Halifax Personal Injury Lawyer Blog

According to a recent report from the Canadian Institute for Health Information an average of 45 Canadians are hospitalized every day in the summer as a result of injuries from wheel and water sports.

“Summer is a great time to be active and enjoy the outdoors, but it is also a peak period for motor vehicle injuries and trauma related to wheel and water sports,” said Greg Webster, director of Primary Health Care Information at CIHI.

CIHI has been collecting data for the last 10 years. Their investigation show that cycling injuries account for half of all sport and recreation related hospital admissions.

Thousands of Cycling Injuries Every Year

In 2009-2010 more than 4000 Canadians were hospitalized as a result of cycling injuries with almost half of those injuries occurring in the months of June, July and August.

Good News

The good news is that while the number of cycling injuries that resulted in hospitalization has remained stable over the last 10 years the number of head injuries has decreased significantly (from more than 900 to 665) for the same period.

Nova Scotia Among Fewest Injuries

When the data is broken down by province hospitalization results were highest in the west (British Columbia and Alberta) and lowest in Ontario and Nova Scotia. No doubt that has to do with Nova Scotia’s early adoption (in 1997) of mandatory helmet legislation. Reseach published by the Canadian Medical Association Journal suggested that the rate of cycling head injuries in Nova Scotia dropped by more than 50% after the introduction of the mandatory helmet law.

Public Education Still Needed

While the results are encouraging, Canadians still have a long way to go. The other night I was walking though Hemlock Ravine Park when a family (two adults and three children) rode by me on mountain bikes. All three of the children had helmets on but neither one of the adults did.

Another example of the old saying: “Do as I say, not as I do”. Perhaps mom and dad would be more likely to wear their helmets if they read the CIHI report that found that 78% of cyclists who were hospitalized with a head injury were not wearing their helmet when their injury occurred.

Have a safe day and enjoy what’s left of our summer.

The New York Times recently reported that 75 former professional football players from the NFL have filed a claim against the National Football League claiming the league was aware that concussions could cause long term brain injury and that the league failed to warn players and properly treat their injuries.

Recently there have been a number of stories in the media surrounding the dangers of concussion and minor traumatic brain injury. Mostly spurred by injuries to professional athletes. See for example:

Hockey Players Losing More Time Due To Concussions

Brain Injury Claims: Female athletes more susceptible to brain injury

25% of Junior Hockey Players Suffer Brain Injuries: Ontario Medical Study

Lawsuit First to Allege Conspriracy?

However, so far as I am aware, this is the first lawsuit to allege that any professional sport organization was aware of the long term dangers of concussions and concealed that information from athletes.

Recent Changes

There is no doubt that part of the NFL’s defense will be the recent efforts it has made to increase awareness of the dangers of concussions. However, the medical profession has known for decades that concussion can have serious long term consequences.

The long term consequences of concussion can be seen in the recent report that Sydney Crosby (who suffered a concussion last season) is still not certain if he will be able to return to play when the season opens this year.

Even more tragically, is the example of former Chicago Bears player David Duerson who committed suicide. An autopsy showed that he suffered from chronic traumatic encephalopathy (CTE) a medical condition brought on by repeated blows to the head. The condition is better known to the public as boxer’s dementia.

While there is no way to know what the outcome of the NFL brain litigation will be, I hope that it will at least have the effect of raising public awareness about the dangers of sports related concussions.

Brain Injury Litigation Challenging

Brain injuries can be difficult to detect and difficult to prove in personal injury claims. That’s one of the reasons why I wrote Brain Matter: The Survivor’s Guide to Brain Injury Claims.

I wrote the book to help educate the public about the challenges faced by survivors of traumatic brain injury. The book is for sale on Amazon.com and I am donating all of the proceeds of sales from Amazon to the Brain Injury Association of Nova Scotia.

However, I will send a copy of the book, at no charge, to anyone who contacts me through this blog, just put "Brain Matter" in the subject line and send me your mailing address.

Diagnosing Traumatic Brain Injury

There are a number of diagnostic tests that doctors use to test for brain injury. The problem is that most of the tests (X-Ray, CT Scan, MRI) are not sensitive enough to detect the subtle changes cause by minor traumatic brain injury.

