Tag Archives: brain injury

Living with a TBI: Your Brain on Exercise

BrainInjuryWritten by: Dale Orlando

We all know that regular physical activity plays a leading role in the maintenance of overall health. Reduced risk of illness such as cardiovascular disease and type 2 diabetes, weight control, increased energy and sound mental health are just some of its many benefits. Along with a balanced diet, exercise can contribute to a life free of serious health concerns.

But when you are living with a TBI, what are the implications of fitness on your health? That is topic of discussion that is much less common.

Why do many TBI patients shy away from physical activity?

For many survivors of traumatic brain injury, the main priority is to once again become comfortable with the activities of daily life. Participation in physical activity may seem out of the question, and as a result, individuals can quickly adapt to a sedentary lifestyle. The role of fitness in the recovery of traumatic brain injury has not been researched extensively; but recent studies have suggested that the benefits of physical activity are just as relevant for those who have suffered a serious brain injury.

How can exercise impact a TBI patient’s quality of life?

It has been shown that people with TBI who exercise have fewer physical, emotional and cognitive symptoms, which contributes to an overall increase in their quality of life. Study subjects experienced fewer sleep problems, showed less irritability and forgetfulness, and even reported less depression.

A condition known as heterotopic ossification can occur as a result of changes in the brain and reduced activity after an injury. Extra bone may form around the joints which causes pain and discomfort and can be a serious obstacle in an otherwise uncomplicated recovery. However, it can be prevented and reduced with physical activity.

Regular exercise is crucial in the control of side effects, which can otherwise interrupt an individual’s ability to return to a normal life. Considering that this is the goal for many TBI survivors, the importance of a healthy lifestyle is undeniable.

Can exercise also benefit the recovery of the brain itself?

Physical activity does have a tremendous impact on the health and recovery of the brain itself. Studies have shown that regular exercise results in increased blood flow and neuro-regeneration of the hippocampus, the area that controls memory. According to the Brain Injury Recovery Network, a physically active lifestyle can actually assist in restoring the damaged areas of the brain.

It is evident that physical activity has a significantly positive impact on not only controlling the physical, emotional and cognitive symptoms that come with a traumatic brain injury, but also facilitating the recovery of impaired areas of the brain as well.

We’re proud to be advocates of healthy living

McLeish Orlando is proud to advocate the importance of healthy living both in our office and for our clients year-round. We’re dedicating the month of June to celebrate a new health initiative. We invite you to keep up with our #MOfit campaign on Twitter and be sure to check back for more blog posts on healthy living.

The 2015 Traumatic Brain Injury Conference

The 2015 Traumatic Brain Injury Conference is a one day conference hosted by UHN’s Toronto Rehabilitation Institute. The conference will cover all ranges of Traumatic Brain Injury (TBI). This event is for healthcare practitioners who contend with traumatic brain injury in their practice: physicians, therapists, nurses, social workers, program service managers, researchers and service providers from rehabilitation, insurance and legal organizations.

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Designating Traumatic Brain Injuries

As the phrase implies, “Traumatic Brain Injury” (“TBI”) refers to damage to a person’s brain as a result of trauma. TBIs have become a pervasive feature of the Canadian social landscape. Where, 30 years ago, certain kinds of trauma to a person’s head would have been fatal, medical advancements now result in more people surviving. This, in turn, means that an increased number of Canadians live with the ongoing effects of a TBI.

The symptoms of TBIs present on a spectrum – anywhere from mild and short-lasting on one end to severe and permanent on the other end. Continue reading

A Weekend of Giving Back

McLeish Orlando Supports BIST 5k Run, Walk and Roll and SCIO Wheelchair Relay Challenge

This past weekend, McLeish Orlando staff, family and friends came out to support two very important causes in our community. In spite of the rain on Saturday, there were close to 300 participants who finished the race for the 3rd Annual BIST 5K Run.

McLeish Orlando participated as part of The Personal Injury Alliance with a team of close to a hundred staff and supporters.

Through sponsorship, fundraising and registration, BIST generated over $50,000 that will go a long way in supporting programs, services and efforts to raise brain injury awareness.

