin the Martian out there from the Flintstones with massive helmets. They've got these big bubble, I think they call them guardian helmets.

0:06:48 - Shane Smith I saw something about that there were. Some people are making a push for everybody to wear guardian helmets, like all the time.

0:06:53 - Thomas Ozbolt Yeah, yeah like during the games and it would look like, it would look like some kind of video game out there, but I guess that's not what it looks like isn't the most important thing. It's how it protects somebody.

0:07:03 - Shane Smith You know when we talk about the evolving standards of safety. When I was a kid, we didn't wear bicycle helmets. Right yeah, you know, we just did whatever. And I can remember, probably being in high school bicycle helmets were suddenly the new thing. My mom trying to tell me hey, you need to wear a helmet, I'm like yeah, whatever mom. You know, nobody's wearing helmets or anything else, you know? We didn't even have the option for any modified helmets. It was just this piece of styrofoam it seemed like, but now they're pretty common. Everybody expects to wear them when they ride the bicycles and stuff. Right, so it's-

0:07:35 - Thomas Ozbolt Yeah, even when we get my daughter on her little scooter, we got a little helmet for her. You know it's not like she's falling off or going high speeds but you know you wanna protect your kids, you wanna protect their little skulls.

0:07:46 - Shane Smith What else? Anything else you would tell us about CTEs or things to look out for in that area?

0:07:51 - Thomas Ozbolt Yeah, I mean it's a rare condition from what we know right now, and a lot of what we found out when somebody has CTE comes from some sort of volatile or you know kind of impulsive or explosive event. Is one of the ways you know you see people degenerate, but then you also see some impulse control things. So a lot of what we know comes from study of essentially like a cadaver you know somebody after they've passed and we're looking inside their brain and we're seeing the accumulation of abnormal proteins. So finding a way to figure out how to do this while someone's living and monitor that ongoing disease process in terms of a brain injury. I think that's maybe the next frontier is: how do we monitor what's going on with someone? Maybe that's that blood test?

0:08:33 - Shane Smith I was gonna say we talked about the blood test. That's what it makes me think of. But I mean, you know, the more I learn about that blood test, the more I think it's gonna become a standard procedure for, like our high end athletes, for UFC, for football, and even I could see it's something the emergency room started doing after every major car accident. Yeah, yeah, so I guess it's just more and more knowledge is what we learn right.

0:08:57 - Thomas Ozbolt Yeah, it's one of those things that you know, we might be talking here today about it and we think we are starting to get a grip on it, and a week from now we find out something that completely transforms the way we think about it. That's how new this brain science is.

0:09:10 - Shane Smith So no longer is it: You just have a concussion, though, right. That's not the right phrase anymore, because we've figured out there's just a concussion, is a ton of other things, right.

0:09:19 - Thomas Ozbolt Yeah, it's really too simplistic and it doesn't really, I think the word kind of does a traumatic brain injury, you know, almost an injustice, because concussion, we think about concuss, we think about an impact, we think about a force, and again, you don't have to have that direct blow, it can be acceleration, deceleration forces.

0:09:40 - Shane Smith All right, Thomas, thanks for being on this episode of Mind Matters. For anybody who's interested in concussions and brain injuries. Hit, like and subscribe and remember: hit the bell for notifications and if you've got a question or concern or you are in an accident or think you're suffering from a brain injury or concussion and need to talk to somebody like Thomas, just give us a call. You can call us at 980-999-9999. You can ask for Thomas and remember, if you're in pain, call Shane.

0:00:07 - Shane Smith Hey, I'm Shane Smith from Shane Smith Law. I'm here with Thomas, one of our attorneys for the Brain and Concussion Group here at Shane Smith Law. Thomas deals with a ton of brain injury cases, ranging from concussions to more serious, mild traumatic brain injuries and even moderate traumatic brain injuries or more severe brain injuries. Thomas, now we were going to talk about DTIs today, which is this fancy new test they're doing that we hear a lot about. I thought it was exciting when I learned about it, so let's just start out in the beginning. What is DTI?

0:00:37 - Thomas Ozbolt Yeah, DTI is an advanced imaging technology and it's really revolutionized the way that providers, medical doctors, are diagnosing and identifying traumatic brain injuries. It's a non-invasive method that allows us to visualize, actually see with our eyes the white matter tracks in the brain which are often affected in traumatic brain injury cases.

0:00:59 - Shane Smith Now why do we need that? Because if I get a concussion, when regular doctors diagnose concussions all the time without any fancy tests, right so they shine it my pupils are dilated, you know I describe the symptoms. They're like you've got a concussion. What is the difference in diagnosing a concussion and maybe diagnosing a TBI or mild traumatic brain injury, which can be a concussion, with the DTI? I mean, what's the difference here? What's the benefit?

0:01:29 - Thomas Ozbolt I think the biggest issue is that if you say you have a concussion or a doctor says you have a concussion, it's like well, how do you prove that? Because anyone can say their head hurts. Anyone can say that they have a ringing in their ears. Anyone can say they're having migraines. Anyone can say a lot of things. But now we can actually show the areas inside your brain that have been damaged. It's not just oh well, this patient is reporting, you know, x, y and z symptoms and because of that we're going to diagnose them with concussions. No, it's not just that, we can actually see it for the first time, objective evidence with our eyes, for the first time.

0:01:54 - Shane Smith Wow, okay, so that's the real benefit. I mean, it takes away any doubt and I know I've had clients in the past where, you know, as cases go on and sometimes they talk to the defense doctors or the other side they start to doubt themselves, am I really having these symptoms or am I making it all up? When the other side alleges- this puts all of that to rest right?

0:02:12 - Thomas Ozbolt Yeah, yeah, you think so, and you know you have to have the imaging study, which is done using an advanced MRI kind of calibration. You have to have the image study done in conjunction with a clinical correlation. So you have to see a doctor and look at what's going on with the particular person, certain to the symptoms that they're presenting, but then you can match up the symptoms that they're presenting with what you can actually see on the DTI imaging. That shows essentially what's going on inside the brain, and what that shows is, you know, our brains, billions of nerve cells that are called neurons, those communicate with each other through these long thin fibers, those are called axons. These axons, they're bundled together and that forms the white matter of your brain, and that creates a complex network for transmitting information between different regions of your brain. When someone gets a TBI, these axons can become damaged and that disrupts the brain's ability to send and receive information. What DTI does, it allows doctors to examine the structure and the health of those axons, to see if there's any damage caused by the injury.

0:03:18 - Shane Smith Alright, so it'll actually see the damaged pathways in the brain, basically. Is that what it is? The stuff that's not working anymore?

0:03:27 - Thomas Ozbolt Yeah, it's almost like if you imagine a Christmas tree lighting up. You know you plug in the cords, you know you've got your old, you know 30-year-old lights that your mom and dad have been plugging in forever and you'll see like a strand of them doesn't come on. You know it doesn't light up and you're like, oh well, this, you know we might have to replace this. Obviously, you can't replace your brain, but you can tell, you know it's a similar kind of thing, where certain areas of the brain light up, and if they don't light up, then you can tell that there's been brain damage.

0:03:52 - Shane Smith Alright, now you mentioned clinical correlation. What does that mean?

0:03:54 - Thomas Ozbolt Yeah, that means it's actually having a doctor talk to you, review your medical records, review your medical history to see if there wasn't something that happened a long time ago that could explain what has happened here. DTI can essentially show things that are more recent versus things that happened a long time ago, really, of the damage. But, you know, having a doctor actually talk with the person is important too, because it's not just an image and then we draw our own conclusions from that. You need a doctor who can, you know, get the patient in the clinic and come to some determinations based on what they're able to observe with the client and determine using, you know, testing.

0:04:34 - Shane Smith How does the DTI work? What is it? You know, whenever we talk about imaging and stuff, I think of like a CT or an MRI. You know, you go into a little machine and it spins around and out pops your MRI, basically. How does the DTI work?

0:04:47 - Thomas Ozbolt Yeah, DTI is really, it's really neat. It's a really neat concept and really interesting, brilliant. It's essentially measuring the movement of water molecules along those axons that we just talked about. You know, in healthy brain tissue water molecules will move smoothly and consistently along the direction of those axons. So smooth, consistent flow. Now, if there's damage to those axons, the movement of the water molecules becomes disrupted and less organized. So during the actual scan you have a powerful magnet and radio waves and these are used to track the movement of water molecules in your brain.

0:05:21 - Shane Smith Now am I drinking like water or soda, like when the test is going on? Or is it just water in your brain normally?

0:05:27 - Thomas Ozbolt Normally it's just water in your brain normally, and so that water in the brain will be tracked by this you know, magnet and radio waves and it'll process that information, the scanner will, and then that'll produce these detailed images. You know, lighting up like a colorful strand of broccoli. That's basically kind of what it looks like, and they'll show the direction and the organization of the water movement. And then doctors can then identify where the structure of the axon has been disrupted due to the injury.

0:05:56 - Shane Smith One, that's just kind of cool. It's amazing that the science has gotten there to prove what we've been dealing with for- I mean what we've been dealing with for decades, but other people have been dealing with for you know thousands of years, you know concussions and things like that, and have to rely on people. What do we use a DTI for?

0:06:12 - Thomas Ozbolt You know, when we look at a case that involves a mild traumatic brain injury, brain injury, concussion, all of those different words you know, we often come up with the challenge of you know, this is a silent injury, it's the injury that you can't really see, because you know a lot of what's going on, is happening inside of the person's body. You know you're not bleeding, you're not, you know, showing your injury in a lot of ways. What this does is it gives us concrete scientific evidence. Objective evidence that nobody can dispute. And that type of evidence, as you know, that always bolsters your case. These imaging advancements, they help us demonstrate, as I would say beyond a reasonable doubt, the extent of a client's injuries. It's not just more likely than not. It's, hey, there's absolute proof of an injury.

0:06:52 - Shane Smith When you talk about it I mean you said it's a monster to prove that the injury occurred. How subjective is that? Can I look at it and say, well, I disagree with you here, it doesn't look like you had a brain injury. Or is it pretty cut and dry like a broken bone?

0:07:03 - Thomas Ozbolt Yeah, I think it's pretty cut and dry. There's always going to be ways to- that, you know, people can come up with to try to challenge these, whether it's the sample group and how they're looking at fractional anisotropy. And you know, just diving into the control groups that are used to get these measures, that sometimes they'll use standard deviation, that's probably a little bit too much. You know there's things in terms of looking at the control group, because a lot of what happens with DTI, or some of what happens with DTI, is they're looking at the flow and disbursement of the water and how it differs from the mean, you know. Okay, a regular person, right, and so you know defense might look at that and say well, who is your actual sample group? Did you use a sample group of a bunch of healthy 25, 26 year olds, or did you get people who are in their 50s or 60s, like this person who's involved here with this sample has been done of, so there's ways that they can look at it and challenge it.

0:07:56 - Shane Smith But my guess is all that's going to- as DTIs are used more and more, those arguments are basically getting weaker and weaker because they're going to have more sample size for all this stuff. Is that right?

0:08:07 - Thomas Ozbolt I think so. I think what we're seeing around the country is DTI becoming more and more accepted and being found to be admissible in courts all over this country, and there's a list that's come out about this. It just came out on one of the lists the other day.

0:08:22 - Shane Smith But it's pretty much, I mean it's growing every, I would say every year, but I mean it's actually growing a lot more rapidly than that, as other brain and concussion lawyers are fighting this fight basically.