Several years ago I had a case where I was asked to provide a second opinion to someone who had been in a car accident. She had received an offer of compensation based on the fact that she hyad broken some bones in the accident.

But after interviewing her, and some of her family members, I was concerned that she was showing signs of an undiagnosed brain injury. After we arranged for further testing she was diagnosed as having suffered a minor traumatic brain injury (MTBI).

"How Do I Know if I Have a Minor Traumatic Brain Injury?"

So how do you know if you or a loved one has suffered a minor traumatic brain injury?

Here is a simple checklist of the signs or symptoms of minor traumatic brain injury. It's important to rememeber that the presence of some or all of these symptoms does not necessarily mean that you have a brain injury.

However, if you have 5 or more of these symptoms, and they appeared after you suffered a blow to the head, then you should tell your doctor to see if he or she thinks further investigation is necessary.

CHECKLIST OF MINOR BRAIN INJURY SYMPTOMS

HEADACHES

Are you experiencing more headaches after the injury or accident?

Do you have pain in your temples or forehead?

Are you experiencing stabbing pains in your head lasting more than a few seconds?

MEMORY

Does your memory seem worse since the accident?

Have family members or friends said you seem forgetful?

Do you have difficulty remembering something you just read?

WORD FINDING

Do you have the feeling that the word you are looking for is "on the tip of your tongue" but you just can't say it?

FATIGUE

Do you get (mentally or physically) tired more easily?

Does your fatigue get worse when you have to concentrate on something?

EMOTIONAL CHANGES

Do you get angry or irrtiated easily?

Since the injury, do you cry or become depressed easily?

SLEEP DISTURBANCE

Do you wake up frequently throughout the night?

Do you wake up very early and cannot go back to sleep?

ENVIRONMENT

Are you easily overwhelmed in noisy places?

IMPULSE CONTROL

Do you find yourself impulsive decisions (saying things "without thinking" or impulse buying?)

CONCENTRATION

Do you have difficulty concentrating or staying focused?

DISTRACTION

Do you find that you are easily distracted?

When you are reading do you frequently lose your place?

ORGANIZATION

Do you have difficulty organizing complicated tasks?

Do you find you are "missing steps" in recipes, projects, instructions or "to-do" lists?

Was this helpful?

If so send me an e-mail or leave me a comment. Let me know what other information you would like to see on this blog.

MORE INFORMATION

What is a Mild Traumatic Brain Injury?

What Are The Symptoms of Mild Traumatic Brain Injury?

8 Myths of Traumatic Brain Injury

Understanding How the Brain Works

Continue reading "Nova Scotia Brain Injury Claims: Signs of Minor Traumatic Brain Injury" »

Baby Dragged By Car

The Ottawa Citizen reported that a 6 month old boy suffered head injuries after being dragged 12 meters by the family car when it rolled backwards down their driveway after being knocked into gear by his 3 year old sister.

The infant's 14 year old sister was helping her mom get the family ready for a trip. The baby had been buckled into a car seat and the car seat was placed on the driveway beside the family car. The family’s 3 year old daughter was playing in the front seat of the car and managed to knock the car into gear. The car started rolling backwards and dragged the infant in his car seat for almost 12 meters. Media reports list the baby as being in stable but serious condition.

Unattended Children in Cars = Danger

This incident highlights all the many dangers that KidsandCars.org Canada have been trying to prevent. Leaving children unattended in a vehicle, even for a short period of time, can have unintended, and often tragic consequences.

And that’s why I have agreed to chair KidsandCars.org Canada! To help educate the public about the dangers automobiles can pose to our children and to lobby for better safety features in automotive vehicles.

Could it Happen to You?

Do you know if your car has the safety features that will prevent it from shifting into gear by mistake?

Here's how you can check to see if your vehicle can be shifted into gear accidentally. You want to make sure your vehicle has a “brake transmission shift interlock” (BTSI) that works in all shift positions.

6 Simple Steps:

1. Make sure your vehicle is parked on a flat surface;

2. Get in your car and put the emergency brake on;

3. Make sure no one is in front of or behind your vehicle;

4. Put the keys in the ignition in the off position;

5. Turn the key one click forward ;

6. Try to shift your vehicle into gear without putting your foot on the brake.

What Happened?

If your vehicle shifts into gear, then you do not have brake transmission shift interlock in that position. You should be aware that your vehicle can roll if it is accidently shifted into gear.

