The 8th Annual State of the Art Medical and Rehabilitative Care in Brain Injury: Clinical and Legal Implications Conference was held at the Silverado Resort in Napa, California on November 16-17, with a fundraising Golf Tournament on November 18th. The conference was hosted in collaboration with the Scarlett Law Group.

Conference attendees and speakers traveled to Napa from as far as the east coast and Hawaii to be part of what has been called “the best educational conference for medical and legal professionals” that provide services to individuals with brain injury. Mr. Randall Scarlett participants were treated to a wine tasting by and Dr. Claude Monday founded the concept the Frank Family Vineyards, Elyse Winery, of medical and legal professionals joining and Falcor Wines, and had the opportunity to together to provide the latest and greatest bid on a variety of items donated to CALBIA updates in their respective fields. At the for the Silent Auction, which provided addibeginning of the conference, Dr. Claude Mun-tional funds for CALBIA. day received an award from CALBIA in recognition of his many years of service to The success of the conference could not persons with brain injury, and for his partici-have been achieved without the many sponpation and leadership on the various boards he sors, exhibitors, speakers that donated their sits on, and his committee work. time and travel expenses, and the work of Following the conference on Friday evening, the planning committee, recognized below:

SPONSORS:
High Impact Litigation Law Cash Paradigm Management Services Jones, Clifford, Johnson & Johnson, LLP Malone Law Office Delano Farms Company San Joaquin Bank Contrabande Control Specialists, Inc. Centre for Neuro Skills Scarlett Law Group Doehrman Chamberlain The Veen Firm, P.C. Law Offices of Michael B. Moore Bostwick & Associates Marcus & Regaldo Newton Medical Group Charles Guy Monnett III Brown & McDevitt Gwilliam, Ivary, Chiosso, Cavalli & Brewer Shea & Shea Frank Family Vineyards Elyse Winery Falcor Wines Chalone Vineyard Kim Battuello Buehler Vineyards Far Niente Winery Freemark Abbey Winery Green & Red Vineyard Crgich Hills Cellar Heitz Wine Cellars Hess Collection Winery Honig Vineyard & Winery Milat Vineyards Winery Peju Province Winery Raymond Vineyard & Cellar Rubicon Estate Rutherford Grove Winery Shafer Vineyards Spottswoode Winery Trefethen Vineyards & Winery Trinchero Family Estates V. Sattui Winery ZD Wines Knights Jewlers

EXHIBITORS:
Care Meridian Casa Colina Centers for Rehabilitation Centre for Neuro Skills High Impact Litigation Juris Productions, Inc. Kentfield Rehabilitation & Specialty Hospital Learning Services Corporation Medtronic Neuromodulation Rehab Without Walls Santa Clara Valley Medical Center Dave Woodruff, Susan Connors, Dr. David Hovda, Lee Woodruff and Dr. Douglas Smith

SPEAKERS:
Dave Woodruff Thomas Malone, J.D. Douglas C. Smith, Ph.D. David Hovda, Ph.D. Michael Shea, Jr., J.D. Sharon Grandinette John Romano, J.D. Frank Branson, J.D. Bruce Stern, J.D. Mark D’Esposito, M.D. Bill Smith, J.D. R. J. Waldsmith, J.D. Daniel Kelly, M.D. Geoffrey Manley, M.D., Ph.D. Susan Connors, B.S. Rick Rollens Randall H. Scarlett, J.D. Deborah Doherty, M.D. Daniel Davis, M.D.

CONFERENCE PLANNING COMMITTEE:
Mark J. Ashley, Sc.D. Paula Daoutis Deborah Doherty, M.D. Sharon Grandinette, M.A. Amanda Helvie Tina Horn Patrick Johnson Steve Katomski Lisa Kreber, Ph.D. Claude Munday, Ph.D. Bruce Nelson Randall H. Scarlett, J.D. Kavie Von Husen

Special thanks to:
Anna Gregory Helen Nelson

In the year 1990, The Americans with Disabilities Act (ADA) affirmed the rights of citizens with disabilities which makes American society more accessible. It paved the way for the Supreme Court’s Olmstead decision, which led to President Bush’s new Freedom Initiative. This initiative is about getting federal agencies to coordinate disability services. It includes systems-change grants to states, which has helped brain injury get to the “proverbial table” in many states.