0:08:36 - Thomas Ozbolt Yeah, once we're realizing the resources that we have available to our clients, that we can actually get them answers, let them know that it's not all just in your head, you know. No pun intended.

0:08:44 - Shane Smith I never want to take away from that aspect of it. I think that's a huge thing for our clients and doctors, patients is to know it's not just in their head, it's a legitimate injury, it can be proven. It's not just oh, you're a psychopath, you know, or that you're just acting out and can't control your emotions. I mean it proves the reasons why you're struggling with these issues.

0:09:07 - Thomas Ozbolt You start to understand why you're having the issues that you have, and it's not just something snapped one day. It's like no, you were injured and your brain was damaged in a way that's gonna affect you for the rest of your life. Yeah, and we can say that. We know that now, as we can see it right.

0:09:18 - Shane Smith No differently than if you crush somebody's knee and they're limping along. But you can physically see that. Brain stuff you can't.

0:09:25 - Thomas Ozbolt Yeah, yeah, and now, now you can, though with with this type of imaging, and I'm sure, as time passes, we're only gonna get better sort of technology and be able to look at these things even, even clearer than we do now.

0:09:41 - Shane Smith And I think back to when MRIs were brand new. You know I mean everybody didn't- you know they were a new thing and anytime there's a new procedure, nobody wants, you know the defense side is, always argues that it's new or it's untested, everything else. And it takes a while to get over that hurdle where everybody's like alright, it's really that- you know, we can't dispute the sciences there. Now we got to find other ways to attack it, right?

0:10:00 - Thomas Ozbolt Right, exactly, and you know there's always those battles at the beginning and you know, having a good team on your side to fight those for you, I think, is this the most important thing, especially in a state like North Carolina where, you know, these technologies, they haven't really been used that much compared to some other places around the country, so we're gonna be at the forefront of pushing those and making sure our clients to get treated the way that they should by insurance companies.

0:10:22 - Shane Smith All right. Well, Thomas, that's great, and thanks for being on the show. We appreciate it. And discussing DTIs and and everything that goes into that, I'll say new technology is what I'll say because I- and I think new is probably the wrong word, I think it's been around like 10, 15 years, but takes a while to trickle out and get, get handed out to everybody and it just makes me think of heck, even some of the new surgical things you know, the first time somebody did what is it laparoscopic with the really tiny tiny holes in it you know that was new too. And even now we have the defense say sometimes we think you should have done it differently. We don't like that procedure. I know that fights gonna be fought, but I know that the DTIs puts a lot of clients fears to rest and helps them with it. So, yeah, thanks for coming on talking about it and we look forward to our next time here on the show. Yeah, thanks for having me. And remember listeners if you like and follow. Subscribe so you can see more TBI updates from the brain and concussion group here at Shane Smith Law.

0:00:06 - Shane Smith Hey, I'm Shane from Shane Smith Law. I'm here on Mind Matters, our podcast, and I'm here with John. He's one of the attorneys here at Shane SMith Law in the brain, or concussion and brain injury group. John, we were going to talk about some of the diagnostic tests they do to determine somebody's got, basically a traumatic brain injury. Is that right?

0:00:25 - John Mobley That's correct, Shane, and that's one of the key areas that we focus on is getting our clients into the correct doctors to receive the correct testing to determine if they've actually sustained a brain injury.

0:00:37 - Shane Smith Why don't we need all this stuff? Because, like a concussion, it seems like I've seen EMTs on TV shows diagnose concussions, right, they just shine the light in your eyes and they're different. What's the difference in these kind of things we're going to do versus that?

0:00:49 - John Mobley Absolutely, and I wish it was that easy because it would make our jobs a whole lot easier. But there are definitely layers to this, and technology, and specifically medical technology, has come a tremendously long way in just the past few decades that allow us to even know more about the brain that we didn't know previously.

0:01:11 - Shane Smith And I've heard, you know it's been said before brain injuries are the silent injuries, because you can't see it, you can't even touch it. I mean it's in somebody's head. So a lot of times we've had clients who they begin to doubt themselves right and doubt they really have a brain injury or not, or doubt they think it's all in their head and I guess it technically is because the brain is there. But it's a real, legitimate injury and some of these tests show it and prove it right?

0:01:37 - John Mobley That's absolutely right. You mentioned the silent injury. It's also been referred to as the invisible injury and that's because, you know, we used- before we had access to these incredible tests, we just only knew that someone was different than the way that they were before the accident. If it was your uncle or your father, they just acted differently and we didn't really know. Yeah, we didn't know why? Right, we had no idea. And as medical technology has advanced and we can now see parts of the brain that are actually damaged and injured, we can now pinpoint the part of the brain that has either an abnormality or an injury, or a lesion or a bruise with, you know, so much more detail than we could 20 years ago.

0:02:16 - Shane Smith So, would it be fair to say, and not that doctors do this. But could a doctor pretty much look at some of these tests and the results and say I bet your uncle Joe is acting this way, or I bet he's lost his ability to talk, or I bet he's having trouble hearing, or can- are the tests that good?

0:02:33 - John Mobley That's, that's correct. At this point, the tests are that good where we can pinpoint the area of the brain that is responsible for whatever function the injured person now has a deficiency in. So if all of a sudden they start not being able to find certain words or slur their speech or have memory issues, we can now corroborate that with the actual brain scan and see if that part of the brain that controls memory and speech has been affected or has a bruise on it or a lesion. So we pair the two things up and it gives us pretty darn conclusive evidence.

0:03:20 - John Mobley That's right. Well, we don't know everything about the brain. We've got it pretty down pat what each portion and segment of the brain does to control certain parts of the body, behavior, cognitive function. We feel pretty confident, and the medical specialists do, about what the brain does in each one of those areas.

0:03:31 - Shane Smith So they broadly they know about what it is, but, and even more specifics, I guess, and they're going to continue to learn more and more, obviously, I mean, yes in the last 10 years alone, they've mountain of knowledge about the brain continues to grow exponentially, I would say.

0:03:49 - John Mobley That's right. It seems as though it's speeding up at this point, as we realize and uncover these things every year, we're just learning more and more at a much faster pace.

0:03:57 - Shane Smith All right. Well, what are some of the tests they would do on here? Because, like I say, I know the EMT test with the flashlight, but I mean, these are fancier tests, right? So right fancy or more expensive, and probably much better than that one.

0:04:08 - John Mobley Oh yeah, the one you mentioned is is something called the Glasgow Coma Scale and this is a test that you know, it's used to measure the initial severity of the injury. It's not so much used to assess if someone is sustained a mild traumatic brain injury. It's more to assess consciousness and the you know the level of emergency. So EMTs use it a lot, first responders, and the scale actually has a whole criteria list of you know- it measures eye response, verbal response, motor response and specifically, like with eye stuff, it'll look at spontaneous eye movement to speech, to spain, to pain, and it'll give you a score number and at the end, when they go through all of them, if your score is around a 15, you have a mild, mild potential brain- excuse me, mild injury. Comatose, it means that it's like eight or less and then severe would be like you're completely unconscious.

0:05:10 - Shane Smith Right. SO the lower it is, the worse it is.

0:05:10 - John Mobley That's right and we see that a lot of the times that initial score may be worse than what the EMT grades it. So sometimes we have to go back with a specialist, or if the attorney is kind of the first line of defense for some of these clients when they get a Glasgow Coma score and the defense is very quick to point well, it didn't look that bad. And then we say, well, witnesses were saying at the scene that they saw rigid arms, which is called a fencing response or some other things that would indicate a much worse score. So by the time sometimes we get them to the correct doctors they say that Glasgow Coma score was way worse.

0:05:51 - Shane Smith It would just perform badly.

0:05:55 - John Mobley Right or stuff at the scene, and this is- it's no blame on the first responders, it's just sometimes car crash scenes are hectic, sometimes a car is on fire, sometimes it's an emergency situation. Medicine's not perfect at that level. But then once we have the benefit of hindsight as 20/20, then a neuro specialist can come in and say they probably had a much worse injury.

0:06:17 - Shane Smith Because I mean an EMT, at the scene, I mean he's primarily trying to make sure you don't die and how quickly he's gotta get you to the hospital, or can he cut you loose? Not really long-term neurological effects. I mean that's not his job, I would argue at the scene.

0:06:30 - John Mobley That's exactly right, and that's not the purpose of the test either. Just to determine hey, is this person gonna make it by the time we can get them to the ER? Gotcha, that's really the case. That's the goal of that test, huh? So that's kind of the first line defense test, and then second is the CT scan, computerized tomography. We see this test done a ton, especially in the ER. Its primary purpose is to rule out neurological emergencies as well, so typically skull fractures, swelling, bleeding in the brain, hemorrhages, the real serious stuff. So this is the stuff that's gonna kill you if it's not addressed in the next hours or minutes or days, I mean that's correct and that's really the big purpose of the test, because it's not as high resolution and as strong as some of the other tests. It's equated to about like several hundred X-rays, which may seem like a lot, but when it comes to the brain there's more powerful tests out there. So it's another frontline ER test.

0:07:28 - Shane Smith So it's not also not used to determine long-term effects basically. That's not it's goal?

0:07:37 - John Mobley Correct, in terms of determining like what they deem a mild to moderate TBI. Now, it may very well diagnose a very severe TBI, like if your, you know your skull is caved in. That's obviously a very severe situation and a CT scan would pick that up.

0:07:54 - Shane Smith But I think the EMT could diagnose that too. That's pretty severe right, I mean, dude's gotta caved in skull, he's gonna- I mean so obviously it pinpoints it and makes it you know you need it. But those severe cases that are that bad, the EMT is probably gonna be pretty- and this is serious case too, everybody knows, right.

0:08:09 - John Mobley Yes, I mean that can definitely be a case where you know outward injuries to the skull or you know cave-in injuries. Those are gonna be pretty evident. I will say that you know, if the CT scan does not find a traumatic brain injury, that is not necessarily a sign that there is not a TBI. The defense attorneys and defense experts love to sometimes point to the fact that a CT scan are- not finding any significant findings means there's no traumatic brain injury. We just know that that is not the case. We just need different types of scans to show the correct injury. So unfortunately, I have to be the bearer of bad news sometimes for my clients when they say, hey, I got the CT scan at the ER, it came back clean, I'm good to go, but I'm still dizzy, still having trouble finding words. My loved ones say I'm still acting differently. So we have to explain to them: unfortunately, you may not be out of the woods yet. You may just be beginning your journey to recovery.

0:09:12 - Shane Smith If a client or somebody was in a car accident, went to the hospital, had a CT scan and it came back quote clean. That isn't, I mean, I don't want to say it doesn't mean anything, but it's certainly if you're showing symptoms of a brain injury, you definitely need to get care. You're not out of the woods.

0:09:26 - John Mobley That's right, it's great at finding those serious things we talked about, but the the long-term injuries from a mild to moderate TBI, which are very serious things themselves, are going to be caught with other imaging. That type of imaging is the MRI or the magnetic resonance imaging. Yeah, way more powerful than a CT scan and it has multiple different types of sequencing depending on what sort of thing we're looking for. Too much to get into here, but there's a lot of them out there, a lot of sequences.

0:10:00 - Shane Smith So the doctors that your specialist usually a neurologist is gonna say exactly what kind he wants or how strong that MRI needs to be. Is that what it is?

