“Behavioral Challenges after Brain Injury:” Booklet produced by the Brain Injury Association of America

The Brain Injury Association of America (BIAA) website has a number of useful online resources for individuals and family members affected by traumatic brain injury.

“Behavioral Challenges After Brain Injury” (PDF) is one such resource that informs people with brain injuries, their families, and caregivers about the kinds of behavioral challenges they may face, while also offering practical ways to address these challenges.*

Find this and other great resources on the Brain Injury Association of America website www.biausa.org.

 

*Please note that while some of the materials referenced on biausa.org are intended for an American audience, the material in general is useful and applicable to anyone affected by brain injury.

After the Crash theatre performance about TBI
sponsored by Webster & Associates

Ruckus Ensemble After the CrashWe are pleased to be sponsoring a performance of After the Crash with Vancouver Coastal Health and Connect Communities.  After the Crash is engaging research-based theatre performance about traumatic brain injury.

The After the Crash performance group are one of the keynote presenters at Pacific Coast Brain Injury Conference (Feb 15-17, 2012) who have agreed to put on an additional, free, performance at GF Strong on Tuesday February 14, 2012 at 11.30am.

What is the play about?
While the story of After the Crash is fictional, each situation or scene in the play is based on real events and situations.

Elliot is a young professional who has suffered a traumatic brain injury. Because of this experience, he is faced with the challenge of rebuilding his life and his relationships, and the people around him play an important role in his struggle towards recovery.

How was the play developed?
Originally developed by the Toronto Rehabilitation Institute and the University of Toronto, it is a unique synthesis of research and art derived from focus group research with brain injury survivors, their family members and health care providers to learn about their experiences.

Who is this play for?
This play is intended for healthcare providers and TBI survivors alike.

Upcoming Performances:

FREE Performance

Date: Tuesday, February 14, 2012
Time: 11.30am
Location: GF Strong Rehabilitation Centre, GF Strong Auditorium, 4255 Laurel Street, Vancouver, BC
RSVP: This performance is open to all and while an RSVP is not required, we are interested in knowing who will attend, so please let us know if you plan to attend. Please call 604.734.1313.


Performed at the 22nd Pacific Coast Brain Injury Conference


Date:
Wednesday, February 15, 2012
Time: 8.30pm
Location: Pacific Coast Brain Injury Conference, Sheraton Wall Centre, Vancouver, BC
RSVP: Conference registration required

More information about the Ruckus Ensemble perfomance group can be found at www.ruckusensemble.com.

 

We look forward to seeing you at one of the upcoming performances.

 

Webster & Associates is proud to sponsor the 2012 Pacific Coast Brain Injury Conference

The 22nd Pacific Coast Brain Injury Conference

Date: February 15-17, 2012,
Location: Sheraton Vancouver Wall Centre, Vancouver, BC Canada
with satellite conferences held in Victoria and Kamloops.
Registration & conference details: brainstreams.ca


This year’s theme is:
Real people with Real Lives: It takes a Village.

Speaker Sessions include:

  • After the Crash (Theatre performance)
    Ruckus Ensemble
  • A Run to Remember
    David McGuire, Brain Injury Surivior
  • Trauma, Rehabilitation and Recovery – It Takes a Village
    Val Lougheed, President, Northern Lights Canada
  • Concussions in Sport
    Kerry Goulet and Keith Primeau, Co-founders, stopconcussions.com
  • Navigating through the Complexities of Life and Brain Injury
    Lois McElravy, Lessons from Lois
  • Neuroplasticity, MRI and Recovery
    Dr. Catherine Mateer, University of Victoria and Dr. Ryan D’Arcy, National Research Council Canada, Captain Trevor and Debbie Greene, Victoria
  • Head Injury and Addictions: What is the Causal Relationship?
    Dr. Gabor Maté, Physician, Author, Public Speaker
  • Brain Injury Associations: Their Role in the Village
    Terry-Lynn Stone, Executive Director, Kamloops Brain Injury Association

For more details on the speaker sessions, click here.

