Orthapedic Injuries in Personal Injury Cases; Motion Analysis

The Journal of Bone and Joint Surgery has recently published an article about a study by orthopedic surgeons about motion analysis. Apparently, this is the study of the gait and walking changes of someone who has suffered an orthopedic injury to the leg. This would include the foot, ankle, lower leg (tibia or fibula), knee, upper leg (femur), the hip or the pelvis.

We have found in our practice here at Hickey Law Firm, P.A. that whenever someone injures their leg or in some other way alters the way they walk, that is their gait, this alters and affects other parts of their bodies. Most commonly, we see back problems after this. Oftentimes the back injury can become as bad or worse than the initial injury which sets off the chain reaction to make the back hurt. That is why measuring the altered gait is so important.

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Motion analysis is an important tool that is used to understand the complexities of movement and lower extremity function. Such a detailed description of function has been valuable for determining both nonoperative and operative management guidelines for individuals with abnormal gait patterns1-4.

Gait-evaluation protocols involving the use of instrumented treadmills are likely to be used in the near future. Riley et al. performed a kinematic and kinetic comparison of overground and treadmill walking in a study of healthy subjects and demonstrated that treadmill gait is qualitatively and quantitatively similar to overground gait and that the mechanics of treadmill and overground gait are very similar5. Having demonstrated the essential equivalence of treadmill and overground gait, the authors proposed the possibility of incorporating treadmill-based protocols into clinical movement analysis.

TBI Can Cause Neuroendocrine Dysfunction. This just in from the newest edition of the Journal of the American Medical Assorciation.

Hypothalamopituitary Dysfunction Following Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage
A Systematic Review

Harald Jörn Schneider, MD; Ilonka Kreitschmann-Andermahr, MD; Ezio Ghigo, MD; Günter Karl Stalla, MD; Amar Agha, MD

JAMA. 2007;298:1429-1438.

Context Neuroendocrine dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage may occur with a much higher prevalence than previously suspected. This sequela is a potentially serious but treatable complication of brain injury.

White matter integrity and cognition in chronic traumatic brain injury: a diffusion tensor imaging study. There are new studies out about this new imaging technique. This is supposed to help quanitify the axonal shearing in the brain following traumatic brain injury.

Call us at Hickey Law Firm, P.A. for a free consultation about TBI, personal injury or wrongful death. 1.800.215.7117.

Thursday, September 27, 2007
Man Hurt in Overnight Boaing Incident

A downstate man lost his leg in a boating accident on a Gladwin County Lake. Deputies responded to the call from Pratt Lake in Sage Township just before two this morning. Passengers say Michael Doty of Grand Ledge jumped out of the boat while the engine propeller was moving. His right leg was severed below the knee. He’s now recovering at a hospital in Saginaw.

Kolcraft Enterprises, the maker of baby furnishings, recalled about 425,000 playpens after the strangulation of a 10-month-old boy, the Consumer Product Safety Commission said yesterday.

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List of Recalled Playpens
Times Topics: Consumer Product SafetyThe agency said in a statement that it received a report of a boy strangled by a looped restraining strap hanging from a changing table on the company’s Sesame Beginnings Travel Play Yard.

Call Hickey Law Firm, P.A., toll free for a free consultation: 1.800.215.7117. Product liability; wrongful death; personal inury.

In August, a baby in Montrose, Colorado died after being wrapped in the strings of a crib bumper or side pad. The parents of the baby are urging a recall of the product. Call us if you or your family has suffered severe personal injury or wrongful death from a product. We handle personal injury and wrongful death cases all over Florida. See more at www.hickeylawfirm.com. Call toll free at 1.800.215.7117.

On August 9, 2007, at about noon, a recreational boat, a speed boat owned and piloted (driven) by a man from Miami, Florida, ran over a diver in the northern Bahamas near Bimini. A helicopter from the United States Coast Guard responded and transported the injured diver to a hospital in Nassau. The diver died.