0:10:09 - John Mobley Yes, and that's why getting to a specialist is crucial, because they will have the expertise to basically prescribe the correct sequencing. Okay, because you could order the wrong sequencing, it could miss your type of injury. Okay, so a lot of times we'll see where the doctors will order a whole battery of different sequences of MRI just to make sure we don't miss anything. Okay, because this stuff is so important, lifelong permanent injuries. We just don't want to miss anything. And one of those types of-

0:10:36 - Shane Smith I was gonna say, when you talk about different sequencing, is that a different type of MRI or is it a different way? Is it the same machine, it just does a little differently? What's the different sequencing?

0:10:48 - John Mobley Yeah. So an MRI uses a combination of magnets and radio waves to basically show what's going on in the brain, and they are slightly different, but that definitely gets into the weeds. The sequencing will vary to prove different things. One of them is like a DTI, it's a diffusion tensor imaging. This is rapidly becoming the gold standard for proving MRIs. There's about over 20,000 peer-reviewed articles basically supporting it as a good way to identify brain injuries. Essentially, it measures how water moves in the brain tissue and where any of that water movement is restricted, it can pretty much clearly illustrate which part of the brain has been injured, and we find that out because it uses a 3D model. These images are just fascinating. I mean the brain is illuminated and it's greens and pinks and oranges highlighting the brain, and the specialists can literally compare each side of the brain and where one part where the water has been restricted, we know the injury is right there and then we match it up to the symptoms. And I said it before, it provides such conclusive evidence of the brain injury because we can clearly see it now on 3D imaging. The future is here.

0:12:08 - Shane Smith I was going to say it sounds like something right out of Star Trek.

0:12:12 - John Mobley It really is. It's almost to that level. It's really eye-opening, and when we first saw these reports and this type of imaging, just everyone in the industry and the community was very excited.

0:12:22 - Shane Smith Now I want to go back just a little bit to the different type of sequencing, because are you basically saying, though, if the doctor ordered the wrong sequencing, you could have a clean MRI, and if he'd ordered the right sequencing it would have shown the brain injury? Is that?

0:12:36 - John Mobley Unfortunately, that is the truth, and what that means is that a lot of the times, if your case is in the hands of someone who's not a specialist, who's not actively doing these types of cases not the right doctor, then the wrong type of sequencing could be ordered.

0:12:54 - Shane Smith Really? Okay.

0:12:54 - John Mobley And your injury. You may still have it, but we just haven't identified it yet.

0:12:58 - Shane Smith So I get my quote clean MRI. My regular doctor refers me for a brain MRI three months after the wreck and it comes up clean. I don't want to say it doesn't mean anything, but it certainly doesn't mean I'm all better and everything's in my head.

0:13:11 - John Mobley That's right.

0:13:12 - Shane Smith Just want to put that out there, because I see a lot of MRIs that are ordered and they come back clean and people are like, well good, and they feel so much better, but their family still says you're acting crazy, you're forgetting things, you're you're dizzy and they're like, yeah, but it I got an MRI that says I'm good, right.

0:13:27 - John Mobley That's right and that's why there are just so many diagnostic tests to be done, because we really have to keep striving to identify the injury, especially when the client is still complaining of these very serious symptoms. Because we know we haven't done our job and the specialist usually knows this too if we haven't identified what the injury is, especially if the person is completely different after the accident.

0:13:50 - Shane Smith And I know that's something we've strived here and our group here at the firm is making sure people are seeing not just neurologists, but neurologists who spend a lot of time on traumatic brain injuries, basically, and making sure the best specialist we can get somebody to right, who's familiar with these acute injuries and the long-term consequences of it and familiar with the science too right?

0:14:15 - John Mobley Absolutely. And that's really why we strive to find the absolute top people in their area, because we've unfortunately seen situations before clients have come to us and gone to their own neuros where they reach a dead end and it's very frustrating and you can imagine if you're in this serious injury. You're a high-performing professional or you used to be a top performer at your job and now you can hardly do half the hours you used to do. Your family says you've completely changed. Stuff at home is tough, you're forgetting appointments and you're neurologist who's supposed to be the strongest advocate for you in your corner is saying there's nothing more I can do. Or here's a handful of pills, come back in two months. That doesn't fit a lot of people's schedule and recovery schedule and that's why we try and find the best neurologist and just know the network and be familiar with the area.

0:15:07 - Shane Smith I was gonna say that's one of the things that frustrates me the most is when somebody says: "my doctor said there's nothing else to do" and I'm like, well, we don't have answers yet, we gotta keep digging or we gotta keep doing something, or we need to see a different doctor or see a fancier doctor, I mean a more specialized doctor or something, and because "there's nothing else I can do and here's some pills" is terrible, right. That's a lifelong sentence.

0:15:29 - John Mobley That's right. We're not really in the business of allowing our clients just to mask pain with pills. We wanna find answers. We owe it to the client. The client wants that, we all want that. So these diagnostic tests allow us to kind of push further and further to get those answers that we need, because that's what we need to prove our damages in the case. That's what we need to, just when the client is going home at the end of the day, just to know what is causing these symptoms is such a relief, so they didn't know that, like you said, it's not just in their head. These are very real things and we can actually point to it because we now have the correct image order that shows where the injury is.

0:16:35 - John Mobley So there's actually some additional tests out there. One is the VNG, which is the videonystagmography, and that is one that is used in order a lot when we see our clients have balance issues, or it can be used to assess abnormal eye vision. You may have heard of this word, nystagmus. It's the same test actually, the horizontal gaze nystagmus that officers use when they're assessing a DUI, because the eye will actually flutter a little bit. And that happens too when you're drinking, but it also happens when you have a brain injury. Crazy.

0:17:26 - Shane Smith And you say that I've had clients before where their neurologist would actually give them a card that said they've been received a brain injury, because they got pulled over and had to go through the whole test and the client got arrested. Oh wow, so that particular neurologist started giving out cards that said I've got a brain injury, and it was like if you're you know, could pull over for something. Give this to the officer, so they you know, know it's legitimate kind of deal. Because, like you say, it's the same evidence either you're inebriated or you've got a brain injury. Wow, yeah.

0:17:58 - John Mobley That's interesting, and another test they used to is something called an EEG, which is an electroencephalogram. That's where they put little wires on your head and they will monitor brain waves to see if there's anything abnormal there. We see that one less, but some neurologists use it quite a bit. I've heard that it's- it's good to distinguish PTSD symptoms from TBI symptoms. Sometimes there can be some overlap there and it's good to distinguish. One area that we're all and some of my colleagues are excited about is the blood test, because sometimes these, what we're finding out more and more is that these brain injuries can cause actual hormonal changes in the brain and that can present as biomarkers in the blood, and a lot of people, a lot of specialists, think this may be the future brain injury test because it's quick and easy.

0:18:45 - Shane Smith I mean I don't want to say I mean, but it is they take some blood and send it off, right?

0:18:50 - John Mobley And if you think about it, I mean with some of these diagnostic tests you know there's some exposure to, a little bit of exposure radiation, but it's considered worthwhile to take the brain injury. With blood type style testing, you're right, way less invasive, probably cheaper. So we're kind of crossing our fingers and are holding our breath that some of these newer tests that are blood related have some good results and may be the future.

0:19:13 - Shane Smith And I would think honestly, if it's a blood type test, your primary care doctor, if they thought you had a concussion, could take the blood and set it off right. You wouldn't even have to see a neurologist if your doctor was trained and aware and, I guess, looking for those types of injuries right.

0:19:27 - John Mobley That would absolutely honestly be the hope. It means that we would catch so many more brain injuries if it was just more readily available, cheaper and easier, to the point where it's like a standard panel that your primary care physician or even who knows an urgent care, go over for you. That would make our jobs way easier in terms of catching these things.

0:19:46 - Shane Smith All right, yeah, so we've talked about a ton of tests here that could be used to diagnose and find a brain injury, from the general, you know, early stages, to something much more specific and more focused is what I would say. We missed any of them?

0:20:02 - John Mobley Really, the last one that we see used a lot of is something called a Neuropsych Test. This is the test before we had all these fancy, expensive imaging devices. It's basically like a PhD or a PsyD. Those are the credentials of these very smart people that conduct these. They implement, a standardized test and that standardized test is done and it looks at all forms of cognitive abilities like memory recall. It's a long test and it's expensive and clients would do these. This is before these imaging. It is actually still done today and supported. Now the issue is that the test is very run-of-the-mill and standard. However, the interpretation of it is up for heavy debate, and what I mean by that is that a lot of times our client will have a treating doctor or the defense will go out and they will hire a, hired gun a defense expert to basically interpret those results in a way that were to say you do not have a brain injury. You're making all this up. We see it time and time again so it becomes a real battle. That's why we're loving these new tests, because they are way hard to argue against. It's way harder for the defense to muddy the water when I have a clear 3d model image showing the part of the brain that's injured and it matches up to my client's symptoms at the scene.

0:21:25 - Shane Smith Because and I'm just gonna play the other side right or ask this question: we usually have correlation. I mean we have the client's symptoms before the test is run right, so these are in the records. Everything is documented, what the client is struggling with. Then they get the test results and they confirm everything's going on with the client. It's not like you just go in and get this fancy test and then afterwards you're like oh well, I can't remember anything, but it would be hard to fake all that in advance, right?

0:21:51 - John Mobley That is, that is truly the key Shane, and that's the thing is that you know, we have these clients that give us all these symptoms at their first or second doctor's visit. They don't get this imaging usually for months down the road, and so it's very insincere sometimes when the defense says that our clients, you know, aren't as injured, or they say they are, they don't have the symptoms. Because it's very hard for someone that doesn't have all these degrees and is a specialist to know all the parts of the brain that they were having injuries in complaining of those complaints and then later get an image and it's that exact part of the brain that controls the symptoms they complain about Sounds a little ridiculous when you uh, when you spell it out like that, yeah, and it. That's why the defense does not like these imagings and they fight, fight to keep them out, because it's, it's very conclusive.

0:22:37 - Shane Smith John, one thanks for coming on the show and talking on Mind Matters and it's always great to learn about, you know the the brain and concussions and TBI and how it affects the law. For our listeners, hit like and subscribe down below for more future updates from Mind Matters. And I'm Shane from Shane Smith Law.

0:00:06 - Shane Smith Hey, I'm Shane from Shane Smith Law. I'm here with Thomas. He's one of our attorneys in the concussion and brain injury group here at Shane Smith Law and today we're here on Mind Matters. We're going to be talking about brain injuries and telemedicine and sort of how those two things are intersecting to sort of change some of the standards of care and some of the future care in this area, right?

0:00:27 - Thomas Ozbolt Yeah, absolutely, and it's a very, I guess I want to say new.

0:00:32 - Shane Smith I think new is sort of the right thing because I mean, to be quite honest, before COVID I can't think of when I had a telemedicine appointment that didn't seem silly and I don't want to say useless, but I mean seemed like we were just pretending that the doctor and me were talking, if that makes sense.

0:00:47 - Thomas Ozbolt Yeah, I think telemedicine really saves people a lot of time, saves doctors a lot of time. It really makes everything more efficient, because how many times when you go into the doctor's office do you actually make physical contact with the doctor? At the first place it's not very often, unless you're going to a chiropractor.

0:01:02 - Shane Smith Yeah and a lot of times, even when you do see the doctor, you've seen somebody in the front intake and all your stuff. Then you see a nurse who seems like copies exactly what you put on your intake form and then the doctor comes in. You may see the doctor, what two, three, three minutes tops five, whereas some of the telemedicine appointments now you're- I think you actually get more face time with the doctor than you did before.