After watching countless spy movies, Westerns, and TV cop shows, I wonder: how easy is it to knock someone out by smacking them on the back of the head with a pistol, club, etc.? Since I’m not willing to act as a test subject, although I’m pretty sure I’d have plenty of volunteers willing to do the smacking, I’m asking you as the next-best source.

—Dave Arnold, Ashland, Kan.

I was wondering: When you get hit in the head really hard, you get knocked out. Why? What causes a person to lose consciousness? This is probably gonna be a tough one.

—Beaner, via e-mail
Could be. See what you make of this:

“Immediately after biomechanical injury to the brain, abrupt, indiscriminant release of neurotransmitters and unchecked ionic fluxes occur. The binding of excitatory transmitters, such as glutamate, to the N-methyl-D-aspartate (NMDA) receptor leads to further neuronal depolarization with efflux of potassium and influx of calcium. These ionic shifts lead to acute and subacute changes in cellular physiology.”

After two more paragraphs in this vein, the authors (Giza and Hovda, 2001) remark, “This overview represents a simplified framework of the neurometabolic cascade [involved in a knockout].” They then launch into the non-dumbed-down version. I get the drift, but the average reader is apt to think he just got hit on the head.

Is there a simpler explanation? Sorta, but be warned—nobody really understands what causes a concussion, as a knockout is more properly known. (Just so we’re clear, what sports types call a “ding,” in which you’re stunned but conscious, is a mild concussion.) A few basics: First, sudden acceleration or deceleration of the head seems to be essential. If somebody clouts you from above, so that your head remains stationary, you may suffer other injuries but probably no knockout. Second, strong evidence suggests that a KO requires twisting or rotational motion—one reason woodpeckers don’t beat themselves silly, it’s thought, is that their bills travel straight back and forth, like a jackhammer. In contrast, a boxer loses consciousness when a blow causes his brain to slosh and spin inside the skull.

Is knocking somebody out as easy as it looks on TV? If we’re talking Tweety pounding Sylvester atop the noggin with a mallet, no, that’s not how it works. A compact, head-snapping shot to the side of the jaw, on the other hand, might well do the trick.

This brings us back to the central question: How is it that a single blow can cause somebody to black out only to revive without apparent permanent damage (although see below)? In a 2002 review, New Zealand physiologist Nigel Shaw rules out some of the more common theories—for example, that you lose consciousness because disrupted blood flow starves your brain of oxygen. Not possible: blood flow is just too poky to account for the near instantaneousness of a classic knockout. More likely, Shaw thinks, a concussion is a form of epileptic seizure involving massive, uncontrolled brain-cell discharge—that’s where Giza and Hovda above seem to be going with their talk of indiscriminant neurotransmitter release.

But the convulsion theory doesn’t explain everything. Consider the sad fate of countless professional boxers, most prominently Muhammad Ali but also Jack Dempsey, Joe Louis and many others. All suffer or suffered from a condition variously called pugilistic Parkinson’s syndrome, punch-drunk syndrome or chronic traumatic encephalopathy (CTE), characterized by tremors, rigidity, slurred speech and a halting gait. Studies have shown that as many as 18 percent of professional boxers develop CTE, and that the more bouts they fight, the worse they end up.

A distinction is sometimes drawn between Parkinson’s syndrome, which is caused by repeated head trauma, and the clinically similar but more common Parkinson’s disease, the cause of which is unknown but presumably doesn’t involve getting regularly beat up. Ali’s doctors over the years have disagreed about whether the champ has the disease or the syndrome. Evidence for the former includes the fact that his condition has worsened even though he retired from the ring long ago; for the latter—come on, the guy was a boxer. Ali suffered only one professional knockout (and a technical one at that), in 1980 against Larry Holmes, to my mind suggesting that, contrary to what many coaches think, getting your bell rung a few times too many can be as bad as knockouts over the long haul. To further complicate matters, research suggests CTE is most likely to emerge in boxers with a particular gene—some veteran fighters (George Foreman and Max Schmeling are two I’ve seen mentioned) don’t develop the problem.

So we’ve got an epilepsy connection, a Parkinson’s connection, and I didn’t even mention the Alzheimer’s connection. Not to give you the old rope-a-dope, but where the brain is concerned, what’s known is greatly exceeded by what’s not.