Try the same test in all key positions. If your vehicle shifts into gear without putting your foot on the brake, then your vehicle does not have BTSI at all!

Most vehicles manufactured today have BTSI in some positions but not all. The old saying goes, “an ounce of prevention is worth a pound of cure”. Simply knowing that your vehicle can accidently roll should make you more aware of the potential dangers to you and your children.

More Information

Formal Agreement Reached on Brake Transmission System Interlock

Automatic transmission cars can kill your child

I am very proud to announce the publication of my latest book: Brain Matter: The Survivor's Guide to Brain Injury Claims.

I have been representing survivors of traumatic brain injury for 20 years. After spending years volunteering with the Brain Injury Association of Nova Scotia I realized there is a real lack of public awareness about traumatic brain injury claims.

So I decided to write a book to try to help educate the public and to provide information to brain injury survivors, and their families, about the legal issues surrounding traumatic brain injuries.

Brain Matter: The Survivor's Guide to Brain Injury Claims is now for sale on Amazon.com. They even have an e-book version for Kindle.

I'm donating all the sale proceeds from Amazon.com to BIANS.

http://www.apmlawyers.com/lawyer-attorney-1790130.html"Novel" Science in the Courtroom

In 1994 the Supreme Court of Canada in the landmark decision R v Mohan settled the following general criteria for the admissibility of expert opinion evidence:

1) The evidence is relevant to some issue in the case;

2) the evidence is necessary to assist the trier of facts;

3) the evidence does not violate an exclusionary rule; and

4) the witness presenting the evidence is a properly qualified expert.

In R.J.D.D. the Supreme Court issued a warning about the wholesale admission of expert evidence. The SCC established the role of the court as one of "gatekeeper" for the admission of novel expert evidence.

I have posted before about the difficulties in proving brain injuries and some of the myths associated with minor traumatic brain injury: What is a Mild Traumatic Brain Injury? and 8 Myths of Traumatic Brain Injury

New Advances in Brain Injury Research

As medical science advances and new tools and tests are being created which help medical professionals diagnose potential brain injuries. See for example Brain Injury Claims: New Blood Test May Help Brain Injury Victims

However, whether or not those tools and tests can actually be used in court to prove the existence of brain injury is open to debate.

Brainwaves Reports Not Admissible

A recent decision from British Columbia addressed the admissibility of QEEG reports in a brain injury claim. QEEG stands for "Quantitative ElectroEncephaloGram". It is a digital measurement of electrical patterns at the surface of the scalp which primarily reflect cortical electrical activity in the brain. Put simply, a QEEG maps "brainwaves."

In Bialkowski v. Banfield the court ruled that while QEEG reports may be admissible in appropriate case the plaintiff in that case did not provide sufficient evidence to establish the reliability of the evidence.

Justice Bracken ruled the plaintiff’s neuropsychologist was not properly qualified to introduce the QEEG evidence.

The relevant findings are as follows:

[3] Electroencephalography (“EEG”) is a means of recording the electrical activity of the brain. Typically, electrical signals are received through 19 electrodes placed on certain areas of the scalp by attaching the electrodes to a cap that fits snugly over the patient’s head. The electrical activity is then recorded either on paper, or digitally on a computer. The clinician can then visually examine the recorded data to analyze the patterns of activity.

[4] QEEG is a relatively new neuroimaging technique. It uses computer assisted analysis of EEG tests. The raw EEG data is digitized and analyzed by means of a mathematical algorithm. It is said that the computer analysis is capable of extracting more information from the raw EEG data and enables the clinician to observe more subtle anomalies than can be seen with the eye on standard visual analysis. Using another program the digitized data is then compared to a normative database to determine if the data are consistent with what is normal for a comparable group of individuals…

[58] While there may be cases where QEEG evidence will be accepted as part of expert opinion in Canadian Courts it should only be through a neurologist who is trained and qualified in EEG testing and analysis. In my view, only a trained electroencephalographer who has the skill, knowledge and training to recognize the potential for error is qualified to give opinion evidence of QEEG analysis.