0:01:21 - Thomas Ozbolt Yeah, more face time with the doctor. You're not traveling, you're not, you know, waiting in the doctor's office for an hour to be seen. It's breaking down geographical barriers too.

0:01:32 - Shane Smith So let's talk about that. So what do you mean by the geographic barriers? Because I think that is actually where I think that's where telemedicine shines, honestly is when people are in weird geographic spots. Maybe they're in rural areas, maybe they're just far away from a specialist, because I know years ago not on a- on a brain injury case but we need to go see a specialist for one of my kids and it was a pediatric ophthalmologist and I don't think- and I lived in Tennessee and they said there wasn't one for like 200 miles.

0:02:01 - Thomas Ozbolt Yeah, yeah. There's some pretty stunning numbers about that when you actually look at in terms of specialists and neurologists in particular, 86.3% of United States counties, all the counties in the United States they don't have a neurologist.

0:02:17 - Shane Smith Give me that number again 86.3%. So really, basically what- what you're saying is you have less than a 15% chance of having a neurologist who practices in your county.

0:02:25 - Thomas Ozbolt Yeah, it's, it's probably isolated to some of the bigger cities, but if you're living in rural areas, if you're living in suburban areas, you're you're looking at not having a neurologist in your area. Or if you do have one, if you think about all the back load that you have there before you can actually be seen. That's something that we see. A lot of clients goes into their health insurance doctor and they're referred to a neurologist for traumatic brain injury and neurologist says all right, it's, it's June, I can see you in December, see you in October.

0:02:52 - Shane Smith Yeah, and we've seen that and that's a four or five month window of whatever happens and during that window a lot of times the primary care doc doesn't see you anymore because they're like I referred you out, I can't do anything, I referred you out, so you got no care there, and I've seen clients sort of left like what am I supposed to do?

0:03:10 - Thomas Ozbolt Yeah, it's breaking down barriers telemedicine is, because it's helping those people get access to care that they otherwise would not have been able to get, sooner than they ever would have been able to get, and, I would even argue, at a higher quality than they're able to get, because you're not restricted to the neurologist who has a contract with the local hospital an hour away. You can see somebody in Las Vegas, you can see somebody from Louisiana, you can see somebody from North Dakota.

0:03:34 - Shane Smith Yeah.

0:03:35 - Thomas Ozbolt Especially something the best in the world.

0:03:37 - Shane Smith So that's what it gives you is the ability to I guess it is doctor shop to look for the specialist who you think can do the best job, but also who can provide the best care for you specifically.

0:03:49 - Thomas Ozbolt Right, yeah, I think it's- you know, I can almost say, it's just doctor choosing.

You know and that's something that we don't get the opportunity to do a lot of times when we're looking at our healthcare is- you know, we have the luxury of choice in so many areas in life. You can choose what you watch on TV, you can choose what you eat, you can choose you know where you go on the evenings and on the weekends. But when it comes to the most vital things that go on in your life, the things that are going to keep you alive or cause you to die, hey, this is your doctor, you're stuck with it. Good luck.

0:04:17 - Shane Smith Yeah, when you, when you put it like that, it seems crazy yeah.

0:04:20 - Thomas Ozbolt It's absolutely nuts and you see how it's something that's denigrated by insurance companies are like oh, you didn't even see the doctor, they didn't even see you in person. Well, actually they saw him on a screen. Yeah, but they got to choose who they got to see and you shouldn't have any problem with that.

0:04:35 - Shane Smith No, because I think about it. I mean, you know, you said the choose things. If I look at, can you imagine the chaos or what would happen if someone in the government came out and said hey, you guys can only drive red Toyota Corolla's. Yeah, and that's your car, Thomas, you don't get to pick, you get that and I get a green- I'm lucky I get a green Ford truck instead, but you got, you know. I mean, nobody would stand for that right?

They said you can only go to this particular restaurant. We'd go crazy. But we let them do it with doctors all the time or at least there's this one doctor who's local to you versus giving you the choice right.

0:05:07 - Thomas Ozbolt Yeah, when you think about it, it's remarkable. You know that the type of argument that they're actually making you know, in terms of life or death, your health, your family, your livelihood. This is who you have to use, instead of: I get to choose in America.

0:05:22 - Shane Smith Yeah, yeah, like you said, this is America. We get to make choices all the time. Right, and I've met doctors in the past where I'm like, dude, I wouldn't want you working on me. You know, I mean the doctor who seems super busy, who doesn't seem like he listens to you, or just, you know, looks at a piece of paper but doesn't look at you or doesn't talk to you. I mean, I've been in a doctor's office where I'm not even sure the doctor looked at- you know, looked at me, they looked at my labs, but they didn't ask me any questions.

0:05:45 - Thomas Ozbolt You're just the person in room one or the person in room four, you know? You're almost a number instead of an actual living breathing human being.

0:05:52 - Shane Smith And when we come to brain injuries and stuff, I think, since this is so much of an injury where you don't just see it, you know, and simple lab work doesn't really show it a lot of times, it requires a doctor who's going to take the time and to talk to the client and listen to the symptoms and correlate it to whatever they can to prove and show that and figure out a treatment path right?

0:06:18 - Thomas Ozbolt Absolutely, and it frees them up to have that time is one of the crucial things to think about with telemedicine. That doctor's not restricted by, you know, being stuck into an office and having to, you know, rely on a thousand other people to make the wheels turn. They can just see people. They can get things done, and you know it's an application that's not new. This is used in other areas of medicine to remarkable effect. Some of the most important decisions that get made in a person's life happen through telemedicine.

0:06:40 - Shane Smith No, I mean business deals are done by Zoom all the time nowadays. We let people negotiate big, huge deals. You can almost buy a house with Zoom and DocuSign. You know, I think, about the size of business deals that happen and nobody ever sees anybody else. And why in the world are we going to say that you can't do with medicine, right?

0:06:57 - Thomas Ozbolt I mean, we do it in terms of stroke, stroke diagnosis, you know the management of stroke conditions. You know, telemedicine has changed the game, in that that's a condition that requires swift intervention. And you know, with 83.8- 86.3 places not having an neurologist or a specialist in that area, what are these places supposed to do when someone has a stroke? They've come up with a solution to that.

0:07:17 - Shane Smith No, I've got a good friend of mine. He's a telemedicine emergency room doctor, which I heard him say all that, and I honestly pictured him sort of sitting in a room and looking at cameras and doing all that. But that's not what it is. He's a specialist of some type but he services rural areas, these places that can't afford to have what you know his type of doctor on staff in the middle of the night and he one time told me he was covering, I think, six counties. He was the doctor on call for this issue or his specialty. So you know, the nurse comes in, calls him and he covers it and makes all these decisions all through telemedicine, yeah.

0:07:52 - Thomas Ozbolt Yeah, it's allowing greater access to better care, and I don't. That seems like the best thing, right. It seems like more- It seems what we should want. We should want more access for more people to the best doctors that are out there.

0:08:07 - Shane Smith So the telemedicine doctors so can they prescribe medicine after they talk to me and see our patients?

0:08:13 - Thomas Ozbolt Yes.

0:08:14 - Shane Smith So they prescribe medicine, they can order tests, they can do all the things a regular doctor can do. The only thing they can't do is what? Put their hands on me?

0:08:21 - Thomas Ozbolt The only thing they can't do is put their hands on you and you know, basically touch your body. They can't take your weight.

0:08:28 - Shane Smith They can actually depend on the truth for that, yeah.

0:08:32 - Thomas Ozbolt That's a take your word for it on that one. But you know patients aren't there to lie, they're there to, you know, find out what's wrong with them. So that's what our clients are there to figure out what, what, what's going on with their body. So you know they're there to tell the truth and get all the information to the doctors so they can make the best decisions.

0:08:51 - Shane Smith And I've even seen some of these telemedicine doctors, they'll have the patients almost do some, I don't want to say a physical exam because the doctor's not there, but they will have a patient step back and do certain movements so they can see that and look at it. I mean almost the same as if they were in a room.

0:09:03 - Thomas Ozbolt Absolutely yeah, yeah, you can measure and get a sense of somebody's posture. You can get a sense that their head is drooping to one side. All of those are things that can be done with telemedicine. It happens in various industries besides just healthcare and doctors. You see that happen with personal trainers. A lot of what you're seeing. You're seeing how somebody moves their body and then you're getting a read on what you need to do to improve this particular aspect of your fitness. Lots of different things like that.

0:09:28 - Shane Smith If they're using it, is it commonly accepted in the stroke area?

0:09:32 - Thomas Ozbolt There was a 2018 study in Stroke Magazine that revealed that telestroke services led to faster diagnoses, accurate treatment decisions and, ultimately, better patient outcomes. There's an FDA-approved remote presence robot that allows for high-definition video and audio communication for real-time patient assessment.

0:09:53 - Shane Smith I assume this is a special type of robot in the hospital, these rural areas in particular, to send super images, basically like 4K, 8k video stuff. But I think what's most relevant about that? You told me this magazine, they said it leads to more accurate diagnosis than I would assume, a local doctor, who's not a neurologist, making a decision, or a physician's assistant, or a nurse on staff or something else. So they're coming in better, even though it's all telemedicine.

0:10:21 - Thomas Ozbolt Yeah, I mean, you think if you had to do it the other way, if you had to do the alternative, you would have essentially, there's somebody taking a picture or video and sending it to a doctor and having them figure it out after the fact, or just getting on the phone with a doctor who lives in one of the 13.7 counties that do have it.

Yeah, and then explaining it to them. It's like, why would we restrict that doctor's ability to save someone's life?

0:10:45 - Shane Smith An you just put it up on the screen and you're like, yep, clearly that's a stroke. Because my assumption is the guy or gal who does it all day, every single day, it's going to be much better at diagnosing a stroke or much better at diagnosing a brain injury, than somebody who does it once a year.

0:10:59 - Thomas Ozbolt Yeah, that's some- yeah, somebody's working a per diem shift at the ER or coming in or hasn't been trained on that particular issue. You have a specialist who's making massive life and death decisions on whether to administer certain medications.

0:11:13 - Shane Smith So it sounds like telemedicine's here to stay.

0:11:16 - Thomas Ozbolt Should be and yeah, I think it absolutely is. Hopefully it becomes more and more accepted, I think, as patient outcomes get better and traumatic brain injuries, in particular, are treated better and better and patient outcomes are improving that we'll definitely see that.

0:11:34 - Shane Smith And what I see, tt comes back to this access of care, because you told the story about "yep. I'm a new patient referred to a neurologist I'll see in five months." I mean that's pretty common, honestly. I mean it sounds like a joke for us, but I mean that happens over and over and over.

0:11:50 - Thomas Ozbolt Yeah, I can't tell you how many times I've seen it happen. They have a client diagnosed with a brain injury or concussion at the ER. They go see their primary care. Bring their records primary care. I can refer you to a neurologist. Call the neurologist. I can see you in three months, but that's the best I can do.

0:12:08 - Shane Smith Yeah, and I think that's a great reason why, when somebody goes well, why don't you go see the in-person neurologist? Why don't you take the telemedicine neurologist? Well, because this guy couldn't see me for three or four months. This guy could see me in two weeks, right? Yeah, absolutely, and I know I've had issues where you have health issues and you're worried about something. Honestly, once that happens, that's usually on your brain the whole time until you get answers right.