This was a tragic accident the likes of which is happening more and more in the waters off of Florida. When recreational boating accidents happen, maritime law applies. Maritime law is a specialized area and you need an experienced maritime lawyer for that type of claim. We at Hickey Law Firm are experienced in martime law as it applies to recreational boating and diving accidents. I have been a trial lawyer specializing in maritime cases for 27 years. I was for the first 17 years of my career a lawyer for the cruise lines, insurance companies, and railroads. For the last 10 years, I have represented only the victims of these accidents. We handle personal injury and wrongful death cases. All consultations are free. We work on a contingency basis and so if we do not recover, you do not pay. See us at: www.hickeylawfirm.com. Call us now toll free at: 1.800.215.7117.

Concept of coefficient of friction a major factor in slip and fall litigation By Melvin M. Friedlander, P.E. Wednesday, August 22, 2007

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When a person enters litigation, because of an injury from a slip and fall accident, the slipperiness of the surface becomes a major factor in the matter before the court. The slipperiness of the surface is measured by a dimensionless ratio called the coefficient of friction, or COF. The COF is the surface force, generated by a pedestrian, in the walking direction, divided by the weight of the pedestrian. As an example, a 200-pound pedestrian generating a 100-pound surface force will have a COF equal to 0.50 The value of the COF is determined by the type of the pedestrian’s shoe bottom (heel and/or sole) or bare foot, and the condition of the surface. For example, a leather shoe bottom, on a given type of surface, will have a greater tendency to cause a slip and fall than a rubber shoe bottom on the same surface. A significant factor in COF research has shown that the COF will remain constant for the same shoe bottom and surface conditions. Under these circumstances, our 200-pound pedestrian generating a 100-pound surface force will develop the same COF as a 100-pound pedestrian generating a 50-pound surface force. This phenomenon allows an investigator to use a simulated test foot, as low, in weight as one to 10 pounds, to obtain the same COF that was generated by a very heavy pedestrian with a weight in the order of 300 pounds, as an example. In these investigations, the assumption is made that the object weight will not be great enough to depress the level surface to a point that will cause the COF to change. Contaminated surfaces will yield lower COF values than clean day surfaces. A surface, wet with water or other slippery contaminants, such as mud, banana skins, or oil will produce a COF much lower than that of a dry surface. Water is the most common contaminant and can wet a surface in varying degrees. For instance, a surface can be damp from rain and yield a lower COF than a dry surface. A wetter surface, with water drops, will be still more hazardous and a surface, covered with pooled water, will have the same effect as hydroplaning, where the pedestrian’s shoe bottom will ride on the surface of the water, never touching the walkway surface. A condition like this will usually show a COF less than 0.10. The value of the COF, in general, will vary from 0 to about 1.1 and is inversely proportional to the slipperiness of the surface. A very slippery surface will have a very low COF like 0.10 for ice and 0.20 to 0.30 for wet smooth tile, whereas a clean broom-finished dry concrete surface will have a COF of about to 0.70 to 0.80. The most slippery surface is considered to be wet soapy glass, which has a COF of 0. In the U.S, most investigators consider a surface to be safe when the static COF is greater than 0.50 and the dynamic COF is greater than 0.40. The probability of a slip and fall increases with the decrease in the COF. With a COF approaching 0, the probability would be close to 100 percent, whereas with a COF - 0.5 or above, the probability would be very low. As a matter of fact, a surface could get so high in the COF value, or traction, that it could lead to a trip and fall due to stumbling. There are two types of COF conditions. The first is called the static COF and the second is called the dynamic COF. In the classical sense, the COF is measured by placing a flat block (usually metal) on a clean level surface and then initiating a pulling force, on the block, where the force is parallel to the surface. The static COF is determined by the value of the force at initiation of motion of the block. It is calculated by dividing the measured force by the weight of the block. The dynamic COF is determined by the same method, but the force is measured while the block is moving. The dynamic force is usually smaller than the static force. The COF is measured by devices called slip-testers or tribometers, which can vary in complexity from the simple block, pulled over a surface (and sophisticated variations of this type), to articulated or pendulum instruments with many parts that can be actuated by methods other than direct pulling. In addition, a ramp-type device, using humans and a self propelled dynamic tester, is popular in Europe. Research also shows the development of robot slip-testers. With the exception of the ramp, all of the instruments basically measure static or dynamic COF in the same manner as accomplished with the simple block. All slip testers attempt to simulate the motion of the bottom of the shoe or bare foot, and hence the COF, either at the initiation of a slip or after slip is initiated. This is accomplished by using material (called a sensor), placed at the bottom of the tester. Popular materials for a sensor are Neolite, leather, rubber and a material called silastic, which is used for testing bathtub and shower slipperiness. In addition, the Brungraber set of tribometers can use any sensor desired such as the bottom of the shoe that was worn at the time of the accident. Depending on accident conditions, testing is normally done at the site, on dry, contaminated, and/or wet surfaces.Concept of coefficient of friction a major factor in slip and fall litigation By Melvin M. Friedlander, P.E. Wednesday, August 22, 2007