[59] On the evidence presented in this case, I find the QEEG evidence to be novel science and not sufficiently reliable for admission into evidence on the principles established in J.L.J. andMohan. I conclude it will not assist the trier of fact. As science progresses this may change and the evidence may meet the test of reliability so as to be admissible at some point in the future. As was noted in Seifert, the fact that expert evidence conflicts does not, by itself, make it inadmissible. Coburn, et al, recognize this in the conclusion of their report at p. 23, where it is stated:

Used cautiously and with appropriate recognition of its limitations, QEEG offers the clinician an accurate laboratory test to aid in the detection and differential diagnosis of several common neuropsychiatric disorders. …

Additional uses of QEEG showing promise but not yet sufficiently developed for routine clinical application include the prediction of medication efficacy and the prediction of the clinical cause of a disorder.

There is nothing in that conclusion to suggest it will become clinically useful in diagnosing traumatic brain injury in the near future; however, it remains open for such evidence to be offered through an appropriate expert if and when it satisfies the evidentiary requirements of Canadian Courts.

[60] The evidence of QEEG analysis given by Dr. Malcolm is rejected as not being offered by a qualified expert. QEEG does not meet the requisite reliability threshold and is still novel science.

Door Still Open?

The ruling leaves open the possibility that properly qualified experts, for example neurologists, could introduce evidence in the appropriate cases.

Continue reading "Using QEEG Test Results in Brain Injury Claims - Bialkowski v. Banfield " »

Fewer Brain Injuries But More Time Lost

This month’s issue of the Canadian Medical Association Journal contained a study of NHL hockey players over 7 seasons. The study indicated that while the number of concussions has leveled off the time that players were loosing as a result of the concussions appears to be increasing.

More Severe Injuries or Better Treatment?

The authors of this study question whether the increase in time off is because players are suffering more serious concussions or whether trainers and team physicians are being more cautious in their treatment of mild traumatic brain injuries.

Better Predictors

The authors pointed to a number of factors which tended to increase the amount of time off the players needed before returning to the ice. The factors included the presence of:

Headaches;

Low Energy or Fatigue;

Memory Loss;

Abnormal Neurological Findings.

The authors of the study conclude:

“Our findings also suggest that more conservative or precautionary measures should be taken in the immediate post-concussion period, particularly when an athlete reports or experiences a post-concussion headache, low energy or fatigue, amnesia, recurrent concussion or many different post-concussion symptoms, or when the athlete has an abnormal neurological examination.”

The findings are similar to the practice guidelines for managing mild traumatic brain injuries due to concussion published by the American Academy of Neurologists.

Spotlight on Concussions

The NHL has drawn attention to the problems of concussions in sports; particularly Zdeno Chara’s hit on Max Pacioretty that caused a severe concussion and a fractured neck as well as Sidney Crosby’s concussion which has put him off the ice for almost 3 months.

In March the NHL announced new concussion rules requiring trainers to conduct a neurological test of players immediately after taking an on ice hit.

Recent research has also revealed that up to 25% of all junior hockey players suffered a concussion.

Better Enforcement-Better Training-Better Testing

The public is slowly becoming aware of the dangers of concussions. People are finally starting to realize that a concussion is a brain injury and the damage from mild traumatic brain injury due to a concussion is cumulative and can be permanent and significantly disabling.

How Can We Protect Athletes?

Referees need to strictly enforce the rules against cross checking and head shots. Coaches, trainers and parents need to have a better awareness of the signs and symptoms of mild traumatic brain injuries.

New and more accurate testing such as the rules introduced by the NHL recently to detect brain injury need to be implemented at all levels of the sport and in any sport where head injuries are prevalent (hockey, football and rugby to name a few).

If there is one thing that everyone knows it's that wearing a helmet reduces the risk of head injury. Or does it?

Risky Business?

New research published by Mikael Colvill-Andersen suggests that people who wear helmets are more likely to engage in the type of risky behavior that results in head injuries.

Colvill-Anderson claims:

“There are actually scientific studies that show your risk of brain injuries is higher when you’re wearing a helmet, and that you have a 14% greater chance of getting into an accident with a helmet on…”

Controversial...or Just Dangerous?

Needless to say, Colvill-Anderson's statements have raised a storm of controversy among doctors, brain injury organizations and sports organizations.

