Tuesday, October 26, 2010

Brain and Spinal Cord Injuries: Causes and Protections

Although design defects have not changed much over the last couple of decades, recent medical advances allow crash victims to survive formally fatal injuries.

Seriously brain damaged and paralyzed spinal cord victims’ survival and increased life expectancies require huge sums for lifetime medical expenses and costly functional and psychological problems.

How brain and spinal cord injuries occur - - and methods for eliminating or reducing their severity - - is discussed below.

Severe Brain Injury

Brain injuries are most commonly caused by head impact, inertial loading of the head, and loss of oxygen (hypoxia).

While brain injury from head impact requires direct impact, inertial loading of the brain results from direct or indirect loading like violent flexion/extension in a rear-end crash lacking properly designed head restraints.

This trauma causes diffuse and focal brain injury, the latter involving harm to defined brain regions in which victim experiences skull fractures and brain contusions or epidural or subdural hematomas located beneath - - or opposite to - - impact’s site.

Head contact may cause diffuse axonal injury, i.e., an initial concussion followed by cellular or bleeding damage to multiple brain regions.

Regardless of whether the injury is focal or diffuse, swelling or edema (tissue damage and increased fluid) more life threatening than the injury may occur and horribly injure the brain stem, i.e., the link between the brain and spinal cord.

Either direct head impact or indirect violent head movement induces two types of brain injury: translational and/or rotational movement.

Translational (or linear) motion is the movement in a direct path through head’s center of gravity (CG). Rotational motion occurs when the brain angulates around the head’s CG causing it to violently move in a non-uniform fashion and exposing areas of the brain to injury.

The brain is a viscoelastic organ susceptible to injury due to sensitivity to force, shape of impacting object, acceleration, and rate at which brain is accelerated.

While most closed head injuries occur within a fraction of a second of exposure to acceleration, the head injury’s nature and extent depends upon the acceleration’s rate of onset, directionality and peak.

Severe Cervical Spinal Cord Injury

The cervical spine is made up of vertebrae positioned to produce “lordotic curvature” causing the spine to arch when standing upright.

The lower cervical vertebrae are similar in shape, with size and mass increasing as there is movement toward the thoracic spine.

The commonly acknowledged mechanism causing cervical spine fracture or dislocation —resulting in catastrophic quadriplegia/paraplegia — is axial loading with failure of the spine in a flexion mode.

Considering the cervical spine with the neck in the neutral position, the spine’s normal alignment is with extension because of the lordotic curve. When the head moves forward and the neck flexes forward, the cervical spine is straightened.

With the force exerted from head impact or arrest of the head with the body in motion, along the axis of a straight spine, loading of the spine as a segmented column occurs. When energy input exceeds energy absorbing capacity, intervertebral disc injury, vertebral body fracture, ligamentous disruption or posterior element fracture results. When maximum vertical compressive deformation is reached, acute cervical spine flexion occurs, with fracture or dislocation. The spinal cord is traumatized by impingement of the spinal process.

Because current research places the critical limits on the compressive load’s magnitude at 700 to 1000 pounds, force exceeding this load causes spinal cord injury.

Automotive and Helmet Design and Injury

To properly design a motor vehicle to reduce brain or spinal cord injury, the restraint system and "head strike zone" (e.g., steering wheel, instrument panel, roof, windshield, etc.) must account for head contact, inertial loading of the head from torso restraint, and spinal cord loading.

Thus, manufacturers must set design/injury parameters under foreseeable accident circumstances then test and measure the safety componentry’s performance. Generally, the more shock attenuation provided by the component or system placed between the head/neck and loading force (e.g., helmet, instrument panel, "A" pillar padding, etc.), the less transmitted acceleration and less likely the victim will be injured.

Head and spinal cord injury is also a major cause of disability in sports activities associated with helmets often due to lax and outdated helmet test standards.

If designed correctly, all helmets protect through load distribution and energy absorption. Distribution depends on the stiffness of the shell while absorption is based upon the liner’s deformable properties, i.e., density and thickness.

Unfortunately, many helmet designers fail to provide head and neck protection in impacts with velocity changes exceeding 15 mile per hour often meeting only minimal governmental or industry standards.

Thursday, September 2, 2010


What is Crashworthiness

Vehicles sold in the United States should protect occupants from injury in moderate speed, foreseeable collisions and those which cannot are not “crashworthy”.

Insufficient crashworthiness is established by demonstrating that:
○ crash was of a kind that is expected to occur;
○ injuries were caused or enhanced by defective vehicle condition which failed to protect occupant; and
○ an alternative design existed which would have prevented or lessened injuries.