Comments, questions? Take it up with Cecil on the Straight Dope Message Board, StraightDope.com, or write him at the Chicago Reader, 11 E. Illinois, Chicago 60611. Cecil’s most recent compendium of knowledge, Triumph of the Straight Dope, is available at bookstores everywhere.

Source: http://www.slweekly.com/editorial/2006/dope_2006-05-04.cfm

On Tuesday, as registered voters in the community of Gaylord and greater Otsego County, we will have the opportunity to reaffirm our commitment to the education of our youth. By now, you are probably aware that the proposed Cheboygan-Otsego-Presque Isle Educational Service District (COP-ESD) special education millage is up for renewal.

However, the really important information is how our special education students benefit from this millage, so vital to 10 school districts here in northern Michigan.

Special education was created in 1975 with the Education for All Handicapped Children Act. Since that time, special education has been changed and re-authorized many times, most recently in 2004. This act is now known as IDEIA – Individuals with Disabilities Education Improvement Act. Special education exists to provide all youth with an equal access to curriculum, and an equal opportunity to learn.

The majority of children with disabilities are now being educated in their neighborhood schools in regular classrooms with their non-disabled peers. High school graduation rates for individuals with disabilities have risen more than 14 percent. Employment for individuals with disabilities after school age is nearly twice what it was just 20 years ago. And a truly rewarding statistic – post-secondary education is also up, with the number of college freshman reporting disabilities tripling between 1978 and 2005.

The term “child with a disability” means a child with one of the following challenges: mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities. In addition, because of the disability, the student often needs special education and/or related services.

These students have extra challenges both in education and in life. The special education system exists to assist in overcoming these challenges and to provide students with equal access to the general curriculum to the maximum extent possible.

Each student is looked at individually in an effort to identify what services he or she is most in need of. A student with a physical impairment may need occupational or physical therapy in order to correctly use writing instruments, or even get around the school. Students who have difficulty talking may be provided with special exercises regarding speech or language. Students with learning disabilities are provided with assistive curriculum and services. It is the job of the student’s educational team to determine what the student’s specific challenges are and what can be done to assist him/her in the educational setting.

It is interesting to note that nationwide, 1 in 8 students receive special education services. This percentage is no different in the Gaylord Schools, and this means that most of us know not just one, but probably several young people who benefit from special education. These are children who, prior to the adoption of special education acts, may very well have slipped through the cracks or simply were not allowed to be educated with their peers.

Special education builds success, not just for the individual students, but for the community as a whole. These are individuals who will soon be members of the community. This is our opportunity to help make them positive, productive and educated members of our community.

By federal law, schools are required to provide special education services for all eligible students. Failure to renew the COP millage will force the Gaylord Community Schools administrative team to cut an additional $600,000 from the operating budget.

The Cheboygan-Otsego-Presque Isle Special Education millage renewal will fund these services, programs and educational success stories for more than 450 students in the Gaylord schools alone. The 10 schools that comprise the COP-ESD – Cheboygan, Johannesburg-Lewiston, Mackinaw City, Vanderbilt, Posen, Inland Lakes, Wolverine, Onaway, Rogers City and Gaylord – have a combined total of 1,400 children who depend on these funds. This millage renewal will not generate any new taxes. In fact, on a $100,000 house, this millage will cost the homeowner approximately $32 a year – or the equivalent of 11 gallons of gas.

The election on May 2nd is our opportunity as a community to continue to provide support for all students in the Gaylord Community Schools – not only support for the general education of our special needs students, but also by supporting individuals with disabilities in the community as a whole.

- Kurt Soltman is the Gaylord Community Schools director of Special education. You may write to him at 615 S. Elm Ave., Gaylord, MI 49735.

Source: http://www.gaylordheraldtimes.com/articles/2006/05/02/news/opinion/opinion03.txt

TORONTO, May 3 /CNW/ – NeuroMedix Inc. (”NeuroMedix”) (TSXV: NMX) today
announced that Dr. Mark Pearson, Chief Executive Officer of NeuroMedix, will
present a company update at the BioFinance 2006 conference in Toronto.
Dr. Pearson’s presentation is scheduled for May 4, 2006 at 11:30 a.m. EDT at
the Toronto Marriott Eaton Centre.