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When a person enters litigation, because of an injury from a slip and fall accident, the slipperiness of the surface becomes a major factor in the matter before the court. The slipperiness of the surface is measured by a dimensionless ratio called the coefficient of friction, or COF. The COF is the surface force, generated by a pedestrian, in the walking direction, divided by the weight of the pedestrian. As an example, a 200-pound pedestrian generating a 100-pound surface force will have a COF equal to 0.50 The value of the COF is determined by the type of the pedestrian’s shoe bottom (heel and/or sole) or bare foot, and the condition of the surface. For example, a leather shoe bottom, on a given type of surface, will have a greater tendency to cause a slip and fall than a rubber shoe bottom on the same surface. A significant factor in COF research has shown that the COF will remain constant for the same shoe bottom and surface conditions. Under these circumstances, our 200-pound pedestrian generating a 100-pound surface force will develop the same COF as a 100-pound pedestrian generating a 50-pound surface force. This phenomenon allows an investigator to use a simulated test foot, as low, in weight as one to 10 pounds, to obtain the same COF that was generated by a very heavy pedestrian with a weight in the order of 300 pounds, as an example. In these investigations, the assumption is made that the object weight will not be great enough to depress the level surface to a point that will cause the COF to change. Contaminated surfaces will yield lower COF values than clean day surfaces. A surface, wet with water or other slippery contaminants, such as mud, banana skins, or oil will produce a COF much lower than that of a dry surface. Water is the most common contaminant and can wet a surface in varying degrees. For instance, a surface can be damp from rain and yield a lower COF than a dry surface. A wetter surface, with water drops, will be still more hazardous and a surface, covered with pooled water, will have the same effect as hydroplaning, where the pedestrian’s shoe bottom will ride on the surface of the water, never touching the walkway surface. A condition like this will usually show a COF less than 0.10. The value of the COF, in general, will vary from 0 to about 1.1 and is inversely proportional to the slipperiness of the surface. A very slippery surface will have a very low COF like 0.10 for ice and 0.20 to 0.30 for wet smooth tile, whereas a clean broom-finished dry concrete surface will have a COF of about to 0.70 to 0.80. The most slippery surface is considered to be wet soapy glass, which has a COF of 0. In the U.S, most investigators consider a surface to be safe when the static COF is greater than 0.50 and the dynamic COF is greater than 0.40. The probability of a slip and fall increases with the decrease in the COF. With a COF approaching 0, the probability would be close to 100 percent, whereas with a COF - 0.5 or above, the probability would be very low. As a matter of fact, a surface could get so high in the COF value, or traction, that it could lead to a trip and fall due to stumbling. There are two types of COF conditions. The first is called the static COF and the second is called the dynamic COF. In the classical sense, the COF is measured by placing a flat block (usually metal) on a clean level surface and then initiating a pulling force, on the block, where the force is parallel to the surface. The static COF is determined by the value of the force at initiation of motion of the block. It is calculated by dividing the measured force by the weight of the block. The dynamic COF is determined by the same method, but the force is measured while the block is moving. The dynamic force is usually smaller than the static force. The COF is measured by devices called slip-testers or tribometers, which can vary in complexity from the simple block, pulled over a surface (and sophisticated variations of this type), to articulated or pendulum instruments with many parts that can be actuated by methods other than direct pulling. In addition, a ramp-type device, using humans and a self propelled dynamic tester, is popular in Europe. Research also shows the development of robot slip-testers. With the exception of the ramp, all of the instruments basically measure static or dynamic COF in the same manner as accomplished with the simple block. All slip testers attempt to simulate the motion of the bottom of the shoe or bare foot, and hence the COF, either at the initiation of a slip or after slip is initiated. This is accomplished by using material (called a sensor), placed at the bottom of the tester. Popular materials for a sensor are Neolite, leather, rubber and a material called silastic, which is used for testing bathtub and shower slipperiness. In addition, the Brungraber set of tribometers can use any sensor desired such as the bottom of the shoe that was worn at the time of the accident. Depending on accident conditions, testing is normally done at the site, on dry, contaminated, and/or wet surfaces.