Because auto defect cases are not always readily apparent, any time a person is catastrophically injured in a motor vehicle accident a crashworthiness claim should be investigated.

The most frequently encountered crashworthiness claims involve tires, airbags, fuel tank design, rollover/roof crush/vehicle stability, seat design/restraints, child safety seats, or passenger vans.

Fuel Tank Design

If an occupant can survive the accident’s initial impact but suffers loss of life or significant burns in the resulting fire, a "fuel fed fire" case may exist. One type of case involves fuel tank placement within a vehicle’s known “crush zone” making it more susceptible to fuel leakage and resulting fire. Other potential defects include the design of the connection points that gas passes through while traveling through the vehicle like the design and location of the filler neck assembly connecting the gas cap to the tank.


It is common in accidents, such as where a vehicle strikes a tree or a pole, for airbags to fail to deploy. Some airbags are incredibly aggressive, deploying at speeds of 200 miles per hour causing head, neck and eye injuries. Some airbags deploy late in the accident sequence, after the occupant is already close to the airbag, or deploy in minor, low speed impacts, which would not have resulted in injury except for those relating to the airbag.

Rollover/Roof Crush/Vehicle Stability

Tall, narrow vehicles such as SUVs are especially prone to rollover, particularly after drivers make sudden steering changes. Recently manufactured vehicles should be equipped with Electronic Stability Control, an intelligent braking system assisting drivers in responding to sudden steering inputs minimizing the risk of loss of vehicular control.

Seat Design/Restraints

Often in relatively moderate speed rear impacts, seatbacks will collapse, causing occupants to move rearward and strike the seat or persons in the rear of the vehicle. In more severe accidents where occupants are ejected from the vehicle, seatbelts may become unlatched, the seatbelt webbing can "payout" during an accident sequence, or seat tracks can fail. Seatbelts must be designed to fit as closely to the body as is possible and claims may be brought against vehicle and/or seatbelt manufacturers for designing belts failing to protect occupants.

Tire Defects

A tire defect case may exist if there is a loss of vehicular control. Sometimes the association between loss of control and a tire condition is relatively easy to determine, like with blowouts. Tire mounting errors can also severely impair a driver's ability to control the vehicle.

Child Safety Seats

Any time a child riding in a carseat is seriously injured in a accident, there must be an evaluation as to whether or not the child seat contained any defects. Frequently seats become dislodged from bases, issues with the seatbelt or latch issues exist, or problems occur with which how the child seat "fits" in specific cars.

Passenger Vans

Because "15 passenger vans" have significant stability and handling problems exacerbated when fully occupied, a crashworthiness case must be investigated whenever an accident occurs.

Wednesday, May 26, 2010

Boating Accidents

A recent U.S. Coast Guard report provides that 4,904 recreational boating accidents occur annually resulting in 676 fatalities, 3,363 injuries, and $35,038,306 of property damage.

Whether on a luxury cruise, fishing trip, diving expedition, or just water skiing, boating has become an increasingly dangerous and injurious activity.

Types and Causes of Boating Accidents

Although collisions are the most reported type of accident, and capsizing and falling overboard account for over half of all fatalities, boating accidents also include sinking/flooding, explosions, disappearance and fire.

Boating accidents are caused by carelessness or reckless operation, operator inattention or inexperience, excessive speed, and operating a watercraft under the influence of alcohol.

Boating accidents also result from poorly designed boats including failure of the boat's machinery or hull.

Boating Accidents Reports

A boating accident report must be filed when a life is lost, an injury occurs requiring medical attention beyond first aid, damage is caused by or to the vessel and other property, or any person disappears under circumstances indicating death or injury.

Boating accident reports must be filed within 48 hours if a person dies or requires treatment beyond first aid and 10 days if there is only damage to the boat and/or other property.

Laws Governing Boat Accidents

Boating accidents are governed by local, county and state criminal and civil laws requiring operating a watercraft in a safe, non-negligent manner.

Boat owners must also must be careful about allowing others to operate their vessel because, regardless of the operator, “accident causing” boat owners may be liable for damages.

Failure to remain on the scene, provide aid or timely report accident to the applicable authorities is also a crime.

Steps to Take if Injured in a Boating Accident

If injured in a boat accident, you have the right to be compensated for property damage, medical expenses, lost wages, pain and suffering, and any permanent injury.