NeuroMedix, a company focused on the development of therapeutic agents
for the treatment of neuroinflammatory diseases, has commenced cGMP
manufacture of its lead compound, Minozac, and expects to initiate
pre-clinical toxicology studies, in preparation for a Phase I clinical trial,
in the next few weeks. NeuroMedix’s clinical development plan is currently
focused on Alzheimer’s disease, based on the efficacy of Minozac in preventing
the release of neurotoxic cytokines from glia in a mouse model of Alzheimer’s
and in blocking the loss of cognitive function in such mice. Nevertheless, in
the effort to ensure that the full value of the aminopyridazine technology
licensed from Northwestern University is fully realized, NeuroMedix is also
investigating additional clinical indications where Minozac has potential to
be effective through its action modulating neuroinflammation. These include
neuropathic pain, traumatic brain injury and multiple sclerosis.

About NeuroMedix:

NeuroMedix is a biotechnology company focused on the development of
therapeutic agents for the treatment of degenerative and inflammatory diseases
of the central nervous system, such as Alzheimer’s disease, multiple sclerosis
and Parkinson’s disease. Our therapeutic drug candidates are based on research
from a team of leading experts in the field of neuroinflammation at
Northwestern University and have been demonstrated to reduce brain
inflammation, to protect neuronal cells, and to prevent the loss of cognitive
function in an Alzheimer’s disease animal model in mice. Based on these
findings, NeuroMedix is pursuing the development of a lead compound for the
prevention of Alzheimer’s disease in humans. NeuroMedix’s shares are listed on
the TSX Venture Exchange under the symbol “NMX”.

The TSX Venture Exchange does not accept responsibility for the adequacy
or accuracy of this release.

Except for historical information, this press release may contain
forward-looking statements, which reflect the Company’s current expectation
regarding future events. These forward-looking statements involve risks and
uncertainties, which may include but are not limited to, changing market
conditions, the successful and timely completion of clinical studies, the
establishment of corporate alliances, the impact of competitive products and
pricing, new product development, uncertainties related to the regulatory
approval process and other risks detailed from time to time in the Company’s
ongoing quarterly and annual reporting.

%SEDAR: 00022976E

For further information: visit www.neuromedixinc.com or contact:
Mark Pearson, PhD., Chief Executive Officer, NeuroMedix Inc., (425) 503-5156,
mark@neuromedixinc.com or Catherine Auld, CA, Chief Financial Officer,
NeuroMedix Inc., (416) 673-8190, cathy@neuromedixinc.com

Source : http://www.newswire.ca/en/releases/archive/May2006/03/c3046.html

American Association of Neurological Surgeons — AANS — Annual Meeting in San Francisco

PLAINSBORO, N.J., April 25, 2006 (PRIMEZONE) — Integra LifeSciences Holdings Corporation (Nasdaq:IART) today announced that the Department of Neurosurgery and Surgery, University of Pennsylvania will present the results of seven clinical studies on the application of the LICOX(R) Brain Tissue Oxygen Monitoring System to the management of brain injured patients, including those with severe traumatic brain injury or subarachnoid hemorrhage at the 2006 American Association of Neurological Surgeons (AANS) Annual Meeting in San Francisco, CA, this week.

The key findings of these studies include the following:

– Conventional strategies of ICP and CPP management may result in
significant reductions in cerebral oxygenation despite what would
otherwise be considered adequate intracranial pressure and
cerebral perfusion.

– Occult cerebral hypoxia occurs in TBI patients who receive
neurocritical care despite traditional practices to maintain CPP.
Medical interventions other than those to treat ICP and CPP can
improve BtO2. These interventions increase the number of possible
therapies for severe TBI in the intensive care unit.

– Occult cerebral hypoxia occurs in SAH patients who receive
conventional neurocritical care. Interventions to augment CPP and
FiO2 can help to maintain cerebral oxygenation in poor grade SAH
patients.

– SAH patients require a higher CPP than TBI patients to maintain
cerebral oxygenation. Guidelines developed for TBI may not be
applicable for SAH.

– CPP values do not always ensure adequate cerebral oxygenation
after SAH.

– Poor outcome in older patients after SAH may be associated with
a greater daily duration of brain hypoxia. In addition, older
patients appear to respond less to pressor treatments to augment
BtO2 than young patients.