The Brain Injury Society of Toronto supports brain injury survivors and family members. BIST aims to enhance the quality of life for people in the City of Toronto, living with the effects of brain injury through education, awareness, support and advocacy.

Photos from bist.ca- Click the photo to enlarge


As part of our weekend of giving back, on Sunday we participated in Spinal Cord Injury Ontario’s Wheelchair Relay Challenge held at Ontario Place.  Continue reading

Study highlights need for brain injury awareness

As seen on AdvocateDaily.com

Brain injuries are occurring at an alarming rate among Ontario teenagers, a new study has found, making education and awareness on the effects of a blow to the head crucial for parents, says Toronto critical injury lawyer Dale Orlando.

“I think there’s a common misconception where people talk about a concussion without understanding that a concussion is considered to be a brain injury,” says Orlando, partner with McLeish Orlando LLP. “A concussion, by definition, is a mild or moderate brain injury.”

The study found that one in five teens in Ontario has had a concussion or another brain injury in their lifetime that was serious enough to leave them unconscious for five minutes or to send them to hospital overnight, CTV reports.

As well, a total of 5.6 per cent reported they had had a concussion or significant brain injury in the past year, it adds.

“Statically, the majority of people who suffer mild traumatic brain injuries go on to have full symptom resolution, but there is a percentage that have significant ongoing difficulties as a result of their mild traumatic brain injury,” says Orlando. “But even for the people that do go on to have a good recovery and are symptom free, they become much more vulnerable to more significant impairments if they suffer a second head injury.”

The study used data from the 2011 Ontario Student Drug Use and Health Survey, CTV reports, noting it used responses from almost 9,000 students from Grades 7-12.

The survey found that the majority of traumatic brain injuries for the teens occurred during sports: 47 per cent for girls and 63.5 per cent for boys, with hockey and soccer accounting for more than half the injuries, the report says.

“I think as parents we have to be hyper vigilant and aware that a concussion isn’t just a minor thing like a scrape or a bruise that happens through the course of childhood that isn’t a big deal,” says Orlando.

“Many Canadian boys and girls grow up chasing the dream of making a living playing hockey, but Peewee games and Bantam games – they’re not the NHL,” he says. “Rules regarding hits to the head should be stringently enforced. Any hit directed to the head should have serious consequences for the person delivering the hit. Hitting from behind, driving somebody’s head into the boards … the penalty should be increased to eliminate it from the sport.”

On the soccer field, Orlando says it’s common to see injuries from regular activities, like heading the ball.

“That may not be appropriate for children of a certain age,” he says.

Orlando says while improvements have been made in sporting rules, more can be done to prevent serious injury.

“I think we’ve come a long way from the days of somebody suffering a concussion and having the coach say ‘Get back out there for your next shift.’ There are practices and protocols in place,” he says. “Parents have to recognize that a concussion is a mild traumatic brain injury and the restrictions associated with return to play are there for a reason.”

Brain Injury Series Part 3: The Challenges That Plaintiff’s Counsel Faces

This is the third part of a series of blogs on Winning Strategies for Handling a Mild to Severe Brain Injury Case. The first part of the series explained the anatomy of the brain, an understanding of which is essential in order to appreciate what happens to the brain after a traumatic brain injury.  The second part explained the ways a brain can become injured.  This part considers the challenges that Plaintiff’s counsel encounters when representing an individual who has suffered a traumatic brain injury.

Difficulties a Plaintiff’s Counsel Faces in Proving a Traumatic Brain Injury

There are a number of difficulties Plaintiff’s counsel faces in trying to prove the existence and severity of a traumatic brain injury.  One of those difficulties is that most brain injuries, unlike other injuries such as a broken arm or an amputated leg, are invisible to the naked eye.  X-rays, CT scans and MRIs can detect fractures, hemorrhages, swelling, and certain kinds of tissue damage, but they cannot always detect injury to a person’s brain. This is because traumatic brain injury, especially in its milder forms, often involves subtle traumas to the brain that cause chemical and physical changes to brain tissues. These changes often cannot be found with standard imaging procedures.