0:12:31 - Thomas Ozbolt Yeah, and there's something to be said for cortisol levels and different parts of the physiological reaction of that stress and not knowing what's going on, making your condition worse. At least you have to believe that there's some sort of impact.

0:12:44 - Shane Smith I would totally. And when you think about the effect of an undiagnosed brain injury on a relationship between a husband and wife. I haven't read a study recently about it, but I know it's got to be huge because until it's diagnosed and we have tests that say this is what happened and this is why you're acting this way, we know people are going to just think the other person's acting crazy. Yeah, I mean because I know the impact on relationships for people who have a serious concussion, brain injury is already very, very high, but undiagnosed, I think has got to be even higher.

0:13:12 - Thomas Ozbolt Absolutely, because you've got conflict or strife in a relationship and that alone is bad but then not knowing what's the cause of it or thinking it could be something that happened to me in this accident, and just not being able to find out, not being able to get support or understanding for that, you know, I can only imagine it makes things so much worse.

0:13:32 - Shane Smith As we talk about it. I think the impact on strokes is huge. It's simple, it's easy and it's easy for everybody to say okay, well, speed is really the issue there in the stroke. How does it affect brain injury stuff?

0:13:44 - Thomas Ozbolt Yeah, just like a stroke or much like a stroke, TBI's and concussions, they often require immediate attention and swift diagnosis that can significantly impact your future prognosis. Telemedicine can make sure that you get that immediate consultation with a neurologist, which gives you access to early intervention and you know all of those, the symptomology, patient history that can be conveyed through a video call, just as what's going on with the stroke can.

0:14:12 - Shane Smith Oh yeah, I wouldn't see any issues with that. I mean, that's not much different than honestly, you can, you can fill out a form and zip it to the doctor just as easy. You can fill out a form and hand it on a piece of paper, right? Yeah, absolutely. So, what are some of the benefits of being seen super quick and early?

0:14:27 - Thomas Ozbolt Yeah, I think it's just being able to get the care and the treatment that you need, knowing what's going on with your injury and then being able to be proactive in getting the treatment so that any impact of that injury you can try to negate or mitigate as best as you can. You know, in terms of getting rehabilitation, whether it's cognitive behavioral therapy, or you know different medications or different supplements that are recommended by the doctor. Even IV infusion therapy is something that's been recommended. So just being able to get it taken care of you know, nip it in the bud.

You know if you break your leg, you know you don't want to wait three months because that's obviously going to have.

0:15:03 - Shane Smith Yeah, it's easy to see how. And maybe that's where the brain injury victims or the advocacy groups need to step up and actually advocate it. Because, you're right, nobody would say wait three months to get your leg fixed, right, you know, if it was broken, nobody would say just tough it out for three months and then get seen. Well, that's exactly what's happening when we don't use telemedicine. When we have to wait three or four months to see a neurologist, everybody's like well, let's just wait and hope it gets better in between. If you thought about it like a broken leg, nobody would stand for that, nobody would do it. And yet that's exactly where we are here. So telemedicine has an opportunity to address that and fix it right?

0:15:37 - Thomas Ozbolt It's a chance to bridge the gap. You know that just people not having access, not having ability to get immediate consultation. And neurology is an area where that can be done with telemedicine. Different from you know somebody has a broken leg. You're going to have to get down there and fix that with your hands you know, to reset things to-

what's the word fixation, you know, put it back in place, a reduction, like an open reduction, you know. But with a brain injury you can start to address things early on, you know, without having to be seen in person. I'm sure at some point in in-person appointment is going to be necessary, but.

0:16:06 - Shane Smith I was going to say but a doctor could easily diagnose you and say well, while we're talking, I've noticed you're having some speech issues, let's get you into some speech therapy, right? They could, you know, while they're talking to them, say they noticed dizziness. Or they could say, step back from the camera and walk back to the wall, touch it and come back to see dizziness and things like that, and then they can diagnose or refer you out to get therapy for those areas, even though they haven't physically seen you in person, but they have seen you on screen and they can get you a lot of the necessary care. Or even my assumption is, if it was really badly at that, that neurologist could call a local hospital and say, hey, you need to see this person right away.

They need to tell you to go to the ER right.

0:16:46 - Thomas Ozbolt Yeah, get a referral to the ER and, you know, maybe canceling out whatever I said about needing to be seen by neurologists at any point, but yeah, just getting, uh, getting to an ER or getting a referral that's immediate, saying hey look, this person needs immediate care. We've seen that happen. We've seen that happen through telemedicine.

0:16:59 - Shane Smith Okay.

0:17:01 - Thomas Ozbolt Someone be referred to go to the ER. Seek immediate attention for issues that they were in.

0:17:04 - Shane Smith And then the ER. I don't want to say saves their life, but all right, I will say saves their life. Yeah, that's your outcome. I've seen it on at least two cases where, but for going to the emergency room, things could have taken a very serious dark turn.

0:17:16 - Thomas Ozbolt Yeah, absolutely Absolutely. Uh, you know, we can have, yeah, all sorts of negative outcomes be averted and getting a specialist who's trained in this particular area, who's gone to school for this particular area, fellowships in this area, you know, versus an urgent care physician who you know. All credit to them for what they do. But you know, having one of those physicians diagnosed something versus someone who's trained to see it.

0:17:41 - Shane Smith Increasing quality of life is a measure of patient outcomes and everything else. So anything else on telemedicine uh for for brain injuries and concussions uh you can think of right now Thomas?

0:17:52 - Thomas Ozbolt I think it's just an excellent option for people who don't have health insurance, uh, who don't have access to a neurologist in their county, and uh it's- it's going to be changing patient outcomes all across this country for foreseeable future.

0:18:06 - Shane Smith I was going to say, because, you know, you quoted that statistic and I'll bring it up again. Basically, 86% of counties don't have one neurologist and my guess is, if you took out the metro areas, it's probably closer to like 95%, I mean. So the statistic is actually, I feel like, a little bit wrong, because if you look at the metro areas, they're likely to have one. Anywhere outside of that is even worse.

0:18:25 - Thomas Ozbolt Yeah, probably a wasteland.

0:18:27 - Shane Smith It sounds like telemedicine or for driving two or three hours is probably the only option for a lot of our clients.

0:18:32 - Thomas Ozbolt Yeah, and it's not ideal in terms of not having an neurologist nearby. But what telemedicine does is it gives people options and it lets them choose, and all of those. We always want options and we always want to be able to choose. All right, and that's great.

0:18:45 - Shane Smith Well, Thomas, thanks for being on Mind Matters. And uh, once again, thomas is one of the concussion and brain injury attorneys here at Shane Smith Law. For those listening, hit like and subscribe so you can get more updates on more podcast episodes from Mind Matters. Thanks a lot.

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0:00:10 - Hey, I'm Shane from Shane Smith Law. I'm here today with Thomas, one of our attorneys on the brain and concussion injury group here at Shane Smith Law, and we were just sort of talking about brain injuries and what happens, but also looking for a way to explain what happens to the rest of the body, and what I mean by that is, you know, everybody's familiar with the initial injury. That's the impact when either your head hits some other object or when your skull, basically when your brain hits the skull because of some kind of spinning force or some kind of just I guess force overall causes it to go back and forth, right?

0:00:43 - Yeah.

0:00:44 - I think I was going to say and so that's the initial injury. But then how do we explain what happens to the rest of the body, what happens there? Because obviously, something in your hands you know it didn't take an injury, or something with your hormones, it didn't take the injury. The injury was to the brain. So what did the experts tell us? How do they explain it?

0:01:01 - Yeah, I think they use stories to explain it. That's one of the things that I think that we can do really well. Also is how can we explain this and make it so anybody can understand what's happened to them or what's happened to one of our clients?

0:01:11 - Because that's part of our job, right, we've got to take the injuries our clients have and explain it to an adjuster or explain it to a jury and also explain it to their family. Right, and situations where we're not being the doctor but we're taking the medical stuff and explaining it to the family because maybe the doctor is busy or maybe the clients didn't think about it when they were there. And then after the fact they're like, well, what does this mean?

0:01:34 - Yeah, and it's complicated, and so I think some of the stories that we can use or one of the examples we can use is you know, your brain's not a computer, it's not just zeros and ones and input and output. But one of the examples that people like to use is to compare your brain to either a city or a castle.

0:01:52 - So definitely, a city is obviously amazingly complex and when I think of a city, I think of this area, and then made up of millions of different people inside of the city all doing different things, and one person can do this and mess this up, and it's incredibly complex, yeah.

0:02:06 - Yeah, an example you could use and one I use, and explain it to my clients. A lot is imagine there's a tornado that drops down in the heart of Charlotte. You're going to have the initial damage from what that tornado does and then you're going to be finding trash cans three blocks away. You know your dog's up in the tree, your cat's over. There's going to be things that it takes you some time to figure out what happened.

0:02:27 - And I mean even, like you know, the tornado damages this area, but then also you have infrastructure failures and things that happen in other parts of the city based on what happens here, or even just transportation, right, because if one highway's torn all up, everybody's got a detour, which creates other problems.

0:02:42 - Exactly If that windstorm or that tornado came down and severed the power lines. Right, okay, if you have blackouts in some areas, power surges in some of the other areas, this would represent the disruption of the electrical impulses that happen in your brain. So you have tornado come down, blow things around, rip power lines.

0:03:00 - Not just in this area, but it impacts blackouts maybe miles away, right?

0:03:04 - Yeah, so maybe you're getting sensations in parts of your body. Here you're having certain different emotional imbalances. There's lots of different things that could go wrong from the electrical.

0:03:10 - And it sounds, you know you're talking about it electrical and emotional, and everything else, sometimes unexpected stuff too right, yeah, yeah, power goes out. I don't think about the fact that I'm gonna date myself here, but my VCR used to have to be reprogrammed, or my DVD. You know, you got to go fix all the clocks in your house, right? I mean, you don't expect that. Once the AC comes up, you're like, okay, it's all better, but it's not really.

0:03:34 - Right, yeah, and another example would be you know, in that city, let's say, a water pipe gets damaged all of a sudden you've got flooding all throughout the city or in other areas you know there's not any water going there. These could be, you know, cerebral edema. You know bruising or swelling or inflammation. You know these things kind of come in and you know create impacts in the city, that you know that excess of fluids in your brain might create intracranial pressure that leads to pain. You know, later on down the line, not necessarily within the first couple days of the collision, but could be within, but could also be a little bit later down the line.

0:04:08 - Really so it could. You could think it's all getting better, but then that inflammation damaged something else and as soon as it starts we think getting better than we figure out there's a problem here which creates other issues.

0:04:21 - Right. Things just continue to multiply and build on each other. Another example would be you know, gas lines are rupturing. You've got fires spreading from block to block. That could be, you know, lined up in terms of the inflammatory response in your brain and where the immune system comes in to repair. What's what's going wrong here? It might inadvertently harm healthy cells. You know, fire does not discriminate, neither does the inflammatory response at times.

0:04:45 - So it sounds like the experts are telling us that they use a bunch of different analogies inside the city from the one tornado windstorm. Right they power out electricity out, water out, all these things, which is, I mean, if you sort of think about it, like the brain is incredibly complex and initial injury can create a whole bunch of different types of injuries throughout. Right that cascade effect.

