Welcome to HurstInjuryLaw.com, the personal blog of William W. Hurst, Attorney at Law in Indianapolis. This is where Bill will post his research notes, case studies, and legal news for public viewing. Feel free to browse the site and use any content you find for your own blogs so long as you properly cite our site. For information on Bill's legal practice, please visit his business website at BillHurst.com.

Archive for September, 2011


WHAT HAPPENS WHEN YOU ARE REAR-ENDED? 

 

  ”Trauma to the Vertebral Column in the Region of the Cord”

The injury to the spinal column resulting from a rear-end collision is generally known as an acceleration-deceleration injury.  The most common injury resulting from this type of collision is diagnosed as a “cervical strain”.  This is frequently called a “whiplash” injury.  This injury effects over “one” million people in the U.S. each year, and is the most common type of injury resulting from car accidents. 

Whiplash injury symptoms are often chronic problems that persist for years.  Headaches, neck pain, low back pain, and travel anxieties are but a few of these symptoms.  Between 25 and 40% of whiplash injury victims never fully recover.  Of these “one” million people in the U.S. who have sustained a whiplash injury, about 25% will suffer long-term chronic disorders.  This injury can be especially troublesome for women who do not have as much muscle mass in the neck as men.  Accelerated/decelerated injuries can range from mild muscle strains to even death or brain injury. 

The acceleration/deceleration injury caused by a rear-end collisions causes energy to be transferred to the neck and the spinal column.  These forces cause injuries sufficient to permanently disabled persons. Clearly studies have shown that the severity of the trauma is not often correlated with the seriousness of the clinical problem.  http://emedicine.medscape.com/article/306176-overview  Even at low speed impacts (around 8 mph) the accident victim’s head moves roughly 18 inches at a force as great as 7 Gs in less than a quarter of a second by comparison.  The Discovery space shuttle is only built to withstand a maximum of 3 Gs.  It is a common misconception that if there is no vehicle damage then there is little or no injury.  Manufacturers use rigid or stiff motor vehicle bodies at testers as well as to improve bumper systems, but they still produce an increased g force to occupants involved in car accidents. 

Recent studies at the Chalmers University of Technology in Sweden suggest that the rapid changes to the spinal column as a result of acceleration/deceleration injuries cause damage to the nerves.  http://neurosurgeon.com/conditions/whiplash.htm   Studies indicate that acceleration/deceleration forces in “rear-enders” may cause tiny focal lesions in the brain.  Focal lesions caused by this type of trauma can affect language as well as difficulties with attention spans, reception and reasoning.  These are symptoms similar to what is known as the “shaken baby syndrome”.  These injuries are often subtle and can only be diagnosed with detailed a neural-psychological testing from an experienced practitioner.  A focal brain injury can occur without an external direct impact to the head but from the “whipping” motion of the head, because of the uneven, rough surfaces of the inner skull.  Acceleration/deceleration head injuries are often seen in the areas of the frontal or templar lobes.  The deficits in this area which may result are in the areas of learning, memory, planning, organization, attention and emotional control of the victim. 

The anatomical difference of a child’s brain (compared to the adult) renders it more susceptible than the adult brain to certain types of injuries following a rear-end collision.  The child’s head is larger in proportion to his/her body and stability of the head is dependant upon the ligaments rather than a bony structure.  A child’s brain has a higher water content which makes the brain softer and more prone to an acceleration/deceleration injury.  Thus, making these young brains more susceptible to sheer-type injuries.  www.emedicine.medscape.com/article/907273-overview

A whiplash injury in its simplest form essentially occurs when the soft tissue in the spine is stretched and strained after the body is thrown in a sudden, forceful “jerk”.  The most frequent accompanying complaints are headaches and stiffness in the neck and the back of the head.  Clearly these symptoms will appear within the first couple of days after the accident and usually pass after a few days or weeks.

A doctor or hospital should be alerted if the person suffering whiplash experiences any memory loss or any unconsciousness after the accident.  This is especially true if the patient experiences severe pain in the back of the head or has pins and needles feelings in the shoulders or arms, or a sensation of heaviness in the arms. 