To protect your rights after a boating accident injury:
○seek medical treatment as soon as is possible;
○obtain all accident information your including names and contact information of all parties and witnesses, insurance information and reports;
○Talk to no one about your accident other than law enforcement officials. Anything you say to an insurance company may make it harder to settle your claim.
○Sign nothing, especially a release form, without talking to an attorney first.

Wednesday, April 28, 2010

Infant Deaths Prompt Safety Commission Warning About Sling Carriers

After fourteen (14) deaths associated with sling-style infant carriers, twelve (12) of which involved babies under four (4) months old, the U.S. Consumer Product Safety Commission ("CPSC") is cautioning parents about using infant slings.

Slings pose two (2) different types of baby suffocation hazards.

First, because of weak neck muscles during the first few months of life, babies are unable to control their heads and the sling's fabric can press against the nose and mouth, block breathing, and suffocate a baby within a minute.

Second, where a sling keeps the infant in a curled position bending the chin toward the chest, airways are restricted limiting the oxygen supply suffocating the baby and preventing cries for help.

Further, because many of the babies who died in slings were a low birth weight twin, born prematurely, or had breathing issues, parents of preemies, twins, babies in fragile health and those with low weight are urged to use extra care and consult pediatricians before using slings.

Slings were recently added to the "infant products requiring a mandatory standard" list and the CPSC recommends that the infant's face is not covered and kept visible to the sling's wearer.

Further, if nursing in a sling, change the baby's position after feeding so the infants head is facing up and clear of the sling and the mother's body.

Structured Settlements in Personal Injury Cases

You just achieved a sizable personal injury settlement or court award.

While receiving the funds in a “lump sum” sound appealing, having the monies distributed in a “structured settlement” often makes more sense.

What is a Structured Settlement

Any personal injury settlement or court award you achieve is reduced by costs associated with a legal action including:
○Attorneys' fees and costs advanced by the lawyer;
○Unpaid costs for treatment resulting from injury; and
○Medical and related costs paid by your insurance carrier.

After costs are deducted, the remaining amount may be paid either in a lump sum or a
"structured settlement," i.e., where monies are paid out in specified increments over a set period of time.

Structured settlements are often favored by the insurance companies paying the monies for reasons including:
○Because most lump-sum awards are exhausted within 5 years, protects against injured party spending award too quickly;
○When injuries are catastrophic, award may be needed to satisfy future income and
medical care needs;
○Many courts are unwilling to allow parents to manage awards on behalf of minors, for fear that they may spend it; and
○May avoid costs associated with lawsuit’s filing and prosecution.

Procedure for Structured Settlements

Although procedures and laws governing structured settlements vary from state to state, common elements often include:
○Negotiations – To determine amount and duration of needed periodic payments, financial planners or other experts are often consulted.
○Determination of award amount – There must be a determination regarding available amount for periodic payments. This calculation may include setting aside amounts needed for attorneys' fees, costs, payment of outstanding medical fees, medical needs in the near future, and lump sum needed by injured party.
○Annuity Contract – Parties must select and negotiate an "annuity contract" to fund the periodic payments. Annuity contracts are offered by insurance companies and may entail one lump-sum payment for a guaranteed stream of payments for a specified time or even for the recipient’s life.
○Drafting Agreement – Because most jurisdictions require court approval for structured settlements, the finalized agreement must be drafted and adopted bythe court.

Tax Benefit of Structured Settlements

Beyond providing a stream of income for a specified period or for life, structured settlements may offer federal tax advantages.

The Internal Revenue Code may allow an injured taxpayer to exclude monies received for physical injuries or sickness from his taxable income, whether from an award in a lawsuit or a negotiated settlement.

Further, annuity payments are based upon various factors, including how long the recipient is likely to live. An injured party may live longer and end up receiving substantially more than the original award or settlement, but the excess may be tax free if he never had receipt of the funds used to buy the annuity and has no ownership rights in it.

Saturday, February 27, 2010

Mishandled Labor Causing Birth Trauma and Injuries

Birth Trauma and Injuries and Causes

Complications in the labor and delivery process - - called “birth trauma and injuries” - - create multiple problems for a newborn baby.

For example, oxygen deprivation, occurring when the umbilical cord is compressed and/or twisted in the birth process, is a huge cause of birth injuries.

“Mechanical trauma” is also a major cause and occurs when the baby assumes an unusual position at the time of birth.

Red flags as to trauma and injury during pregnancy or birth include excessive bleeding, long labor, breech births, fetal distress and excessive water retention and weight gain.