0:05:05 - The ripple effect all throughout. You know even the. You think about the city's communication network. You know tornado comes and you have the loud sirens. You can hear different announcements about things that are going on. That could be mirroring what happens in your brain. With a diffuse axonal injury, that's where you're having the connections between the neurons in your brain, which are the communication lines. Those are getting severed and that disrupts the flow of information throughout the city or throughout the body. Wow, that could lead to cognitive behavioral impairments, anything that's imaginable.

0:05:39 - And as we're talking about this, it sounds like it's mostly physical stuff, but same analogies work for the emotional and mental stuff as well.

0:05:46 - Yeah, absolutely. In terms of the emotional aspect. You know these can. All you know different parts of the brain correspond with different actions, with different emotional regulatory response to your ability to control emotions. If you're irritable, you know, if you're having mood swings, personality changes even.

0:06:02 - Can you so? Can you look at where the initial injury is and know like, hey, these are all the symptoms they're gonna pop out for you, or is it like you just can't? You know there's an injury and we know that's gonna be there, but we don't know everything it's gonna impact.

0:06:15 - Yeah, I think there are definitely some patterns that can recur in terms of motor vehicle accidents and where you'll see certain areas of the brain be impacted more than others. A lot depends on the mechanism of the injury, though, you know. Are you having just a sudden acceleration, deceleration, Are you having a spin where the brain's starting to almost kind of twist inside your head while your body moves? Those different things can impact and kind of line up and be something that the experts can look at the diagnostics to say, okay, we know this is how the accident happened and we see this area damaged on the brain and we know that gets damaged in these specific types of motion.

0:06:54 - Got you so they can sort of narrow it down, but obviously it's not a perfect science, yeah not a perfect, because every every brain is different in some sense. You know, we're all different people, yeah now, when you say an acceleration, deceleration, that is primarily what like a rear end collision, you get hit from behind. So the brain accelerates, then it decelerates, or the head does.

0:07:13 - Yeah, and it could be one or the other too. It could just be like a rapid acceleration and then a stop. You know you don't have to have acceleration and then deceleration, but I guess they do kind of go together. Yeah, so you could have, you know, just a sudden, but it's just a one impact, as opposed to a forward and backward kind of thing.

0:07:27 - Right, right, and is the spin normally? You know, when you talk about that shearing or the spinning of the brain, is that usually like if you're I was hit from the side like a t-bone, or is it if I was looking one direction or the other? Is that when that normally comes up the most?

0:07:40 - I think you would probably see it the most is if it was a t-bone that happened either at the front of the car or the back of the car and then that sends it off into a spin, almost like when you're stuck in the teacups with your kid at Disney World and you don't want to be there. Yeah almost like that kind of spin. At least I don't want to be there.

0:07:54 - Gotcha, I can understand that. So that sort of puts on how it happens, yeah, or how those injuries occur the most. And you said the experts. Then so when the experts happen they can look at how the accident occurred and sort of I don't wanna say guistimate, but I mean narrow down where they think the injuries are gonna take place. Then they look at the imaging that shows yes, these are the areas that are affected. Then that sort of leads to what treatment they would expect.

0:08:22 - Yeah, I think what's gonna happen at first is you get kind of an initial, a specialist, somebody who's trained in looking at brains. You want them to be looking at it. You know you don't want your primary care doctor necessarily, or an orthopedic doctor, you want somebody who's been trained on looking at brains. And then they are gonna get your symptoms and move from there to saying we should probably do some more advanced diagnostics on this to figure out what's going on. And then you know there are experts who can do a full fluid map of the inside of your brain essentially Diffusion tensor imaging is what's called where they're charting the water flow through your brain. Yeah so our brains, you know, like the oceans, like 95% of water or whatever it is, our brains are largely water. So this advanced diagnostic DTI diffusion tensor imaging came out FDA available three to five years ago and since then they've been able to especially calibrate MRI machines to look at the flow of water through your brain through about 29 to 30 different angles, to chart how it flows through your brain and actually reproduce color imaging of that flow of water through your brain in terms of you know how much is there, how little is there, and basically map it. It almost looks like if you have a bunch of grapes and you've taken all the grapes off and you see like all the branches go out in different directions and hey, there's none here, like this area of the brain is completely absent of water flow. So clearly that's bad, that would be bad, and experts would be able to look at that presumably and say, well, this area of the brain that's missing or there's not as much water flow here. This was, you know, let's say, on the side of their head, and this is the same side of their head that they had the collision that took place. And so it's likely, you know, based on all the symptoms and everything that we've seen, that you know this was caused by this.

0:10:12 - Well, I mean that sounds cool and I know in one of our future podcasts or episodes we're gonna talk about the DTI and go through to sort of see some of those images and how that takes place. I mean, to be honest, it sounds crazy to me. You know, it sounds like something right out of a science fiction magazine. You know, when we start talking about 3D stuff, I mean that's what you see in all the movies the scanner comes in and it's all there and you can figure out what's going on. But that's becoming real.

0:10:41 - Yeah, that's where we are now. It's amazing.

0:10:43 - Wow, I know when we were talking before the show where we were talking a little bit about also sometimes the experts, instead of using a city, they talk about a castle analogy. Tell me about that? What's that mean?

0:10:54 - Yeah, I've heard it talked about as a cerebrum castle.

0:10:58 - Cerebrum castle okay.

0:10:59 - If you think your brain is a castle and let's imagine you know there's a giant boulder that comes rolling along and that boulder, you know it comes and it crashes into the side of the castle, okay, and that would be your primary injury, your first impact, and now presumably there's gonna be things that happen structurally to that castle as a result of a massive boulder hitting it.

0:11:20 - And I got you kind of like I'm thinking about the little object years ago where you would pull the ball out and it would hit here and it would go over it. You know all this force is out somewhere over here. So if we hit the wall of the castle it's not just here, it's gonna impact structurally the rest of the castle as well.

0:11:35 - Exactly, you would have that boulder coming and crashing in and that impacts the structural integrity of the castle. This is something you could compare to that you know diffuse axonal injury, again, where the brain's communication lines are being disrupted by this massive impact and affecting everything transmitting the messages around the brain from different regions of the brain.

0:11:56 - I know we're gonna have to get you on and talk just about the brain and what really all that. You know, I don't know. Sometimes the brain people think about it just like in cartoons. You know, it's just this pink thing up there and who knows what goes on. So we're gonna get a little more into specifics there. But so much of the brain is all communication, right, I mean that's. So one little injury to that messes up the whole body.

0:12:18 - That's like you almost think of those cartoons where you had, you know, the eyeballs that somebody was looking through while they were moving the gears on the inside of the brain, making the rest of it work. You know, if the brain shuts down, you know, as you see when people who are seriously injured or in a coma, if the brain's not working, the rest of the body's not gonna work either.

0:12:34 - And it doesn't have to be something I didn't and a lot of our clients. You know they go to the emergency room and they're not. You know they're not getting the CT scans, they're not in a coma. Basically you know they're not suffering the huge open bleeding skull or swollen skull. How bad does that have to be to suffer some of this permanent injury.

0:12:52 - Yeah, when you think about a CT scan and that's there to detect if there's internal bleeding or a brain bleed, something that's gonna cause you to die or become comatose or have a massive, catastrophic impact.

0:13:06 - So the ER is not looking for personality changes or these communication errors. They're looking to make sure you don't die on the table, basically before you can get home and get better care.

0:13:13 - Exactly. And then that's where, at the end of those ER records, you hear them say with their discharge papers seek follow-up care with a specialist. Take a look at somebody else who knows this area.

0:13:25 - Can just a concussion lead to some of this stuff?

0:13:28 - Yeah, absolutely. A concussion can absolutely lead to some pretty significant impacts over the course of somebody's life.

0:13:34 - So it sounds like we shouldn't just call it just a concussion, basically like it's common, because I think about boxers and stuff like that and our football players. I mean well, there's been huge studies in football in the last several years about concussions and the impact of concussions and that might be something to dig into later on.

0:13:51 - Yeah, I mean a concussion. I tell our clients you may have had a concussion, but a concussion is a traumatic brain injury. It's a traumatic. It may be a mild traumatic brain injury, but it's a traumatic brain injury nonetheless. We can't let that label, you know, get us away from the fact that there's been trauma to the brain I was gonna say mild makes me think it's not bad, but Right mild can have some of the worst impacts that you might have. It might have a more moderate or kind of severe brain injury that causes a lot in terms of the direct injury but in terms of what happens later on down the road, it might be something that might seem lesser to you and I that causes some of the worst impacts.

0:14:22 - Just depending on exactly where it injured and what part. Because I know with John the other day we talked about, we pulled up a picture of the brain and we were looking at it and you know, some of those areas that control certain important functions are pretty small. Yeah, so if you just took an injury right to that area, that could have devastating consequences, even though it was sort of mild. I mean, it wasn't that bad of a hit, but it just happened to hit the wrong spot, right, right, exactly. Or I can think about the times when you know I suffered a minor injury. But even think about the amount of pain you suffer if you hit your funny bone.

0:14:56 - Right, yeah, you know right on.

0:14:58 - That nerve cluster is what it is. But if you hit that nerve cluster in the brain, yeah, prick in your famed gear for a blood draw. Yeah, that's for weeks after Well, John, all right, Thomas. I think those are great analogies and great ways. I like the castle one. I mean it makes more sense. I know when you first told me I was like, really, but you know the fact that, yeah, it's gonna impact all the structure of your brain. You know structurally that the rest of that castle makes sense to me, and then the city, and obviously the brain is hugely complex and we find new things out every single day. I think, yeah, absolutely, all right, you're welcome, great. Well, that is our episode for today. Remember, I'm Shane from Shane Smith Law, and we're here with Thomas from the concussion and brain injury group, here at Shane Smith Law talking about concussion injuries. And if you're in pain, call Shane 9-8-0, 9-9-9, 9-9-9,. If you're suffered a concussion or something like that, feel free to find more information on our channel. that, hopefully can help you out.

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0:00:03 - Hi, I'm Shane from Shane Smith Law. We're here today with John, one of our attorneys in the Traumatic Brain Injury Group here at Shane Smith Law, and this is sort of part two of some of the areas of the brain that get impacted in a collision and other factors of a traumatic brain injury. So, john, where? Were we before we took a break.

0:00:21 - So we had just landed on a very, very important part of the brain called the frontal lobe. This part of the brain, Shane, is kind of what they call the governing part of the brain. It controls important things like decision making, motivation, problem solving, planning, attention, and the underlying factor of all those things is that that's what kind of makes someone a contributing member of society. Those are all important characteristics of the brain controls that makes you a successful employee, happy in a relationship, a good spouse, partner, father, mother. And when that's not functioning at full speed, everyone notices, the person notices, employers notice and it can have a real detrimental impact on the person who's injured.

0:01:10 - And when you say not functioning, is this like an all or none, or is it their spectrum on it and talk a little bit about that.

0:01:18 - Absolutely. So yeah, certainly, depending on the severity of the accident and just really the person who's injured. I mean these things, like I mentioned earlier, there's a lot of unknowns and things we're just totally not 100% on in the medical community regarding brain injuries, so it can range from a slight reduction to those abilities to them being completely wiped out. You know, there's cases where the part of the brain that controls memory where people will remember nothing of their short-term memory, and those are obviously the more severe accidents, or incidents, right.