Another difficulty for any Plaintiff’s lawyer in a brain injury case is establishing that the traumatic event caused ongoing organic damage which affects the person’s ability to function in the real world. This is often difficult to prove because many brain injured individuals appear “smart.”  They are articulate and can perform many of the tasks they did before they were injured.  It is difficult for most of us to understand how a person may retain, for example, a high IQ after suffering a traumatic brain injury and still perform very poorly on certain neuropsychological tests and in real life.  It is hard for us to understand that deficits do not occur in all areas of the brain and that indeed, many parts of the brain remain intact while the person’s ability to function in many aspects of his or her life is significantly reduced.

A third difficulty is that in the months after suffering a traumatic brain injury, many individuals are in denial.  They insist they are fine and have told all their treating health professionals that they are fine.  They may tell their treating health professionals the only reason they are seeing him or her is that of ongoing pain resulting from a back injury suffered in the collision.

For these reasons, proving the existence of a traumatic brain injury, and the consequences of that injury to your client can be difficult.  However, as Plaintiff’s counsel, that is your job.

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Brain Injury Series Part 2: The Ways a Brain Can Be Injured

This is the second of a series of blogs on Winning Strategies for Handling a Mild to Severe Brain Injury Case.

We first discussed the anatomy of the brain, including the structure of neurons.  Here we will discuss the ways that our brain can be injured and the implications that flow from the various kinds of injuries.

The brain is very delicate and is considered to be the consistency similar to that of gelatin.  If a brain is suddenly jolted or banged or twisted, it will cause a traumatic impact that ripples through the entire brain and can cause complications.  The brain is made up of billions of neurons that can be damaged by trauma to a person’s head.

Some of the ways damage can occur to a human’s brain is as follows:

Mild Traumatic Brain Injury or Concussion

The term mild traumatic brain injury is used interchangeably with the term concussion.  A concussion is caused by a blow or jolt to the head that disrupts the function of the brain.  Unlike more severe traumatic brain injuries, the disturbance of brain function from a concussion is caused more by dysfunction of brain metabolism rather than by structural damage.  The current understanding of the neuropathophysiology of a mild TBI involves a paradigm shift away from a focus on anatomic damage to an emphasis on neuronal dysfunction involving a complex cascade of ionic, metabolic and physiologic events.  After an impact causing a concussion, there is an increase in glucose metabolism, and then a subsequent reduced metabolic state.  These events interfere with the neuronal function in the brain and may lead to cell death after the injury.

Diffuse Axonal Shear

In a diffuse axonal shear injury many of the nerve cell pathways (axons) may be torn apart or stretched. This can cause a loss of connection between brain cells and can lead to a breakdown of overall communication among neurons in the brain. Information processing may be disrupted.  A diagram demonstrating the process of axonal shear appears below:

Coup – Contre-Coup

A coup contre-coup injury to the brain occurs when there is a sudden impact to the head, which causes the brain to first slam into one side of the skull wall, then bounce off that wall and slam into the wall on the opposite side of the skull.  Continue reading

9 Things NOT to Say to Someone with a Brain Injury

An excellent blog post written by Marie Rowland, PhD, EmpowermentAlly.

Brain injury is confusing to people who don’t have one. It’s natural to want to say something, to voice an opinion or offer advice, even when we don’t understand.

And when you care for a loved one with a brain injury, it’s easy to get burnt out and say things out of frustration.

Here are a few things you might find yourself saying that are probably not helpful:

1. You seem fine to me.

The invisible signs of a brain injury — memory andconcentration problems, fatigue, insomnia, chronic pain, depression, or anxiety — these are sometimes more difficult to live with than visible disabilities. Research shows that having just a scar on the head can help a person with a brain injury feel validated and better understood.

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Brain Injury Series Part 1: Anatomy of the Brain

This is the first of a series of blogs on Winning Strategies for Handling a Mild to Severe Brain Injury Case.

To begin, an understanding of brain anatomy is essential to gain some knowledge of what happens to the brain after a traumatic brain injury.  It is one of the responsibilities of counsel in a traumatic brain injury case to educate the judge and jury on the anatomy of the brain.