____________________

Hickey Law Firm, P.A. handles all types of slip and fall c

A recent scholarly article described studies on nerve growth factor in children who have suffered traumatic brain injury.  In plain language, when there is a TBI, the brain produces cytokines, cells in the brain to protect the brain in time of injury.  However, there are within the brain at this time too much fluid buildup because of a number of secretions, that is neuro inflammatory mechanisms.  This inflammation in turn can cause damage in the brain.  The relationship between all of these secretions is not well understood.    

 Nerve growth factor expression correlates with severity and outcome of traumatic brain injury in children Antonio Chiaretti^{a, ,} , Alessia Antonelli^a, Riccardo Riccardi^b, Orazio Genovese^a, Patrizio Pezzotti^c, Concezio Di Rocco^d, Luca Tortorolo^a and Giovanni Piedimonte^e
aPaediatric Intensive Care Unit, Catholic University School of Medicine, Rome, Italy
^bDepartment of Paediatrics, Catholic University School of Medicine, Rome, Italy
^cAgency for Public Health of Lazio Region, Rome, Italy
^dPaediatric Neurosurgery, Catholic University School of Medicine, Rome, Italy
^eDepartment of Paediatrics, West Virginia University School of Medicine, Morgantown, WV, USA
Received 26 January 2007;  revised 26 June 2007;  accepted 30 July 2007.  Available online 18 September 2007.

Abstract

Background

Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms, mainly dependent on the intracerebral production of cytokines. In particular, interleukin 1β (IL-1β) is associated with neuronal damage, while interleukin 6 (IL-6) exerts a neuroprotective role due to its ability to modulate neurotrophins biosynthesis. However, the relationship between these cytokines and neurotrophins with the severity and outcome of TBI remains still controversial.

Aims

To determine whether the concentration of IL-1β and IL-6 and neurotrophins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF)) in the cerebrospinal fluid (CSF) of children with TBI correlates with the severity of the injury and its neurologic outcome.

Methods

Prospective observational clinical study in a university hospital. CSF samples were collected from 27 children at 2 h (Time T1) and 48 h (Time T2) after severe TBI, and from 21 matched controls. Severity of TBI was evaluated by GCS and neurologic outcome by GOS. CSF concentrations of cytokines and neurotrophins were measured by immunoenzymatic assays.

Results

Early NGF and IL-1β concentrations (T1) correlated significantly with the severity of head injury, whereas no correlation was found for IL-6, BDNF, and GDNF. Furthermore, higher NGF and IL-6 and lower IL-1β expression at T2 were associated with better neurologic outcomes. No significant association was found between BDNF or GDNF expression and neurologic outcome.

Conclusions

NGF concentration in CSF is a useful marker of brain damage following severe TBI and its up-regulation, in the first 48 h after head injury together with lower IL-1β expression, correlates with a favorable neurologic outcome. Clinical and prognostic information may also be obtained from IL-6 expression.

Keywords: Children; Cytokines; Neuroprotection; Neurotrophic factors; Traumatic brain injury

Nerve growth factor expression correlates with severity and outcome of traumatic brain injury in children Antonio Chiaretti^{a, ,} , Alessia Antonelli^a, Riccardo Riccardi^b, Orazio Genovese^a, Patrizio Pezzotti^c, Concezio Di Rocco^d, Luca Tortorolo^a and Giovanni Piedimonte^e
aPaediatric Intensive Care Unit, Catholic University School of Medicine, Rome, Italy
^bDepartment of Paediatrics, Catholic University School of Medicine, Rome, Italy
^cAgency for Public Health of Lazio Region, Rome, Italy
^dPaediatric Neurosurgery, Catholic University School of Medicine, Rome, Italy
^eDepartment of Paediatrics, West Virginia University School of Medicine, Morgantown, WV, USA
Received 26 January 2007;  revised 26 June 2007;  accepted 30 July 2007.  Available online 18 September 2007.