In the first twenty-four (24) hours after a minor whiplash injury an icepack applied to the back of the neck will often help relieve inflammation.  The patient should lie in bed with his or her head resting on an ice bag for twenty minutes at a time.  If normal over-the-counter pain killers don’t work you should consult your general physician.  There are a number of exercises that can be used to relieve pain and stiffness to the neck after the initial onset.  There are a number of sites where you can obtain specific information on these treatments, for example see www.netdoctor.co.uk/diseases/facts/whiplash.htm 

The “whiplash” injury cannot be seen on x-rays, CAT scans or MRIs.  Most doctors recommend that despite the pain in the cervical region, patients should start neck exercises as soon as possible and get out of bed within two or three days.  Few people will develop continuing symptoms after a few weeks; but some may demonstrate reduced motion of the neck, tingling in the arms, back pain, fatigue and sleep disruption.  This type of “syndrome” which continues after a few weeks is often difficult to treat.  Fortunately, only in a small number of people with severe whiplash injuries do symptoms persist for months or years before receding.  Even then, there can be residual long term discomfort in a small percentage of cases.  In any event, after a few weeks if you are not better you should see your physician.

 What is known as “whiplash syndrome” refers to persistent symptoms present for more than six months after the accident.  This is at times called “cervical myofascial pain syndrome” and/or “hyperextension-flex injury”.  In the event that over-the-counter pain medications and self-care treatment at home are not enough, your doctor may suggest prescription painkillers, injections of corticoid steroid medicine or lidocaine into painful muscle areas and/or muscle relaxants which are drugs that ease muscle spasms but can often cause drowsiness.  In addition, there are various forms of physical therapy that may include ice, heat or ultrasound, as well as exercises to stretch and strengthen neck muscles.  The doctor may even prescribe a foam collar which were once used a great deal but is no longer the recommend routine.  During the day the cervical neck collars should never be worn longer than three hours at a time.  http://www.mayoclinic.com/health/whiplash/DS01037/DSECTION=treatments-and-drugs

Currently there are many non-traditional therapies being employed to successfully treat whiplash pain including acupuncture, (which involves inserting ultra-fine needles into specific locations on the body); and chiropractic care, (which is similar to physical therapy); massage, (which is kneading the tight muscles in your neck) and could be helpful if you continue to have muscle spasms for more than a week or two.  If the pain doesn’t resolve doctors often prescribe the use of a TENS unit.  A TENS unit is a device which applies mild electrical currents to the skin.  This non-harmful current helps decrease some types of pain, possibly by interfering with the transmission of pain segments.  http://www.mayoclinic.com/health/whiplash/DS01037/DSECTION=alternative-medicine

If you or a loved one has suffered a severe “whiplash” injury as a result of an automobile crash, contact the Law Office of William “Bill” Hurst at www.billhurst.com for a free consultation.

If you live in Fort Collins, Colorado, congratulations! Your city is the safest driving city in the nation according to Allstate.  This is based on its seventh-annual “Allstate Americans Best Drivers Report”.  http://www.autoblog.com/photos/allstate-2010-safe-driver-report/

In Indiana, Fort Wayne came in fifteenth.  However, this was a drop from the city’s number eleventh spot the prior year, and a sixth place ranking in 2009.  It is clear that drivers in Fort Wayne, Indiana are making great progress in keeping America’s roads safer.    By comparison, drivers in Indianapolis are forty-sixth on the list, beating the national average.

Drivers in the nation’s capital are the least safe, according to the study.   Indeed, it found that motorists in Washington D.C. are more than twice as likely to be involved in an accident as the national average.  The company’s report was created to encourage dialogue on safe driving to save lives.  While automobile crashes have declined over the past years, more than 32,000 people die each year in auto crashes, according the National Highway Safety Administration.  In defense of Washington D.C’s record, the problem with using crash frequencies to determine a driver’s ability and fault jumps to the conclusion that Washington D.C. areas drivers are the nations worst.  This puts blame on all drivers rather than on defective road design, licensing authorities, police enforcers of law, etc.  For a complete review of the report see http://www.journalgazette.net/article/20110902/LOCAL/309029974 Certainly, there are other cause for accidents/claims than other “bad drivers.”