Interestingly, the brain is not a hard muscle-like substance, but rather a soft gelatin-like organ that sits within a rough and bony skull.  The brain is covered by three thin protective layers called the meninges. The space between the meninges and the brain is filled with a clear liquid called cerebral spinal fluid. This fluid works to keep the central nervous system healthy. The brain is innervated by a sophisticated system of blood vessels which carry blood to and from the heart.
Within these two hemispheres there are four lobes – frontal, parietal, temporal, and occipital, and each lobe is responsible for specific functioning.  The brain stem and cerebellum also play a significant role in the brain’s functioning.The outermost and largest part of the brain is called the cerebrum and it controls things like thoughts and actions. It has a wrinkled surface and is divided it into two halves, known as the left and right hemispheres.

  • Frontal Lobes – deals with reasoning, planning, self-control, some speech and emotion functions, and problem solving.  The frontal lobes also play an important part in memory, intelligence, concentration, and are responsible for executive functions.
  • Parietal Lobes – are involved with movement, and also help people to understand signals received from other areas of the brain such as vision, hearing, sensory and memory.  A person’s memory and sensory information received give meaning to objects and “put it all together”.
  • Occipital Lobes – found at the back of the brain, receive signals from the eyes, process those signals, allow people to understand what they are seeing, and influence how people process colours and shapes.
  • Temporal Lobes – are located at around ear level, and are the main memory centre of the brain, contributing to both long-term and short-term memories.  The temporal lobe is also involved with understanding what is heard, and with the ability to speak.  The left temporal lobe is involved in verbal memory and aids in understanding language, where the right temporal lobe is involved in visual memory and helps people recognize objects and faces.
  • Brain Stem – is responsible for maintaining the body’s most basic functions such as breathing, heartbeat, and blood pressure.
  • Cerebellum – it is divided into two halves, with the main function of controlling and regulating the body movement of the muscular skeletal system.

The brain and nervous system also consist of billions of tiny cells called neurons.  Neurons are the “communicators” and each neuron has three main parts:

  • Cell body:  the central station that sends out impulses
  • Axon:  long, slim “wire” that transmits signals from one cell body to another via junctions known as synapses
  • Dendrites:  networks of short “wires” that branch out from an axon and synapse with the ends axons from other neurons.

The neurons receive and transmit information in a relay where electrical impulses alternate with chemical messengers. The electrical impulses flow through nerve cell pathways along the axons and dendrites. Neuro-chemical transmitters leap the synaptic gaps between each neuron’s axon and the other neurons with which an axon makes contact. Each neuron is its own miniature information center which decides to fire or not fire an electrical impulse depending on the thousand or so signals it is receiving every moment.

Stay tuned for the next part in the blog series on the ways a brain can be damaged.This is a basic overview of the anatomy of the brain.  It is important that lawyers understand the functions of the brain to better understand how injury to a particular area of the brain can impact your client.


The Ontario Neurotrauma Foundation releases “Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms”

The majority of people who suffer mild traumatic brain injury recover within three months. However, up to 10 to 15 percent of people who suffer mild traumatic brain injury continue to have symptoms three months later. Research has shown that early diagnosis and management of mild traumatic brain injury greatly improves a patient’s outcome and reduces the impact of persistent symptoms.

Unfortunately, until now there have been no standardized guidelines that doctors or healthcare providers in Ontario could use to identify mild traumatic brain injuries early on or to treat individuals who suffer persistent symptoms following mild TBI.  To respond to this concern, the Ontario Neurotrauma Foundation appointed a team of medical experts, doctors, healthcare providers, and mild traumatic brain injury survivors from across Ontario, Canada and outside the country. The team reviewed and vetted relevant clinical guidelines published in the last 10 years, and consolidated this information into one standardized guideline. The results of this process are the Ontario Neurotrauma Foundation’s Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms.

These guidelines will improve patient care by providing healthcare professionals with uniform, evidence based, best practice recommendations to effectively identify and treat individuals who suffer persistent symptoms following mild TBI. As part of Brain Injury Awareness Week, McLeish Orlando commends the work of the Ontario Neurotrauma Foundation and the project members who contributed to these guidelines in order to improve the care and quality of life for individuals living with the potentially devastating effects of mild traumatic brain injury.

Click here to read a brief summary of the guidelines for assessment and management in each of the 13 areas listed in the guidelines.