Register for the 2012 PCBIC at: brainstreams.ca/conference/registration

 

Over $9 million in recent client settlements

The key to a successful settlement is a thorough investigation and a full preparedness for trial. It is through our trial experience and successes that we are able to obtain significant settlements for our clients. It is Webster & Associates’ reputation for trial preparation and willingness to take matters to trial that allows for the largest settlements.

In our practice approximately 80 to 90% of our cases are resolved before trial. Below, we have listed some of our recent settlements.

  • $5,000,000 for a teenager who became a quadriplegic following a serious accident in the BC Interior (Okanagan).
  • $2,000,000 + for a woman injured in a single vehicle rollover accident on ice in the Cariboo Region of BC. Her previous lawyer was unaware that there was anything seriously wrong with her. Though her family lived far away, we worked with them and with appropriate professionals to prove that her memory and executive function deficits affected her ability to care for herself, resulting in a very significant settlement.
  • $2,000,000 (policy limits) for an older man who suffered quadriplegia (tetraplegia) when the vehicle, in which he was travelling a passenger, was struck in an intersection in the Fraser Valley.
  • Policy limits for our client, a left turning vehicle. Our client was the servient driver (did not have the right of way) turning left when struck by the oncoming vehicle. We were able to show, based on the speed that the dominant (straight through with the right of way) driver was travelling and through his admissions upon cross examination, that the driver of the left turning vehicle fairly turned left, believing it was safe to do so, with the other car so far away.

See more of our settlement results and trial achievements in the ‘Achievements’ section of the website.

New technology aims to get TBI survivors back in the driver’s seat

For many people, driving represents freedom and independence. For survivors of traumatic brain injuries driving has been identified as a key component of achieving autonomy and re-integration into the community. Unfortunately, many TBI survivors (and indeed people with various disabilities) have residual cognitive impairments that impact their ability to drive safely and defensively, among other activities. Such impairments can affect:

  • Visual scanning
  • Spatial perception
  • Attention focusing
  • Problem solving
  • Self-awareness of individual shortcomings and driving abilities (anosognosia)

While many technologies help the physically disabled drive, no technology exists to help drivers overcome the above cognitive impairments to enable safe driving… until now.

In recent months, the Shepherd Centre assistive technology team, the Georgia Tech Sonification Laboratory, and Centrafuse™ have collectively developed an in-vehicle assistive technology (IVAT) – an in-dash, touch screen computer system that uses driver interaction and positive reinforcement to improve and sustain behaviours that are known to increase driver safety.

The use of this type of technology stems from a key observation made by researchers that TBI survivors tend to be better able to remain focused on the driving task in the presence of the evaluator than when driving solo.

In order to replicate the experience of driving with an evaluator, the Shepherd Center team designed a device they called the Electronic Driving Coach (EDC), a three-button box that rests on the driver console. Each of the buttons is labelled to match the three tasks that an individual needs to perform in order to be a safe driver: mirror scanning, speed maintenance, and space monitoring. Every time the individual noticed himself practicing one of these tasks, he or she was to push the corresponding button. The EDC would then give the driver an auditory positive feedback. The researchers found that

“After 3, 6, and 12-month re-evaluations, the individual’s driving skills have been rehabilitated to a much safer level as evidenced by continued evaluations and the discontinuation of traffic violations”

The researchers recognize the limitations posed by the physical in-dash box, and are continuing to evaluate IVAT in both simulators and on-road vehicles with the hope that this technology will not only help TBI survivors, but also other groups of cognitively disabled peoples.

To find out more about driving after a traumatic brain injury, click here.