While good road design can reduce severe crashes, as well, bad road design can contribute to collisions.  Poor signage or markers can confuse drivers and induce sudden movements.  Also, our roads that are crumbling and maintenance of the road design and warnings may be an issue.  None of those contributory circumstances were taken into consideration by the survey. In addition, Allstate ranked areas based on the average time between claims per driver.  If one adjusts the numbers to equalize vehicle miles traveled per capita, then Maryland comes out with the fewest collisions.  So, this story could have easily borne the headline “Maryland Drivers, the Best in the Nation”.  This at least is the reasoning of David Alpert, the founder of Great Greater Washington.  http://greatergreaterwashington.org/post/11906/are-washingtons-drivers-really-the-worst/

It is true that all of these ingredients do not necessarily point to the lack of abilities of the drivers in certain locals.  However, obviously this is of some value in determining the exposure resulting from insurance claims from automotive collisions.  Or at least that is the position taken by Allstate Insurance in their seventh-annual “Allstate Americans Best Drivers Report”.  http://www.allstatenewsroom.com/channels/News-Releases/releases/seventh-annual-allstate-america-s-best-drivers-report-reveals-safest-driving-cities

As a result of the annual report, Allstate continues to offer safe driving tips for drivers, such as:

A. Minimize Distraction

B. Be aware of road conditions

C. Be a safe driving distance between your car and others around you

D. Steer clear of road rage

E. Maintain your vehicle to ensure your car brakes, exhaust system, etc. are in good working order

The top ten safest driving cities according to the recent review of collision claims over two years lists these cities in order of the “most safe” first:

1.  Fort Collins, Colorado

2. Boise, Idaho

3.  Lincoln, Nebraska

4. Chandler, Arizon

5. Huntsville, Alabama

6. Knoxville, Tennessee

7. Spring Mill, Missouri

8. Reno, Nevada

9.  Eugene, Oregon

10.  Chattanooga, Tennessee.

The National Transport Safety Board (NTSB) recently put Florida on its list of states that need the most improvement in their highway safety laws.  Florida is one of just twenty remaining states that have not yet enacted any restrictions on talking or texting on cell phones while driving, even though the Florida Highway Patrol passed a new policy for its troopers prohibiting them from doing the same.  In addition to Florida, the NTSB gave Pennsylvania a failing score in its driver safety laws for the second year in a row. http://www.allstate.com/insurance-industry-news/road-safety-news-and-tips/florida-ranks-among-the-countrys-worst-states-for-highway-safety-800404596.aspx

In addition to Allstate, Mother’s Against Drunk Drivers (MADD) also ranks States based on the total percentage of traffic deaths in each state relating to drinking participation.  www.madd.org/drunk-driving/campaign/state-ranking Their ranking is based upon 2010 statistics ranked Indiana nineteenth.  In Indiana, the percentage of all traffic deaths that involved drinking was 30%.  Of our neighboring states, in making the rankings, only Kentucky has a higher ranking, being second in the nation.

US News has ranked the “best states” for teen driver safety.  USN used about eleven variables, the most important of which were the licensing, fatalities, and generally safety laws.  For the best states for teen driving, see http://www.usnews.com/news/features/best-states-for-teen-drivers .  US News concluded that Washington D.C. was the safest place for teen drivers.  The District of Colombia topped the list, having some of the most rigorous laws in the country governing driver’s license requirements for teens, laws banning text messaging, and using automated traffic cameras to control speeding.  South Dakota was at the bottom of the list, allowing teenagers to legally drive at the age of fourteenth.  South Dakota also has some of the most relaxed laws regarding driving while intoxicated or distracted.  More than 4,000 teens die in car crashes each year, making this the leading cause of death for teenagers between the ages of 16 and 19.  There has been a drop in teen fatalities over the lasts few years which has been attributed to new “graduated” driver licensing laws in most states.  National Safety Counsel researchers have developed information that delaying the licensing age from 16 to 16 and a half reduce fatal crash rates from teens 15 to 17 year olds by 7%.  In addition, restricting teen drivers to daylight hours cut fatal crashes by 18%; (comparable to states with no restrictions).  The conclusion of the National Safety Council is that it takes a while to learn to drive safely, and we need to promote laws which help teens do that.  The Center for Disease Control and Prevention also has done in depth research on what can be done to keep teen drivers safe.  This research includes recommendations for graduated driver licensing laws, which may be reviewed at http://www.cdc.gov/Motorvehiclesafety/Teen_Drivers/index.html