– Fluid therapy to increase CVP does not ensure cerebral
oxygenation in all patients during the first 25 hours after SAH.
“Since we started using the LICOX(R) Brain Tissue Oxygen Monitoring System in 2002 we have found it to be a useful addition to existing neuromonitoring methods. In addition to our experience in TBI, we now have added considerable experience in SAH patients, where LICOX(R) seems to be a useful tool too,” said Peter D. LeRoux M.D., FACS, Associate Professor and Vice Chairman, Department of Neurosurgery, University of Pennsylvania.

Integra LifeSciences Holdings Corporation is a diversified medical technology company that develops, manufactures, and markets medical devices for use in a variety of applications. The primary applications for our products are neurosurgery, reconstructive surgery and general surgery. Integra is a leader in applying the principles of biotechnology to medical devices that improve patients’ quality of life. Our corporate headquarters are in Plainsboro, New Jersey, and we have research, manufacturing and distribution facilities located throughout the world. We have approximately 1,400 employees. Please visit our website at http://www.Integra-LS.com.

This news release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements include, but are not limited to, statements concerning the use of the LICOX(R) Brain Tissue Oxygen Monitoring System. Such forward-looking statements involve risks and uncertainties that could cause actual results to differ materially from predicted or expected results. Among other things, the willingness of physicians to use the LICOX(R) Brain Tissue Oxygen Monitoring System may affect the prospects for its use in clinical procedures. In addition, the economic, competitive, governmental, technological and other factors identified under the heading “Factors That May Affect Our Future Performance” included in the Business section of Integra’s Annual Report on Form 10-K for the year ended December 31, 2005 and information contained in subsequent filings with the Securities and Exchange Commission could affect actual results.

CONTACT: Integra LifeSciences Holdings Corporation
John B. Henneman, III, Executive Vice President
Chief Administrative Officer
(609) 936-2481
jhenneman@Integra-LS.com
Maria Platsis, Senior Director of Corporate Development
and Investor Relations
(609) 936-2333
mplatsis@Integra-LS.com

Source : http://www.primezone.com/newsroom/news.html?d=97878

Mesabi Daily News
Van Patten elected
to academy board
VIRGINIA — Peter Van Patten, M.D., of the Duluth Clinic-Virginia, has been elected to serve on the board of directors for the Minnesota Academy of Ophthalmology.

The organization, founded in 1911, is made up of about 200 medical doctors who specialize in eye and vision care. Twelve volunteer members from across the state make up the 2006-2007 board, along with a team of officers and committee chairs.

He has been providing eye care to Iron Range patients since 1996.

Memory loss, dementia
caregivers meeting set

VIRGINIA — A four-session program for family caregivers of persons with mid-stage dementia and other memory loss will be held 9:30 a.m.-12:30 p.m. on Fridays, June 2, 9, 16 and 23, in the meeting room at the Range Mental Health Center in Virginia.

The program is sponsored by the Alzheimer’s Association.

Participants will learn skills to help them in the daily care of someone with Alzheimer’s disease or related dementia. The evidence-based program helps caregivers to develop and master the caregiving role, helping them focus on managing daily life, behavior, resources and care for the caregiver.

Preregistration is required by May 26; call 218-726-4819; a $25 donation is suggested. On-site respite care is available through Virginia Adult Day Services; call 218-741-4714 for hourly rates and arrangements.

Klander attends
eyecare symposium

ORLANDO, Fla. — David Klander, C.O.M.Y., NCLEC of the Duluth Clinic-Virginia, recently attended the contact lens and eyecare symposium held at the Royal Pacific Resort at Universal Orlando in Orlando, Fla.

The symposium is the premier national contact lens meeting in the country, with the latest research, fitting techniques and clinical issues related to contact lenses and eyecare offered.

The meeting incorporates the full annual education meetings of the Contact Lens Society of America and the Contact Lens Association of Ophthalmologists.

Adult mental health
services offered

VIRGINIA — Range Mental Health Center is offering adult rehabilitative mental health services through its community support program.

The services are available to persons who are 18 years or older, on medical assistance and diagnosed with a mental illness or traumatic brain injury and who are impaired in three or more functional areas.

Services can be one to one or in groups, and can be provided in the person’s home or in a community setting. The services will help and enhance psychiatric stability, social competencies, personal and emotional adjustment, independent and community living skills, and stability and functions if at risk of significant decompensation.