Read the full, original article here:
“In-Vehicle Assistive Technology (IVAT) for Drivers Who Have Survived a Traumatic Brain Injury” By J. Olsheski, B. Walker, and  J. McCloud

Vote for Head Strong, semi-finalist in the Aviva Community Fund Challenge

Help bring Head Strong $35,000 closer to helping Brain Injury survivors with their education costs. Zehr Insurance Brokers Ltd has nominated Head Strong, a brain injury awareness campaign, as an idea in the Aviva Community Fund Challenge to receive $35,000 that will benefit the Brain Injury Association of Canada’s Bursary Fund – assisting brain injury survivors with costs associated with post-secondary education.

Vote now!

Find out more here.

Troubled pasts do not impact the value of a brain injured suvivors’ future

The decision of Madam Justice Dickson in Gilbert v. Bottle, 2011 BCSC 1389 was released on Monday, October 17th, 2011 . In my view, this is a good decision on many fronts.

The injury

Ms. Gilbert was injured in a motor vehicle accident on March 8, 2005 when she was a backseat passenger ejected from a vehicle being driven by an impaired driver.  She was not wearing her seatbelt.  As a result of the accident, she suffered a traumatic brain injury, fractured clavicle and multiple soft tissue injuries.  At issue were Ms. Gilbert’s contributory negligence for getting into a car driven by an impaired driver and not wearing a seatbelt, and the extent of her injuries.

Ms. Gilbert’s credibility

Ms. Gilbert is a 37 year-old First Nations woman who lived much of her life on the Sugarcane Reserve near Williams Lake.  She was exposed to poverty, substance abuse and other tragic circumstances before the accident.  In part because of these circumstances, the credibility and reliability of her evidence, as for the evidence of all witnesses, was scrutinized particularly closely.  Despite being mistaken and careless in her testimony, the judge did not find her to have consciously attempted to mislead the court.  This had a bearing on the contributory negligence and damages components of Ms. Gilbert’s claim.  Ms. Gilbert was not found to be contributory negligent in this case.

The judge’s conclusions

Madam Justice Dickson concluded that Ms. Gilbert sustained a “complicated” mild traumatic brain injury with significant and permanent sequelae as a result of the accident.  The factors she based this finding on are:

  1. Ms. Gilbert lost consciousness for at least 20 minutes after the accident and experienced posttraumatic amnesia for over a day.
  2. Ms. Gilbert’s brain was vulnerable to injury due to her pre-existing and long-standing pattern of significant substance abuse.
  3. Ms. Gilbert’s increased post-accident problems with cognitive processes, including poor memory and focus, executive function and associated personality change, are characteristic of frontal lobe brain injury.
  4. There is a strong temporal relationship between Ms. Gilbert’s increased cognitive and executive function problems and the accident in that the increased problems appeared immediately after its occurrence and have persisted ever since.
  5. Ms. Gilbert’s increased problems with cognitive function improved for a time, then plateaued, in a pattern typical of partial recovery from brain injury symptoms.
  6. The MRI findings show organic change to Ms. Gilbert’s brain, which, given her presentation, I am satisfied was caused by the accident.
  7. There is no plausible alternate explanation for the constellation of altered cognitive, executive function and emotional compromises consistently displayed by Ms. Gilbert since the accident.

She preferred the opinion of Ms. Gilbert’s experts with respect to causation of the traumatic brain injury.  Despite Ms. Gilbert’s history, Madam Justice Dickson found that Ms. Gilbert’s increased cognitive, emotional and neurobehavioural problems were related at least in part by the injury, and that the memory loss, low frustration tolerance and poor concentration are primarily connected with her TBI.  Madam Justice Dickson also concluded that Ms. Gilbert suffers from a chronic pain disorder, particularly in her neck, shoulder and back.  She also suffers from cervicogenic headaches.

Relationship between Ms. Gilbert’s past and her injuries from the accident

Discussing the relationship between her past and her injuries from the accident, Dickson J. described her as a “thin skull plaintiff” (taking the plaintiff as she is found, in the already damaged condition that may affect the extent of the loss actually suffered), as opposed to a “crumbling skull plaintiff” (a plaintiff who would have likely suffered the debilitating effects of her damaged condition in any event, regardless of the accident).