Clearly, it is good news that law enforcement and government bureaus are stepping in to try to prevent motor vehicle crashes for drivers of all ages, but it is still up to drivers to operate their vehicles safely.  From time to time people “slip up” and cause accidents as a result of failing to drive with care. If you or a loved one in your family was injured in an auto accident, and you would like to have a free evaluation of your case, please contact William “Bill” Hurst at www.billhurst.com Bill Hurst is an attorney with over 35 years of experience in representing victims suffering various kinds of accidental injury.

Brain injuries can be classified in mild, moderate and severe categories.  The Glasgow Coma Scale (GCS) is the most commonly used system used for classifying traumatic brain injury severity.  http://en.wikipedia.org/wiki/Glasgow The GCS grades a person’s level of consciousness on a scale of 3 to 15 based on the verbal, motor and eye opening reactions to stimuli.  It is generally agreed that a GCS of 13 or above is mild, 9 to 12 moderate and 8 and below is severe.  The most common causes of traumatic brain injury in the U.S. include violence, vehicular accidents, construction accidents and sports injuries.  Bicycles and motorbikes are a major cause with the latter increasing in frequency in developing countries.  There are estimates of between 1.6 and 3.8 million traumatic brain injuries each year.  These injuries are caused by the direction, intensity, and duration of the forces involving significant acceleration or deceleration of a persons head.  Diagnosis of these injuries involves a neurological examination, CAT scans, magnetic imaging; and with neuropsychological tests and assessments which can be ultimately performed to evaluate the long term cognitive issues and aid in the planning of rehabilitation.

Once a person is medically stable and recovered from the acute stage of the injury, they are generally institutionalized in rehabilitation hospitals for a period of time to attempt rehabilitation.  While it depends on the patient, various modalities of treatment such as physiotherapy, speech and language therapy, cognitive rehabilitation therapy and occupational therapy may be essential to a person’s rehabilitation.  People who have the more severe cases cannot live independently and disabled person may require care in a supportive living facility such as group homes.  As a result of the emotional issues which are often associated with severe brain injuries, trauma logical treatment may be needed to manage psychiatric or behavioral problems. Permanent disability is thought to occur in 10% of mild injuries, 66% in moderate injuries and 100% in severe injuries.  Coma is closely related to the severity as a strong predictor of a poor outcome.

Cognitive deficits that follow severe traumatic brain injuries involve various aspects of the cognitive function including impaired attention, disruptive insight and judgment, reduced processing speed, distractibility and deficits in executive functions such as abstract reading, planning and problem solving.  People with these types of injuries are often at risk for early onset dementia.  http://wikipedia.org/wiki/Dementia

In addition to the cognitive defects that may result from severe traumatic brain injury, speech and language may also be severely impacted as may the person’s sensory functions.  This includes loss of function in vision, hearing, smell and taste. Physical changes can also include chronic pain, bowel and bladder dysfunction, sleep disorders, appetite issues and may also in personality changes including aggression, depression or a total lack of awareness.  www.traumaticbraininjury.com/content/symptoms/severetbisymptoms.html

The Brain Trauma Foundation was created to help improve the outcome of traumatic brain injuries for patients worldwide by developing practice guidelines and conducting clinical research and educating medical professors and consumers.  This Foundation created the first training program to free hospital TBI carrier care, established the first New York TBI trauma center, and was involved in the first research funded by the McDonald Foundation to study the neuro biology of concussion and develop diagnosis and methods for therapeutic interventions.  www.braintrauma.org For a source listing of various associations and organizations relating to traumatic brain injury see www.ninds.nih.gov/disorders/tbi/org_tbi.htm