0:01:53 - That makes me think of that, There was a movie about that one year where the person had no short term memory. After one day everything started over, kind of deal. They couldn't put anything into a longer-term memory. It was 50 First Dates, I think, with Adam Sandler in it and obviously that's a comedy movie. But there is memory issues that come into play and where people can't remember short term. They forget where their car keys are, they forget what they're in the car to go. They can't handle basic tasks at work. They can't remember anything at all. Or even some people who remember people they met years ago, but they can't remember anybody they met recently.

0:02:28 - Right, that's correct. And you know just one of the classic examples that you hear about this, because you know, when we're trying to explain this to jury members, to say, hey, this is why we're asking for an extraordinary sum of money. Because when you start thinking about the day to day, well, you know how much money would you put on it if your spouse couldn't be trusted to turn the gas burner off and they're leaving the home? Or would you be able to trust someone who you know couldn't remember if they left the child in the back seat when they're going grocery shopping? These things are scary and terrifying. And then you realize that like you know, if you're a spouse with someone with a brain injury, it almost becomes like you're the parent to two people. At that point it's not. You lose that support system, that structure, and you're now taking care of two people, you know versus one.

0:03:16 - So you lose your partner and you pick up a child.

0:03:18 - That's right and it becomes in and unfortunately becomes a huge burden. We see that in this statistic show that it has a huge detrimental effect on people with brain injury and the success of their marriage. You know they have higher divorce rates, things like that.

0:03:32 - And I would imagine, let's say, they do get divorced from that loving partner they had one time. Imagine it's hard to go find another spouse because you come with all these issues right.

0:03:42 - Absolutely, you know, and that's a hard undertaking for any new person who's had the picture to undertake, because it's a lot to the point where some people have to get, you know, assistance for their life, medical assistance to be able to do daily functions and daily tasks.

0:03:57 - When somebody living alone, who can't remember anything, like you, say leave the gas on, leave the burner on. I mean that is an easy way to get hurt or burn down your house or perish, and that's through no fault, you know. I want to say no fault to their own because they didn't mean for that to happen. But still happens and still doesn't fix the tragedy.

0:04:17 - Correct and you just don't know. And especially when you see issues with impulse control with the frontal lobe, like someone who previously had good judgment. Well, how do you put a price on not having good judgment for the rest of your life? Right, it's a non-tangible thing but it really adds up. And that's what we ask jurors to write to the occasion to be like look like. This person's life is different forever at this point.

0:04:39 - And yeah, and we've seen it like impulse control or emotion control, or they don't have a filter anymore, so they just say whatever comes to mind, which you know sometimes you get crazy thoughts about people that are totally you know you wouldn't say them to their face, but these people do say that. You know they, you know. The joke is somebody says how do my shoes look? And they're like they look terrible, you should never wear them again. You know. They say something like that and obviously that destroys societal interaction and I guess it's overall. It just compounds. Like you say, it's a bigger and bigger thing.

0:05:14 - That's right the shoe example you gave that. That filter, that soft filter that most people have there, unfortunately gets removed when people experience injury to the frontal lobe area.

0:05:24 - And we've talked about injury to the back of the head and we've talked injury to the front of the head, because those are the most common in a whiplash case when somebody gets rear ended. But what are the other big areas that most likely hurt?

0:05:35 - Sure, absolutely, and it varies depending on the type of injury. Sometimes we see T bone where there's side swipe style accidents, where someone hits the side of their head on a on the glass versus, like the airbag or the classic back of the seat. Then you start looking at other portions of the brain that can get injured, like the portion that controls actually hearing. We have had also and also vision as well. We've had clients that have had their prescription glasses change overnight due to an injury, so it can immediately change your vision overnight after the accident occurs. Also the portion of the brain back here. That is not as often but I do see sometimes with my brain injured clients that enter that portion of the brain. They lose the ability to find words in a sentence and put sentences together as well as recalling certain words. So that means imagine if overnight your vocabulary got cut in half. Wow, not great, not great at all. And it's really frustrating for a lot of people who are previously. I see it a lot with some of my high performing clients that are in, you know, very important jobs or roles or managerial roles where when you can't find the right words, it is just so frustrating for someone Because you knew how you used to be before the accident and now that's gone in the blink of an eye. A whole life of education and reading and learning. And now you just can't access that part of the brain that has all those important words you're trying to call.

0:07:08 - And it's got to be terribly frustrating for the individual who remembers how they used to be and now they're not that person anymore. I can't imagine how difficult that must be on that individual. And you know we talked one time about the imaging tests they can run. How have you found, do clients like to do that test? Do they not like to do it? Does it provide some results for them that make everything real? I mean, let's talk about that.

0:07:36 - Absolutely so. There's quite a few tests that are out there that help us diagnose these injuries and also the severity of these injuries. A lot of times when you go to the ER, they'll initially do a CT scan, which is kind of like the weaker scan but gives a good first impression of what the injury is. It's mainly there to document the big injuries to the brain.

0:07:57 - And make sure you're not dying. Right, exactly, you're not going to die in the next day or two.

0:08:02 - And it's a good thing, but it also sometimes we see a lot of our clients leave the ER thinking they dodged a bullet, so to speak, because the ER is basically just there too with some of their imaging to make sure you're not dying, right, but it doesn't get into the nuances of a more microscopic brain injury. That gives our clients these mild TBIs and all these weird symptoms.

0:08:24 - So you could leave the ER that could say the CT scan is fine, go out thinking, okay, I don't have a head injury, and start picking up all these symptoms and then think you're going crazy.

0:08:34 - That is the scary walk away, unfortunately. So it's our job to then if they weren't redirected to a neurologist which they rarely are from the ER then we need to stress the importance to our client of, hey, you need to see a neurologist to get the proper testing done. And that proper testing usually takes the form of a DTI, diffusion tensor imaging or neuropsych evaluation and some clinical correlation where a real professional who is looking for these more kind of nuanced injuries that are harder to pick up on in the ER room can really sit down with the client see what's going on. Sometimes they'll interview family friends, because these are the real front line eyewitnesses to the victim's brain injury. Yeah, you know who knows you better than a spouse or a son, or you know a teacher who sees you every day and then sees you before and after the accident.

0:09:29 - And they're like yeah, something's definitely changed. It's off.

0:09:29 - Right.

0:09:30 - And I've seen clients before where, once they get a test result like the DTI or something else, they're like, wow, okay, now I feel like I was worried, I was going crazy, I was worried, I was making it all up, I was worried all this. And then you can see the scan and they're like, yeah, you suffered an injury right there. And then they talk about what it impacts, like it makes perfect sense.

0:09:49 - Yeah, and that is just the benefit of the, the time and the age that we live in and our medical advancements is, you know, 15, 20 years ago Someone would have felt just that they were crazy and that would have really been the end of it, really. Um, you know there's very limited imaging but that with this new imaging, you know it's as clear as day where you can see, where you know one part of the brain doesn't match the injured side and the neuro Radiologist and the brain doctors can literally point to the part of the brain that doesn't match the other part and they can see when it's been damaged and then they can sync it up with whatever that part of the brain was responsible for Speech or vision. And you know, if those match the client symptoms, then it's it, it corroborates itself and it matches itself and that really gives our clients a ton of answers and in a ton of relief, at least knowing that they're not going crazy and that these Symptoms and injuries are very real.

0:10:50 - Well that's awesome or awesome information. That's what I'll say now. Obviously, uh scary that we even have to talk about it, but, like you say, thank goodness we have the technology here now to do that and I can only imagine it's going to continue to get better and better as more Attention is put on these head injury cases.

0:11:05 - Absolutely, and you mentioned scary there's, you know there's some other scary long-term consequences and you know part of this, you know Discussion we're having today is, you know why do these cases with firms? Why are these, sometimes these settlements in the tens of millions of dollars? Is it, is it that these people are Greedy and they need a lot of money? Is it plaintiffs large? It's not. It's it's really that the injuries warrant these types of settlements. One of the long-term Consequences is almost a four-fold increase in dementia, oh, wow. And sometimes it can cause an early onset, two to three years than it normally would. So when you say, hey, what price do I put on a four times risk for, you know, dementia and in losing my mental faculties, you can see why Jurors, when confronted, that place big value on on these types of claims.

0:11:56 - Well, I think I mean, when I look at Changing your spouse's personality and that's gotta be totally. I mean my wife. If she said Suddenly I'm a different person, she'd say you took my whole life away from me, you know. Or if my wife became a totally different person because of a head injury, I would say you destroyed my life. Because I love my wife, I married her. I didn't marry somebody else, you know. So to me I understand why jurors get big numbers on these kind of cases. Because it totally takes one life away and gives you a different one.

0:12:27 - Right absolutely, and some of the other things just in terms that we see for long-term consequences. I mean it can range from seizures to infection, nerve damage, the whole host of things. They even think now that there's, you know, real hormonal changes too that people experience during a brain injury, and these things are. We're just at the tip of the iceberg in terms of medical research. Every year it seems like we're learning something newer about the consequences and newer about the science Just a lot of things.

0:13:04 - So it's not just things like a seizure, there's a whole list of symptoms and things like that, which is one of the reasons I guess why we've got our brain injury group is so that clients can talk to you guys and you get better at identifying and making sure they're getting the treatment. When they say something offhand and you're like, oh, that's serious, alright, what else would you tell our listeners?

0:13:27 - Just, you know, this is one of those things where it's difficult when it happens to you, because it can seem confusing at first. It's difficult to understand as an outsider because it's an invisible injury. For the most part it's very much visible when we do the correct diagnostic test and imaging and clinical correlation. But that's why we have to get to that point, because before we get to that point we just don't know, because we like to see things on the outside and what the injuries are. You know, if you break your arm, that's very easy to see what's wrong. It's very hard when it's your brain and it's an invisible injury. Luckily, with modern advancements we can see very clearly now that it's a very real injury that's not invisible and it has real, lasting, serious consequences and outcomes for our clients. So really sometimes too, when we handle these cases, we like to get a certified life care planner on board Because the future damages are so immense and the cost are so hard to put a number on. These certified life care planners will actually take that task under their belt and essentially itemize reasonable future medical expenses, cost of potential medical assistance if they need it as well as we, for our clients sometimes get economists involved in what's called vocational rehabilitation experts, where we look at what sort of job they were doing that they can no longer do and say well, what can this person do? What do they do for the rest of their life. After this, moderate to severe brain injury.

0:15:06 - One. I think about the thing with no filter. I mean that alone could make it very difficult to employ you in anything where you have to do with other people. I mean, I can only imagine even taking orders in a fast food restaurant.

0:15:17 - Absolutely. Customer service and sales is probably right off the table if you snap at every person that comes by due to your brain injury.

0:15:26 - A life care planner. What does that mean? If you had to reword that to somebody, what would that? How would you simplify what that person does?

0:15:35 - is a person who literally specializes in putting a value on some of the injuries and future injuries that you're going to be needing to be compensated for.

0:15:46 - And so that person. But they've got the training that they know what your injury is, they know what's likely to happen in the future, versus if I just talk to you with a brain injury, you may not know or I wouldn't have known. Dementia is a huge issue, you know, but that's what they're trained to do is to say, yeah, but this is, this increases the chance that this is higher. This is higher, or yes, almost certain, this is going to happen in 10 years.

0:16:08 - Yeah, absolutely, and that's the real key walk away for people not familiar with the legal system is that a legal case can't really go on for 50 years, the rest of person's life. That's not how it works. We usually have a finite time where we've got to take care of the case, and so well, how do we, how do we account for all those future expenses that you know the victim is going to have to deal with for the rest of her life? We do it through life care planner a lot of the times, who, through data and studies and you know prior outcomes of other people with similar injuries can then predict out to a certain degree of medical certainty what the injuries and medical expenses are going to be, within reason.