Abstract

Background

Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms, mainly dependent on the intracerebral production of cytokines. In particular, interleukin 1β (IL-1β) is associated with neuronal damage, while interleukin 6 (IL-6) exerts a neuroprotective role due to its ability to modulate neurotrophins biosynthesis. However, the relationship between these cytokines and neurotrophins with the severity and outcome of TBI remains still controversial.

Aims

To determine whether the concentration of IL-1β and IL-6 and neurotrophins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF)) in the cerebrospinal fluid (CSF) of children with TBI correlates with the severity of the injury and its neurologic outcome.

Methods

Prospective observational clinical study in a university hospital. CSF samples were collected from 27 children at 2 h (Time T1) and 48 h (Time T2) after severe TBI, and from 21 matched controls. Severity of TBI was evaluated by GCS and neurologic outcome by GOS. CSF concentrations of cytokines and neurotrophins were measured by immunoenzymatic assays.

Results

Early NGF and IL-1β concentrations (T1) correlated significantly with the severity of head injury, whereas no correlation was found for IL-6, BDNF, and GDNF. Furthermore, higher NGF and IL-6 and lower IL-1β expression at T2 were associated with better neurologic outcomes. No significant association was found between BDNF or GDNF expression and neurologic outcome.

Conclusions

NGF concentration in CSF is a useful marker of brain damage following severe TBI and its up-regulation, in the first 48 h after head injury together with lower IL-1β expression, correlates with a favorable neurologic outcome. Clinical and prognostic information may also be obtained from IL-6 expression.

Keywords: Children; Cytokines; Neuroprotection; Neurotrophic factors; Traumatic brain injury

Hickey Law Firm handles severe, moderate, and mild traumatic brain injury from both open head injuries and closed head injuries.  John H. (Jack) Hickey has been involved in this field for almost as long as he has practiced law, 27 years.  He is a Board Certified Civil Trial Lawyer, is rated A/V by Martindale Hubbell, and is rated by his peers as a Superlawyer in Superlawyer.com, and the insurance companies and cruise lines know it.     Call toll free:  1.800.215.7117.  See us at www.hickeylawfirm.com.

This just in about the hearings in Congress this week.  Remember, if you have a claim against the cruise lines you have to bring suit in the city specified in the ticket and within one year of the incident.  For Carnival Cruise Lines, Royal Caribbean Cruise Lines, Celebrity Cruise Lines, and Norwegian Cruise Lines that city is Miami, Florida.   Call Hickey Law Firm, P.A. in Miami, Florida today toll free: 1.800.215.7117.  “Was an attorney for the cruise lines;  now an attorney for you.”  John H. (Jack) Hickey testified before Congress on this subject on March 27, 2007.   This is the story of the hearings this week:      

Cruise Hearings: Scandal on the High Seas?

Congress Addresses Complaints About the Cruise Industry; Do They Escape U.S. Law?

Congress to hold cruise ship hearings. (PhotoDisc) From GMA Sept. 19, 2007 Font Size

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Share var addthis_pub = ‘abcnews’;It’s estimated that more than 10 million Americans will go on cruises every year.

Now after complaints of onboard assaults, thefts and even mysterious disappearances, Congress is investigating how safe these vacations are. A House Transportation subcommittee is holding hearings on cruise safety this morning.

Related Stories

• Fancy a Cruise? You’re Not the Only One
• Prosecutor to examine Australian cruise ship death
• Attack Survivor Dies in Cruise Ship Jump
• FBI Investigating Cruise Ship Incident
• Cruise Ship to Return to Service in July

Top GMA stories

• Robin Roberts Set to Begin Chemotherapy
• Not All They’re ‘Croc’d’ Up to Be?
• How Behar’s Celeb Pals Get Happy

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Two hundred cruise ships dock in the United States, 198 of which are registered in foreign countries, exempting them from abiding by most U.S. laws and regulations.

This morning, Congress will hear testimony from passengers with stories about poor security and little accountability in this $30-billion-a-year industry.