In 1998, the NIH held a Consensus Development Conference on Rehabilitation for Persons with Traumatic Brain Injuries.  The Panel recommended that moderate to severe injured patients receive rehab treatment that draws on the skills of many specialists.  This involves individually tailored treatment programs in the area of physical therapy, occupational, speech, psychiatry, psychology and social.  The National Institute of Neurological Disorders and Stroke (NINDS) conducts and supports research to understand these injuries and the biological mechanisms which underlie damage to the brain.  NINDS develops strategies and interventions to limit primary and secondary brain damage that occurs within days of head trauma.  One area of research which shows promise is the study of the role of calcium ion influx into the damaged neurons as a result of cell death and general brain tissue swelling.  Calcium enters the nerve cells through damaged channels in the axon’s membrane.  The excess calcium inside the cell causes the axon to swell and activates chemicals called protesis that break down proteins.  Excess calcium within the cells is destructive to the cell structures that produce the cells energy.  In a general sense, calcium influx that causes problems in the brain is diminished with the use of  ion influx.

The use of stem cells to repair damaged brain tissue is a new and exciting avenue of research.  Researches are investigating the ability of stem cells to develop into neuro transmitter-producing neurons specifically dopamine producing cells.  One study has shown that bone marrow stem cells can develop into neurons, demonstrating that neural stem cells are not the only type of stem cells that could be beneficial in the treatment of brain and nerve injury disorders.  At the moment stem cell research for traumatic brain injuries is in its infancy.

Researches are investigating into the mechanics of neural connectors in the brain allowing one part of the brain to take up the function of an injured part, called “plasticity” and researches theorize that children have an over abundance of hardwire neural networks, many of which naturally decrease through a process called “pruning”.  When an injury destroys an important neural network in children another less-useful neural network that would have eventually died takes over the responsibilities of the damaged networks.  Researches are looking into the role of plasticity and memories while others are using imaging technologies such as MRIs to map regions of the brain and record evidence of this “plasticity”.  “Plasticity of the brain” in its simplest meaning is the ability of the brain to adapt to deficits and injury.  With regard to identification of various institutes involved in brain research see www.ninds.nih.gov/disorders/tbi/org_tbi.htm

According to the Journal of Head Trauma Rehabilitation there are at least 5.3 million Americans living with a disability as a result of a traumatic brain injury.  Over 80,000 each year will experience long term disability as a consequence of their brain injury.  To care for these individuals there will be significant financial demands.  In addition to Social Services through a hospital or rehab facility it may be necessary to consult with legal professionals to help brain injury survivors in the areas of Social Security, Medicare, Medicaid, guardianship, estate planning and the like.  It is important that an experienced attorney be brought in early in the process to make sure the legal rights are protected by preserving evidence, conducting investigations, and reviewing and analyzing all benefits available under the insurance policies and public benefits available.  The more severe injured may be required to live in transitional living programs which are non-medical residential programs that teach living skills for community living.  However, in many instances residential facilities in long term care and supervision for the more severely injured are needed for those who cannot live independently.  Some useful resources in this regard include the Centers for Independent Living (CIL) at http://www.virtualcil.net/cils/; Social Security and Disability Insurance (SSDI) and Supplemental Security Income (SSI) at http://www.ssa.gov/; Brain Injury Association of America (BIAA) at http://www.biausa.org/; The National Disability Rights Network Protection and Advocacy for Individuals with Disabilities at http://www.napas.org and the Head Injury Hotline at www.headinjury.com.   The American Residential Treatment Association has approximately 30 members listed in their Directory of Residential Facilities at www.artausa.org/.  For a listing of treatment systems for traumatic brain injury also see http://www.allabouttbi.com/centers/.  Various resources and search engines for residential programs for those with severe brain injuries in Florida and Michigan see Neuro International at http://www.neurointernational.com Center for Brain Injury Rehab at http://www.neurocrecer.es/.  Most states have what are known as “ombudsmen” to advise the disabled on long term care.  These people are advocates for residents of nursing homes and special care facilities.  An ombudsman may provide information on how to find a facility and what to do to get quality care.  This program is administrated by the Administration on Aging (AOA) and the network has 87,000 volunteers certified to handle complaints and programs in various states.  http://www.ltcombudsman.org/about-ombudsmen

If you or a loved one has suffered a severe brain injury as a result of the negligence of another, contact William “Bill” Hurst, an experienced attorney for a free consultation at (800) 636-0808 or online at www.billhurst.com.

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