Anyone with questions can contact Sandy Wallin at (800) 450-4714 or (218) 741-4714. In Hibbing, contact Sally Ribarczek at (218) 263-9237 or 1-888-344-9237.

Lab supervisor
takes on new role

VIRGINIA — Craig Ward, Duluth Clinic-Virginia laboratory supervisor, was elected as senior director of Area II for the Minnesota chapter of the American Society for Clinical Laboratory Scientists.

The organization serves as the voice of all clinical laboratory professionals, creating a vision for advancement of this field. The group promotes the value and role of the profession, ensuring safe, effective, efficient and patient-centered health care.

Stroke screening
set in Eveleth

EVELETH — Life Line Screening will be offering screenings for stroke starting at 9 a.m. May 8 at the Range Recreation Civic Center, 901 Hat Trick Ave., Eveleth.

Stroke, also called a “brain attack,’’ is considered the third leading killer in the world, and second among women. Preventive screenings can greatly reduce the risk of having one.

Screenings are fast and painless, with ultrasound technology scanning for any possible blocked arteries, aortic aneurysms and hardening of leg arteries, often a predictor of heart disease. A bone density screening is also offered. A complete vascular screening package is offered for $109, with the osteoporosis and vascular screening for a total of $139.

For more information on screenings or to schedule an appointment, call 1-877-237-1287. Preregistration is required.

RMHC offers more
expanded services

VIRGINIA — Range Mental Health Center has added more services, both in the Tower/Ely area, and also a children’s partial hospitalization program.

Intensive mental health services will be provided now to the Ely, Tower, Soudan, Babbitt and Embarrass areas through this community support program. The service is for persons age 18 years and older, with serious and persistent mental illness. Services include in-home visits, assistance accessing community services and daily living skills.

A drop-in center is now located at the Ely Baptist Church at 1515 Camp St. in Ely, open from 9 a.m. to 3 p.m. on Thursdays and Fridays. The center allows a positive place for socialization and relaxation, with activities including arts and crafts, field trips and budgeting and nutrition tips. A women’s group addresses concerns from a woman’s perspective, while a medications group helps educate on medication management and other issues.

Anyone having questions can contact Sandy Wallin at (800) 450-4714 or (218) 741-4714; Mariah Wiedemer at (218) 235-0755; or Mary Alice Johnson at (218) 780-5759 or (800) 450-4714.

The children’s partial hospitalization program gives intensive therapeutic services for children ages 7-11 having difficulties at home, school or community settings due to serious emotional and behavioral disturbances.

Group therapy focuses on issues a child is struggling with, and individual and family therapy also are offered.

Primary goals in the program are stabilization and symptom reduction, with psychiatric assessment, medication management and different therapy modalities.

Family members are actively involved, with family therapy and a partnering with parents on learning new skills to handle difficult behaviors included. The program runs five days a week, four hours a day, year round, at the Northland Learning Center in Virginia.

For more information contact RMHC program director Anneli Bowman at 218-749-3257.

Hospital quality
information available

ST. PAUL — Information on the quality of care in Minnesota hospitals is only a click away, with the Minnesota Hospital Quality Report offered at www.mnhospitalquality.org.

Health care consumers will be able to access information on three medical conditions, heart attacks, heart failure and pneumonia, with information specific to each hospital in the state. The site is for information, not to rank hospitals.

The Medical Bulletin Board is a quarterly feature of the Health Pulse 2006 editions. Professional and hospitals, clinics and other businesses related to the medical and health care fields are encouraged to submit items on promotions, honors, papers presented, meetings attended, accreditations or other achievements to Medical Bulletin Board, c/o Mesabi Daily News, P.O. Box 956, Virginia, MN 55792. Photos may be sent by mail or else by e-mailing them to mdnedit@virginiamn.com. Photos sent by mail will be available for pickup after publication at the MDN business office or will be returned with a self-addressed, stamped envelope.

Source : http://www.virginiamn.com/mdn/index.php?sect_rank=1&story_id=206145

Spring is here — the time when millions of Americans are heading outdoors to take part in their favorite sports activities. Getting ready for fun also means using the right gear and wearing a helmet each time you jump on a bike or skateboard, go for a horseback ride, play baseball or put on your in-line skates.

Not all helmets are created equal. Different activities require different helmets. Helmets are available for every season’s sports. Each type of helmet is designed to protect your head from the impact that can take place in the particular sport for which it is intended.