The court awarded $200,000 for her pain and suffering, noting particularly her permanent loss of capacity to work and engage emotionally with others in coming to this conclusion.  No amount was deducted for failure to mitigate despite Ms. Gilbert’s failure to follow recommendations made by her family physician.  She could not afford recommended programs and had deteriorated because of her injuries which led to her difficulties in pursuing recommended treatment.

Her past loss of capacity was nominal for any loss of capacity to work between the accident and the trial date but her loss of future earning capacity was much more significant, at $400,000, assuming a present value of an annual loss of $24,000 in earnings to age 65 (28 years).  Madam Justice Dickson took into account the risk that Ms. Gilbert might have continued her substance abuse habit beyond mid-life but also that her health may have improved somewhat, thereby opening up other career options to her.

Future care awards are notoriously difficult as they require prediction about what will happen in the future.  Madam Justice Dickson awarded $200,000 for future care needs based on her conclusion that Ms. Gilbert’s pre-existing mental, physical and emotional condition deteriorated significantly because of the accident; her traumatic brain injury sequelae are serious, debilitating and permanent; and her chronic pain is also debilitating.  What the court did not award was costs for a shared-living arrangement as it was considered to be highly likely that she would be helped and supported by her family with shelter and care for the rest of her life.

The bottom line is that notwithstanding Ms. Gilbert’s very significant history on physical, emotional, mental and psychological fronts, a significant award was warranted for her injuries, earning capacity and care because of the huge impact that her “complex” mild traumatic brain injury and chronic pain symptoms have had and will continue to have on her life.

Everyone has a history; this does not mean that injuries or the effects of those injuries are either without merit or merit less attention.

“There’s a lot to lose by not wearing a bike helmet”

image of bike commuter wearing helmetWhile reading the paper this past weekend, I came upon an article addressing two issues that are near and dear to my life:  cycling and brain injury.  I commute by bike approximately 14 km each way every day to our offices where I then represent individuals with mild, moderate and severe brain injuries.  Reading this article, in which Mr. Cox described being hit by a street race 25 years ago at the age of 31, really struck home:  “There’s a lot to lose by not wearing a bike helmet.”  Although I have been fortunate enough not to have had any major altercations with vehicles in my cycling career, it is something I think about every day as I put on my helmet and turn on the 4 lights on my bike.  Wearing a helmet is required according to section 184 of the Motor Vehicle Act, and for good reason.  Time and time again, I hear about catastrophic injuries to cyclists and think that at least some of them may have been avoided had the rider been properly equipped and wearing a helmet.  As Mr. Cox quotes, and as is sometimes the experience of our clients:

Cyclists who flout the law by not wearing a helmet might lose more than just their lives – they might lose who they are.  They might become so impossible to live with that all they love leave them.

Certainly, if you or a family member is in this situation where a brain injury is affecting every aspect of your life and you require legal assistance, please contact us.  Otherwise, be safe out there and wear your helmet!

Driving After Traumatic Brain Injury (TBI)

Physical disabilities and cognitive impairment are the main reasons that an individual may be unable to drive after a traumatic brain injury.

Doctors are required to inform the Superintendent of Motor Vehicles that a person has a health condition which impairs their ability to drive. However, this does not mean a person will never drive again. Nonetheless, individuals that have sustained serious should not drive unless their doctor tells says it is safe to do so.

Some of the factors that affect the likelihood that a TBI survivor will eventually be able to drive include:

  • Age (Younger TBI survivors are more likely to recover than older ones.)
  • Mental outlook and effort in recovery
  • Support team, including his or her doctors, therapists, family and friends (strong, reliable support teams aid recovery.)
  • The severity of the primary injury and the resulting complications
  • Whether or not the individual had driving experience before the injury (prior driving experience makes re-learning driving easier.)