Birth injuries occurring during labor or delivery include seizures, meconium aspiration, fetal distress, excessive bleeding, fever, brachial plexus, cerebral palsy, and shoulder dystocia.

Cerebral Palsy

“Cerebral palsy” describes a group of disorders affecting movement control including jaundice, kidney or urinary tract infection, viral infection or measles, oxygen deprivation during delivery, bleeding, head injury, bacterial meningitis, and viral encephalitis.

Cerebral palsy has no one cause and may result from an injury to the brain before, during, or after birth.

Factors suggesting that cerebral palsy results from improper medical care or insult to the brain during the birthing process include seizures developing within 24-48 hours of birth, blue skin, infant needing resuscitation shortly after delivery because he is not breathing, poor sucking or problems maintaining temperature after birth, and meconium (fecal) staining on the body at the time of delivery.

Erb's Palsy, Brachial Plexus Palsy

Erb's Palsy, Brachial Plexus Palsy occurs when excessive lateral traction is applied to the fetal neck region during delivery tearing nerves resulting in a limp arm.

Tearing of these nerves can cause permanent arm paralysis, the most common forms are
“Neuropraxia” (stretching - - but not a tear - - of tnerve from which child usually recovers without treatment) and “Neuroma” (where nerves are torn and heal leaving scar tissue exerting pressure, and disabling, nerve).

Surgery can improve nerve rupture (i.e., when stretching causes nerve tear at any point except at spinal attachment) or avulsion (i.e., when nerve tears at spinal attachment).

Shoulder Dystocia

Shoulder dystocia refers to a complication in which the baby’s shoulder gets caught behind the mother’s pelvic bone preventing the baby from breathing.

Methods of changing mother’s position allowing her pelvis to open - - and the baby's shoulder to pass through - - include reaching into birth canal and turning child, “McRoberts Maneuver” (flexing legs toward shoulder and placing pressure above pubic bone to allow room for baby to shift), “Woods Maneuver” (applying pressure to free shoulder to turn baby's body and release trapped shoulder) and pushing baby back in and performing a Caesarian Section.

If you or a have been harmed by doctor error, medical malpractice, mishandled labor, or other forms of medical negligence, contact us at schain@schaininjury.com today.

Wednesday, January 27, 2010

Spinal Cord Injuries

What is the Spinal Cord

The spinal cord is a long, thin tubular bundle of nervous tissue and support cells extending from the brain down the middle of the back. It is surrounded and protected by the bony vertebral column.

The spinal cord carries messages between the brain and the rest of the body allowing you to move, feel, and touch.

The lower spine has a series of vertebra through which the spinal cord runs. Each vertebra is separated by a disc cushioning the vertebra and promoting comfortable disc movement as we bend. Nerves controlling the lower body’s muscle function branch from the spinal cord and pass through spaces in the vertebra as they connect to various muscles.

What is a Spinal Cord Injury

Spinal cord injuries stop the flow of messages below the site of the injury. The closer the injury is to the brain, the more the body is affected.

The discs separating the vertebra are made up of a jelly-like center disc material encased in a strong fibrous like covering. If the disc covering is damaged, the disc material partially escapes causing the disc material to come into contact with an adjacent nerve root coming off the spinal cord or touching or impinging upon the spinal cord itself.

The escape of the disc material from within a lumbar disc is called a "herniation".

How Are Spinal Cord Injuries Caused

Spinal cord injuries commonly result from trauma caused by a car accident, motorcycle accident, or fall.

Radiologists distinguish how much the disc material is pushing out of the disc with terms like bulge (the least amount), protrusion, herniation and frank herniation (total escape of the material). These conditions may be caused by the wear and tear process of disc degeneration as we age, an injury from trauma, or a combination of the two.

Pain Created By Spinal Cord Injuries

The escaped disc material’s contact with the nerves causes pain and, for most people with a herniated disc, low back pain is initial symptom.

The pain may last for a few days, then improve and often is followed by the eventual onset of additional symptoms such as numbness, weakness and leg pain.

This leg pain typically occurs in - - and moves through - - the back and buttock down into the knee, ankle and foot.

Symptoms include back pain, leg and/or foot pain (sciatica), and weakness/numbness in the leg and/or foot.

Whiplash Distinguished From Spinal Cord Injury

“Whiplash” is a non-medical term describing neck pain often diagnosed as cervical sprain, cervical strain, or hypertension injury.

Whiplash is caused by the neck and head being thrown suddenly backward then forward upon impact, such as in a car crash.

The impact forces the neck and head beyond their normal range of movement, causing tissue damage and pain.