A helmet should be labeled to indicate it is certified by a reputable standards and testing organization — American National Standards Institute (ANSI), Snell or American Society for Testing and Materials (ASTM) International.

As long as it’s certified and new, let kids pick out their own helmets. If they think a helmet looks cool, they’ll be more likely to wear it when you’re not around.

As bicycle riding is the most common sport among kids, the largest number of youngsters’ emergency room visits stem from bike accidents.

Properly fitted bike helmets could reduce the risk of bike-related brain injuries by 88 percent; however, only one out of five cyclists ages 5 to 14 usually wears a helmet.

Each year in the United States, more than 100 children die from bicycle-related injuries, and more than a quarter million are treated in emergency rooms. Nearly half have traumatic brain injuries.

Safe Kids reminds parents and caregivers:

• Make sure the helmet fits and your kids know how to put it on correctly. In a crash, the risk of head injury is doubled if the helmet is worn incorrectly. A helmet should sit on top of the head in a level position and should not rock forward, backward or side to side. The helmet straps always must be buckled, but not too tightly. Safe Kids recommends the “Eyes, Ears and Mouth” test: The rim of the helmet should be one to two finger-widths above the eyebrows, the straps should form a “V” just below the ear lobe, the buckle should be flat against the skin and the strap should feel snug when the rider’s mouth is open.

• Remember that bike helmets are for riding bikes and other human-powered wheels. Kids should not wear bike helmets on the playground (where straps can get caught on equipment and cause injury) or for activities that require specialized helmets (such as skiing or football). Bike helmets are appropriate for roller skating, in-line skating and skateboarding without aerial stunts, and for use with non-motorized scooters. The American Academy of Orthopaedic Surgeons recommends children younger than 12 wear a bike helmet while sledding.

• When in doubt, get help. The sales staff at any bicycle shop or outdoor recreation store should be able to provide expert advice on fitting and adjusting bikes and helmets. For more information, visit www.usa.safekids.org.

“My husband used to be so calm. But after his injury, he started to explode over the littlest things. He didn’t even know he had changed.”

When someone close to you has sustained a TBI, it can be hard to know how best to help. They may say that they are “fine”, but you can tell from how they are acting that something has changed.

If you notice that your family member or friend has some of the classic symptoms, that are getting worse, or not getting better, talk to them and their doctor about getting help. You might also want to talk to people who have experienced what you are going through. Your State Brain Injury Association may be able to help, as may the National Brain Injury Association.

You can reach BIA National office by calling the toll free BIA National help line at (800) 444-6443. You can also get information through the National BIA website at www.biausa.org. Additional information about brain injury is available through the Center for Disease Control & Prevention (CDC) website at http://www.cdc.gov/.

We at the Scarlett Law Group also stand ready to support you from a legal context. You may reach us on our toll free line at (800) 262-7576.

Those who sustain concussion, hemorrhage, significant loss of consciousness, coma, and/or skull fractures are typically diagnosed as having sustained a “moderate” to “severe” traumatic brain injury.

Injuries of this nature are generally detectable on CT, MRI, and other imaging devices. In many instances, the patient’s very survival is an issue. Brain swelling, contusion and edema are likely complications. In virtually all cases, quality of life is a premier end goal.

The resulting impairments suffered by the “moderate” to “severe” traumatic brain injury victim can generally be related to the original insult, although in case after case insurance companies and their lawyers contest these relationships. Physical consequences of “moderate” to “severe” traumatic brain injury are diverse and vary from patient to patient. They may include: paralysis, sensory losses, decreased muscle control, including hemipareses, weakness, seizures, sleep disorders, speech and eating disorders, as well as memory and recall difficulties.

Individuals, while in coma, represent the “severe” end of traumatic brain injury. This is not to infer that one need be comatose to be classified as having sustained a “severe” traumatic brain injury, but comatose individuals have clearly sustained a “severe” traumatic brain injury irrespective of its potential transient nature.

Family members of comatose patients are often times left with nothing but hope, as health care professionals too, must wait as the human recovery process begins. It is no less important for family members to seek assistance from support groups during the recovery process.

A multi-disciplinary treatment and rehabilitative approach can be justified in virtually all cases of “moderate” to “severe” traumatic brain injury.