0:16:49 - And is that same person, taking into consideration that things cost differently. You know, go back 10 years ago things were one price. Now they're different prices, that the person handles all that or said somebody else.

0:17:01 - Absolutely so you know the cost. The rising costs of medical expenses, which we're all very familiar with, does get factored in typically with these, in that you know what an injection or some form of therapy today is definitely not going to be what it costs. You know, 20 years from now, gotcha.

0:17:19 - All right, I mean a lot of great information. Anything else about the long-term effects of injuries and things like that you would want to talk about today, John?

0:17:29 - I think we've covered just about everything. Shane, I certainly appreciate your time today.

0:17:33 - No thanks. And for all our listeners, hit, like and subscribe to catch next week's episode as well. We're going to continue talking about traumatic brain injuries and the impact on our clients but also other individuals as well. So it's not just legal stuff here on the TBI podcast. Thanks a lot. I'm Shane from Shane Smith Law.

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0:00:03 - Hey, I'm Shane from Shane Smith Law. I'm here today with John. He's one of our TBI attorneys from the TBI Law Group here at Shane Smith Law, and we're going to talk about just generally traumatic brain injuries. That's what we mean when we use the term TBI as traumatic brain injury. So we're going to talk about sort of the long-term effects one of these cases can have. And, john, when I hear TBI or traumatic brain injury, that sounds like something scary and horrendous and almost devastating. Is every one of them like totally severe or does some start smaller? What's sort of the range?

0:00:33 - Yeah, absolutely, Shane. So, with traumatic brain injuries, they encompass a wide range of injuries that can occur to the brain, ranging from a more minor concussion, what they deem a mild TBI, all the way to a moderate and severe TBI, and death even.

0:00:50 - Wow, okay, so mild TBI can mean something similar to a concussion?

0:00:55 – Correct

0:00:56 – So, these football players, they get two or three concussions, or boxers get a concussion, or somebody in a car accident gets a concussion. All of that is some type of TBI then.

0:01:08 - That is correct and typically in motor vehicle accidents and slip and falls things we see, the type of head injury that occurs is called a closed head injury, because there's other types of traumatic brain injuries can occur, like a rod through the head or an impalement or a broken skull, but a lot of the injuries we see are closed head injuries, where the brain is actually injured inside the skull.

0:01:33 - Now as a closed head injury. If I split my head open but the skull is the same as that, that's a closed head injury. That's correct. So if your child were to, you know have kids trip sometimes and they bust their scalp open, but they could have a closed head injury as well. That's one of the things they could be checked out for.

0:01:49 - That's right. That is something that the emergency room typically or the first responder will screen for.

0:01:53 - Are first responders, are they the best ones to identify head injuries?

0:01:57 - You know, typically there are more emergency personnel. The actual determination is going to be made, probably by a medical doctor who has the appropriate diagnostic tools, and that's usually where we see the first diagnosis.

0:02:10 - How do they screen these out, kind of then.

0:02:13 - Typically, a concussion or head injury comes with a lot of symptoms and we'll get into that here in a little bit where, depending on the area of the brain that you injure, you'll see certain symptoms and the doctors will screen for this same with things like emergency paramedics and personnel. They'll use something called the Glasgow Coma Scale, where they'll look for certain indicators showing the severity of the injury, like responsiveness, loss of consciousness. Is the injured person not making sense when they speak? These are all big indicators of a potential head injury and they usually will be followed up and triaged accordingly with certain protocol, like doing things like CT scans, MRIs, interviews with the victim at the ER.

0:02:58 - Does somebody have to lose consciousness to have a head injury?

0:03:00 - Believe it or not, shane, they don't, and that's the surprising thing but a lot of people are surprised when they find that out is that there's other ways of determining if the head injury has occurred. Sometimes it's disorientation, dizziness, other things can present. You don't actually have to black out.

0:03:16 - What are some of the other common symptoms that, like a triage person might be looking for?

0:03:20 - Sometimes people will show with ringing in the ears is a very common one Balance issues, so what has been called vertigo, when you feel like you're gonna lose your balance and you may lose your footing. That's a very common one. Loss of memory or short-term memory, being disoriented. Sometimes people will describe the sensation as I felt like I knew I was there and what was going on, but I didn't know where I was going, where I needed to go, and sometimes I'll drive to work after an accident and coworkers will then have to intervene and be like look you need to go to the hospital because you're acting differently.

0:03:53 - Okay, wow. And we say sometimes in car wrecks, when people are like I just don't remember anything at all about the accident, right, even though they technically don't lose consciousness, they lose that moment of time or whatever.

0:04:04 - That's right and that's when we start to look at the different classifications of the traumatic brain injury. When you just don't remember things for 30 minutes to sometimes up to a day, that usually falls more in line with a more moderate to severe TBI.

0:04:19 - Okay, so that's no longer the mild one. It's moved on to more serious, and I would guess the more serious the TBI, the more you expect it to have a significant impact on the person's life.

0:04:32 - That is correct. And you know, those initial kind of symptoms can be a good or bad indicator of what's to come for the victim and the person who sustained the injury.

0:04:40 - Now a lot of people think concussion. They think they just it just goes away and they're totally better. Is that always the case? Is that not always the case? Or is that not even relevant as far as whether somebody has a TBI?

0:04:51 - So we actually have some studies and information on this. Basically, some of the studies show that the outlooks look where, basically a good recovery. Well, actually, the study pulled and tested a few hundred people and those studies show that, you know, a good outlook and recovery was about 31%. Some people experienced moderate disability. That kind of accounted for about 14% of the injuries. Severe disability actually was about 24% Well, okay, and then a vegetative state was a very small percentage and death was 29%. So when we talk about the long-term outlooks of a severe or moderate to severe TBI, it's very serious, very serious consequences In the outcomes a lot of times are not good for people and we see that and that's why and some of the statistics show that you know, there's numbers. While the reporting can vary, it's expected that about 40% of cases have some degree of head injury or involvement. So the number is much higher than you would expect.

0:05:55 - So 40% of accidents, be it slip and fall, be it car accidents, be it just other accidents, 40% of them there's some kind of component with the head.

0:06:03 - That's right. The numbers that we have in the data sometimes point to about 800,000 plus yearly. However, we think that that number is probably vastly under reported. We think that it may be even a greater, bigger problem than we know. Because you think about, sometimes people just don't go to the hospital, so it's not documented, or they try and just tough it out. You know, you and I would probably have we all probably know a friend or family member that just won't go see the doctor. No matter what, and they're just not gonna go and unfortunately, with head injuries, it means that we're not getting the full, accurate picture. And 800,000 a year is already a lot, but it's probably a lot more.

0:06:41 - Yeah, when we say we, who's the we in that that context? That thinks there's a lot more than 800,000. Is that like you? Is that like lawyers? Is that like doctors? Is it school counselors? Who is it?

0:06:51 - This is going to be the smart medical pupil that compiles all this data yeah. And give us those nice, you know peer reviewed reports that we all rely on, because if we're just relying on our own experiences, we may not get the full picture. But when we have numbers to back up stuff, as lawyers we really focus on the hard data, the hard numbers, to know what we're dealing with.

0:07:14 - And you know, when you talk about that friend or family member, that just toughs it out, it always makes me think of the people who play sports. You know they take a hard hit or they get knocked down and next thing you know they're like put me back in, coach, let me get back in. A lot of times I don't even want to ever step out of the game at all. I know they've changed a lot of the rules along that in the last 10 years or so for fighters. You know I watch UFC, so there are rules for them, there are rules for all this. And is it because of these head injuries? That's the main thing, and people are not sort of acknowledging how bad they are. So now we're, I guess, acknowledging it and making changes.

0:07:44 - Absolutely, Shane, and big steps have really been taken in this area of medicine. I mean, we think about space and other things. The great frontier. Medical researchers actually describe the brain as one of the big frontiers, because we know a lot but we know so little and, as we see it in the news, it does a great job to move the dial forward. So think of, like the NFL and the concussion stuff that we've seen get advanced, or recently, same with the MMA fighting and the more strict concussion protocols we have. Now, back in the day it just wasn't taken as seriously because we just didn't know. And now we have different ways to diagnose. We have tests that are, you know, 10 times more powerful than a CT scan, where we can see the brain injury on a microscopic level and we can track which area of the brain was injured and then pair that up with the symptoms. So it gives us real good, objective evidence of the injuries. And it's just by virtue of things like the NFL and it being in the public media. It benefits victims that are injured in car accidents, because a lot of those injuries like that you see football players sustain are similar to the types of forces that occur in a motor vehicle crash or a slip and fall. Very similar forces on the brain.

0:09:06 - You know, I just was thinking about everybody's nose, the boxer who in the early days of their career was articulate and well-spoken and then by the time they got older and they'd taken so many concussions, you know the damage is there, I guess.

0:09:20 - Absolutely. No better case than, you know, the late Great Muhammad Ali, who in the early portion of his career had, you know, the gift of gab and later on in life he suffered from serious cognitive decline and, to the point where he was hard to understand, slurring his speech. These are all common symptoms and unfortunate end results from repeated head trauma.

0:09:40 - Well and I know, John, you want to talk about a couple of things today as well. Let's go in and sort of your first, first topic you want to talk about.

0:09:47 - Sure. So the I mentioned here and I have a small diagram here of the brain and what we do as attorneys and medical doctors is we want to try and identify the area of the brain that was injured, and that's usually done through diagnostic tests, things like what's called a DTI, which is a diffusion tensor imaging, a form of an MRI that can show different areas of the brain. We can actually see, through 3D coding and imaging, the part of the brain that is injured. And so what we do, and what can be sometimes scary for people that are involved in these accidents, is depending on the area of the brain that is injured. It affects whatever part of the brain and motor function is controlled by that part. So if you were to hit the back of the head which we see very commonly when forces of whiplash cause someone to go forward and back and strike the back of their head against the seat all of a sudden that person who sustained that brain injury will have problems with vision, because that's what part of the brain controls, so it might be blurry vision. Sometimes you'll have to see a specialist called a neuro ophthalmologist, which is literally a brain eye doctor. Very specialized, but it's more than just going to your optometrist and getting a new pair of glasses. It's like you hurt the part of your brain that sees. So I've had clients in the past that have noticed when scanning something that it seemed like the eye wasn't tracking where they wanted to look and you can imagine that's a scary thing. When your eyes aren't listening to your brain, it can be disoriented. If you've ever had trouble with vision, it can be kind of nauseous or make you dizzy.

0:11:29 - Yeah, so that's all of that would be associated with just striking the back of your head. There you go Because of the vision part, that nausea and all that kicks up because the brain's into there.

0:11:39 - That's right And with the frontal lobe. This is a bit another big strike zone, because you think the front of the brain. That's where, if the airbags deployed, your face is taking the brunt of the blow. Unfortunately, the airbag didn't deploy. Well, you know you're going to be hitting the steering wheel or the windshield or whatever Exactly.

0:11:57 - Hey, this has been part one of traumatic brain injuries and their long-term consequences. Stay tuned for part two, where we go a little bit further in the detail and we talk about a little bit about the other areas of the brain that can also be injured in a collision or other accident as well, and like and subscribe for more future updates from the TBI podcast.

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