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Concussion Injuries-A Potentially Severe Problem.

A concussion injury is a mild Traumatic Brain Injury. But there is nothing “mild” about its severe impact in terms of incidence and severity-in terms of lost function and total economics loss.

The Center for Disease Control (CDC) estimates that there are 1.4 million TBIs which result in hospital and emergency department visits every year. 50% “fly under the radar”, never seeking medical attention. That means that there were really more than 2.8 million, 75 to 90% of which fall into the mild category.

Yet, there is nothing mild about a “mild” TBI. That term is used in the medical literature to reference those TBIs that do not involve a skull fracture, a closed head injury without a hematoma or bleeding, and those that do not show positive organic damage on MRI or CT scanning.

Mild TBIs can often result in severe disability, including cognitive dysfunction, severe visual impairment, and severe balance and dizziness disorders. They can result in delayed major health problems, including delayed seizure disorders, Parkinson’s disease, early Alzheimers and dementia, and even infectious diseases.

Concussion Injuries-Overlooked For Many Decades.

The severity of concussion injuries has been overlooked for decades. The NFL ignored the horrible brain damage of Chronic Traumatic Encephalopathy from concussion injuries for over 30 years. It has been called to public attention back in 1986 by the National Brain Injury Foundation (NBIF) which disclosed that autopsy studies had provided proof positive that “even minor blows to the head” with only brief periods of unconsciousness could produce permanent damage to the brain. 30 years later, a study of 202 brains of professional football players revealed proof positive of “Chronic Traumatic Encephalopathy” (CTE).

In 1996, the U.S. Congress tried to remedy this ignorance by passing the Traumatic Brain Injury Act. In 1986, the Center for Disease Control attempted to educate the medical community, publishing “Heads Up-Facts For Physicians About Mild Traumatic Brain Injury (MTBI)”. In 2011, the Minnesota legislature recognized the problem and passed the Minnesota Sports Concussion Law (Minn. Stat. 121A.38.)
In spite of these heroic measures, the “Silent Epidemic” has continued to be ignored.

Concussion Injuries-Still Overlooked Today.

In 2016, the Brain Injury Association of America acknowledged that (1) concussion injuries are not always understood as brain injury, (2) frequently not diagnosed or underdiagnosed, and (3) subsequent problems not associated with the concussion.

Emergency room doctors acknowledge that they cannot reliably assess which patients will experience Post Concussion Syndrome.

It is a fact that a large percentage of medical doctors fail to provide concussion screening to car accident victims at a level of scrutiny even close that that required by law to be given to youth athletes!! Recognizing this problem, the author’s law firm routinely screens new car accident victims for concussion. We have found that approximately 60% of the victims of moderate to severe car accidents have presumptive evidence of a concussion injury. Well more than ½ have not been diagnosed by a medical doctor or other health care provider. This is a problem of massive proportions.

Whiplash of the Spine-Whiplash of the Brain.

It has long been recognized that the same forces that cause “whiplash of the spine” also cause “whiplash of the brain”, or concussion. The symptoms of both are quite common, especially headaches. The textbook, Whiplash Injuries-The Cervical Acceleration/Deceleration Syndrome, co-authored by Dr. Arthur Croft back in 2002 extensively discussed the relationship between spinal whiplash and brain whiplash.

Basic Concussion Screening Is Very Simple-But Often Not Understood.

Basic concussion screening is not difficult. Remember that the goal is not to reach a definitive diagnosis. Instead, it is simply to do a “quick and dirty” preliminary screen to look for presumptive evidence of a concussion that would call for a referral to a concussion expert. (Remember that 90% of the medical community does not fall in that category!)

Step #1: Ask detailed questions about the patient’s memory of the traumatic event, both before and after. Remember that loss of memory of details before the trauma is “anterograde amnesia” which is strong evidence of a TBI. Loss of memory of details after the trauma is “retrograde amnesia”, which is stronger evidence of a concussion than actual loss of consciousness.

Step #2: Ask about loss of consciousness (LOC). Remember that LOC can be total (coma) or partial (lethargy or stupor). Mere confusion or disorientation is a partial loss of consciousness sufficient to be evidence of a concussion injury.

Step #3: Use one of the well-recognized screening tools such as the Rivermead Post Concussion Questionaire or the SCAT5. Either can be given to the patient for self-assessment in the waiting room and then reviewed with the Doctor during the examination.
Both the Rivermead and the SCAT5 ask the patient to identify classical symptoms of Post Concussion Syndrome

(PCS) such as headache, nausea, blurred vision, mental confusion, etc. and then to self-rate the severity of each.

Doctors of Chiropractic Can and Should Be the Safety Net for Concussion Injuries Overlooked by the Medical Community.

Studies tell us that as many as 3 million concussion injuries fall through the cracks of the medical community. Doctors of Chiropractic are wonderfully situated to provide a safety net to those who seek chiropractic treatment. Here is one of many success stories of where a Doctor of Chiropractic has been the “safety net” for a person whose severe concussion injury was totally ignored by the medical community:

Jamie’s Story

Jamie was stopped in rush hour traffic when her car was rear-ended at 30-40 mph by a huge semi-truck. Her car was totaled. The front bumper of the truck ended up in the back seat of her car.

She was evaluated at the Emergency Department of a local hospital with no concussion screening and discharged with no treatment recommendations.

Two days later, she presented at the Urgent Care Clinic of a major health care network, again complaining of “whole body pain”, again with no concussion screening.

Five days later, she was seen by her primary care physician-again no concussion screening.

Thankfully, her MD referred her to a Doctor of Chiropractic who took a history of the classic symptoms of a concussion injury: forgetfulness, loss of concentration, headache, dizziness, ears ringing, fatigue, depression, light sensitivity, and irritability-and diagnosed the concussion. A referral was made to one of the few medical doctors who are Board Certified in Traumatic Brain Injury Medicine confirmed the concussion diagnosed and instituted appropriate therapy.

As of this printing, Jamie remains unable to work for 5 months and has lost her job in a very high level professional occupation.

Conclusion: In this case, a single Doctor of Chiropractic outperformed 3 medical doctors, recognizing the acute symptoms of concussion, and served as the safety net for this victim of a serious concussion injury. Bravo!!!

CONCUSSION INJURY LAWYERS MINNESOTA have focused their personal injury practice on bringing justice to the victims of concussion injuries which are often overlooked by the medical profession. Senior trial lawyer Douglas Schmidt has practiced as a personal injury lawyer for 50 years and is a nationally recognized specialist in concussion injuries.  He is a member of the Brain Injury Association of America and the Minnesota Brain Injury Alliance.  Recently, his practice has focused on the representation of the victims of concussion injuries which are often overlooked by medical doctors. He is the author of a soon-to-be published book, Overlooked Concussion Injuries-The Silent Epidemic. Schmidt is the senior trial lawyer at the Schmidt Salita Law Team.

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1. McCrea, Mild Traumatic Brain Injury and Post Concussion Syndrome, American Academy of Clinical Neurology-Oxford University Press 2008.
2. Heads Up
3. The Essential Brain Injury Guide, Brain Injury Association of America, Ed 5.0 (2016).
4. Kay, Minor Head Injury: An Introduction for Professionals, National Head Injury Foundation, Dec. 1986 (study funded by the US Department of Education, National Institute of Disability and Rehabilitation Research Grant).
5. Minnesota Statutes 121A.38.
6. Foreman-Croft, Whiplash Injuries-The Cervical Acceleration Deceleration Syndrome, 3rd Ed (2002).
7. King et. al, Rivermead Post Concussion Symptoms Questionaire, J. Neurology 242 :587-592 (1995)
8. SCAT5