Helmet Laws Reduce Injuries

Most provinces have laws requiring people to wear helmets when they ride bicycles. Ontario’s helmet law was passed in 1995 and a test conducted by Toronto’s Hospital for Sick Children found that bicycle fatalities among children dropped after the legislation was introduced. However, bicycle fatalities among adults (who were not covered by the helmet law) remained the same.

Colville-Andersen’s research is based on the “risk homeostasis” theory that everyone has a "preset" level of risk tolerance. The theory suggests that when you do something to decrease your risk of injury you compensate by engaging in more risky behavior.

For example, the risk homeostasis theory states that if someone decreases their risk by wearing a seat belt they may unconsciously drive faster.

It appears that the weight of scientific evidence is critical of the risk homeostasis theory.

Helmets or No Helmets?

While some sports require helmets as a condition of playing (hockey and football are obvious examples) other sports that some might consider equally violent actually ban helmets, rugby and lacrosse for example.

What Do You Think?

If you wear a helmet are you more likely to engage in risk taking behavior? Or are helmets just a common sense way of preventing concussions and brain injury?

This is interesting. The Globe and Mail has reported that researchers have discovered that women are more susceptible to sports related concussions than men.

The problem is that most "return to play"criteria are based on research on male athletes. This may result in injured female athletes being returned to play before they are fully recovered, resulting in a greater chance of multiple concussions and long term brain damage.

Thanks to my colleague Bruce Stern for the heads up on the article.

ThinkFirst Canada is a nonprofit organization dedicated to preventing brain and spinal cord injuries.

They have released a new educational video about concussions in hockey. But the medical issues apply to all sports.

This video should be required watching for ANY parent that has children playing minor sports.

It tells you what the signs and symptoms of a concussion - brain injury are and what to do when you see them.

Please share this with anyone you know who has children playing minor hockey!

Body Checking Increases Risk of Bain Injury

Perhaps this new research should have been published in the Journal of Common Sense (if there was such a thing they probably wouldn't have enough subscribers).

A new study of minor hockey players has found that the incidents of brain injury in 9 and 10 year olds has increased ten times since Hockey Canada decided to allow body checking at a younger age in minor hockey.

I have posted many times about the problems with brain injury due to concussion in minor sports such as hockey, football and basketball. See for example:

Hockey Nova Scotia Recommends New Concussion Policy to Prevent Brain Injury

25% of Junior Hockey Players Suffer Brain Injuries: Ontario Medical Study

Another Study Linking Football and Brain Injury

Ignoring the Problem?

However, it seems that players, fans and officials were turning a blind eye to the problem until recently.

No doubt the high profile given to the injuries suffered by Sydney Crosby has played a part in recent public interest.

Professional Sports Starting to Pay Attention

For example, the NHL has announced details of a new concussion protocol that will require players showing symptoms of concussion to be tested by a doctor before returning the play. Until now, sports trainers would conduct player examinations on the bench during a game.

Last week the National Football League announced that this coming season every team will be required to use the same standard test: “the NFL sidelines concussion exam” to evaluate whether a player has sustained a concussion (or more serious brain injury). [Thanks to my colleague Bruce Stern at the Brain Injury Law Blog.]

What About Our Children?

While the "powers that be" in professional sports appear to be taking steps to protect the athletes that work so hard to entertain us, I have to ask: "Who is looking out for our children?"

Decade Long Study

Dr. Michael Cusimano of St. Michael’s Hospital in Toronto reviewed the records of more than 8,500 boys aged 6 to17 who attended Ontario area emergency departments for hockey related injuries during a 10 year period.

Dr. Cusimano is the volunteer Vice President of Think First Foundation of Canada, a non-profit organization dedicated to the prevention of brain and spinal cord injury.

More than half of the reported injuries (4,460) were the result of body checking!

But the scariest finding was that the risk of a head or neck injury, including concussions increased significantly across all minor hockey divisions.

It is simply common sense that we shouldn’t do anything to unnecessarily increase the risk of injury to our children.

The rule change that allowed body checking for 9 and 10 year olds in the Atom hockey division is simply wrong. It does not increase children’s skill levels. It does not teach them how to “take a hit”. It simply increases the risk of injury and exposes children to serious, potentially life threatening, brain injuries.

Want to do something about it?
Email Sean Kelly who is in charge of Regulations and Legal Affairs for Hockey Canada. Tell him you oppose body checking for 9 and 10 year olds.