Evaluating Individual’s Driving Ability
Determining whether a person with an acquired brain injury can safely drive again involves a number of professionals and assessments, including: medical or neurophysical exams, visual tests, and active driving tests (simulated or on-road).

Getting Back on the Road, in British Columbia
In British Columbia, once the survivor, their doctor, and/or healthcare team are confident in their ability to drive safely, the Office of the Superintendent of Motor Vehicles (OSMV) determines the legality of driving – usually authorized testing is all that is required.

Office of the Superintendent of Motor Vehicles (OSMV)
The OSMV is a BC provincial agency that is in charge or road safety and driver behaviour. The OSMV reviews information from the medical community, law enforcement agencies, and Insurance Corporation of British Columbia (ICBC) licensing when making decisions about a driver’s license.

The Superintendent of Motor Vehicles may require a driver to take a vision test, a functional driving assessment, a medical and/or other evaluation, in order to help determine whether they are able to drive safely. These may include:

  1. Driver Medical Examination (DME)
    The driver’s doctor must conduct a driver medical examination at the request of the OSMV and submit a completed assessment form to the OSMV
  2. Functional Driving Assessment
    The driver may be asked to complete one of these two assessments:
  • Driver Rehab Assessment
    • For persons who are seen as being likely to drive safely again after an illness or injury
    • The goal is to help the individual to get driving again by offering assessments, lessons, strategies and vehicle modification, if necessary
    • This assessment may be the best one for persons with a brain injury
    • Community Therapists
      Unlike other services which are heavily computerized and focus on a rigid “pass/fail” methodology with little or no opportunity for training, the Community Therapists methodology focuses on the assessment of the client’s rehabilitation potential to return to driving. Where appropriate, clients are offered a comprehensive driver rehabilitation program to facilitate a return to this vital daily activity. For more information about Community Therapists, visit their website.
  • DriveABLE
    • Assessment involves an in-clinic perceptual and cognitive assessment, and may be followed by an on-road evaluation
    • Rehabilitation and compensatory strategies are not addressed
    • Not appropriate for those with visual or physical impairment
    • Is best for persons with progressive cognitive conditions and impairments
    • For more information about DriveABLE visit their website.

Where can I get a functional driver assessment?

  • For information about driver rehabilitation programs in British Columbia, visit the brainstreams.ca website.
  • Do an OT search through BC Society of Occupational Therapists and select “Driver Rehab Assessment”

How long does the whole process take?
The entire process can take a significant amount of time. The duration depends on the individual’s injury as well as the activity of the groups involved – healthcare team, driver rehab centre, OSMV, licensing.

How much does it cost?

  • You may need to pay for the cost of the assessment yourself. The cost can usually be submitted as a medical expense on your income tax return.
  • If you have a claim against a third party, speak to your lawyer or call Workers Compensation Board if it covers your claim.
  • Functional Driving Assessments centres set their own fees
  • Funding may be available from third party funders (e.g. ICBC, WorkSafe BC) and extended health plans, or through OSMV.


Article References:

22nd Pacific Coast Brain Injury Conference | Feb 2012

Date: February 15-17, 2012,
Location:
Sheraton Vancouver Wall Centre in Vancouver, BC
Satellite Conferences held simultaneously in Victoria and Kamloops, BC.

The Annual Pacific Coast Brain Inury Conference will return February 15-17, 2012. The theme for 2012 is: Real people with Real Lives: It takes a Village. Sign up to receive the conference e-newsletter and keep up-to-date on event developments.


Check out highlights and presentations from the November 2010 Conference.

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Medical and legal information posted on this website and blog is meant to provide readers with information of a general nature rather than medical or legal advice that will apply to any specific case. Content on our website is based on B.C. law and readers should be aware that laws will vary from country to country and province to province. If legal advice specific to your situation is sought, please contact us