Testifying will be Angela Orlich of Springfield, Mass., who with family and friends, went on a Royal Caribbean cruise in January 2003.

“We just thought that was the perfect thing to do, to see all the islands,” Orlich said.

Aboard the ship, Orlich bought a scuba excursion in Cozumel, Mexico.

But once her instructor got her alone underwater, she says he started to sexually assault her.

“I started going towards the rope and I started to pull myself up on the rope, and he was pushing me down,” Orlich said. “I started going up the rope again and at this time he started taking my bathing suit off, pulling it down.”

She said he proceeded to shut her air tank off.

“I don’t know if he was trying to murder me or what. But I got back up, I got to the top.”

Orlich says no one at the cruise lines seemed to care. Royal Caribbean did not respond to ABC News’ requests for comments.

In one three-year period, 178 cruise passengers reported sexual assaults and 24 passengers disappeared - like George Smith, who vanished during his honeymoon.

“We can’t hold a funeral, and as, you know, as far as Royal Caribbean is concerned, they would merely have another drunk falling in the water - ‘nothing we could do about it’ - and that’s not good enough,” his sister Bree Smith said.

In March, Terry L. Dale, president and CEO of the Cruise Lines International Association, testified before Congress that “the cruise industry has a zero tolerance for crime. Our industry takes all allegations and incidents of crime onboard seriously.”

Cruise Hearings: Scandal on the High Seas?

Congress Addresses Complaints About the Cruise Industry; Do They Escape U.S. Law?

Congress to hold cruise ship hearings. (PhotoDisc) From GMA Sept. 19, 2007 Font Size

E-mail
Print
Share var addthis_pub = ‘abcnews’;It’s estimated that more than 10 million Americans will go on cruises every year.

Now after complaints of onboard assaults, thefts and even mysterious disappearances, Congress is investigating how safe these vacations are. A House Transportation subcommittee is holding hearings on cruise safety this morning.

Related Stories

• Fancy a Cruise? You’re Not the Only One
• Prosecutor to examine Australian cruise ship death
• Attack Survivor Dies in Cruise Ship Jump
• FBI Investigating Cruise Ship Incident
• Cruise Ship to Return to Service in July

Top GMA stories

• Robin Roberts Set to Begin Chemotherapy
• Not All They’re ‘Croc’d’ Up to Be?
• How Behar’s Celeb Pals Get Happy

adsonar_placementId=1280600;adsonar_pid=59749;adsonar_ps=-1;adsonar_zw=165;adsonar_zh=220;adsonar_jv=’ads.adsonar.com’;

Two hundred cruise ships dock in the United States, 198 of which are registered in foreign countries, exempting them from abiding by most U.S. laws and regulations.

This morning, Congress will hear testimony from passengers with stories about poor security and little accountability in this $30-billion-a-year industry.

Testifying will be Angela Orlich of Springfield, Mass., who with family and friends, went on a Royal Caribbean cruise in January 2003.

“We just thought that was the perfect thing to do, to see all the islands,” Orlich said.

Aboard the ship, Orlich bought a scuba excursion in Cozumel, Mexico.

But once her instructor got her alone underwater, she says he started to sexually assault her.

“I started going towards the rope and I started to pull myself up on the rope, and he was pushing me down,” Orlich said. “I started going up the rope again and at this time he started taking my bathing suit off, pulling it down.”

She said he proceeded to shut her air tank off.

“I don’t know if he was trying to murder me or what. But I got back up, I got to the top.”

Orlich says no one at the cruise lines seemed to care. Royal Caribbean did not respond to ABC News’ requests for comments.

In one three-year period, 178 cruise passengers reported sexual assaults and 24 passengers disappeared - like George Smith, who vanished during his honeymoon.

“We can’t hold a funeral, and as, you know, as far as Royal Caribbean is concerned, they would merely have another drunk falling in the water - ‘nothing we could do about it’ - and that’s not good enough,” his sister Bree Smith said.

In March, Terry L. Dale, president and CEO of the Cruise Lines International Association, testified before Congress that “the cruise industry has a zero tolerance for crime. Our industry takes all allegations and incidents of crime onboard seriously.”