Accidents & Violence, Legal-Malpractice, Neurology, Paralysis / 08.04.2026
The Lifetime Cost of a Spinal Cord Injury and Why Getting That Number Right Is the Most Important Legal Work in the Case
[caption id="attachment_73205" align="aligncenter" width="267"] Photo by SHVETS production[/caption]
Spinal cord injury cases are unique in personal injury law because the damages are not primarily about what happened in the past but about what the rest of the injured person's life will require. The medical bills from the acute hospitalisation, the rehabilitation facility stay, and the first year of outpatient therapy are significant — but they are typically the smallest component of the lifetime damages picture for a seriously injured SCI survivor.
The largest components are the future ones: the attendant care that becomes more intensive as the survivor ages and as family caregivers are no longer able to provide the physical support the injury requires; the medical monitoring and treatment for the secondary complications that SCI consistently produces over decades; and the adaptive equipment and home modification costs that must be updated as technology changes and as the survivor's functional needs evolve. Getting the lifetime cost calculation right is the most financially consequential legal work in an SCI case — and it requires a specific team of experts that most personal injury law firms do not maintain.
Photo by SHVETS production[/caption]
Spinal cord injury cases are unique in personal injury law because the damages are not primarily about what happened in the past but about what the rest of the injured person's life will require. The medical bills from the acute hospitalisation, the rehabilitation facility stay, and the first year of outpatient therapy are significant — but they are typically the smallest component of the lifetime damages picture for a seriously injured SCI survivor.
The largest components are the future ones: the attendant care that becomes more intensive as the survivor ages and as family caregivers are no longer able to provide the physical support the injury requires; the medical monitoring and treatment for the secondary complications that SCI consistently produces over decades; and the adaptive equipment and home modification costs that must be updated as technology changes and as the survivor's functional needs evolve. Getting the lifetime cost calculation right is the most financially consequential legal work in an SCI case — and it requires a specific team of experts that most personal injury law firms do not maintain.
Dr. Piantino[/caption]
Juan Piantino, M.D., MCR
Assistant Professor of Pediatrics
Division of Neurology, School of Medicine
Director, Inpatient Child Neurology
Oregon Health Sciences University
MedicalResearch.com: What is the background for this study?
Response: Astronauts are exposed to several stressors during spaceflight, including radiation, lack of gravity, and sleep deprivation. The effects of those stressors on the brain remain unknown. Is it safe to travel to space? For how long can humans survive in space? What are the effects of spending months under zero gravity? With more extended missions, and an increased number of civilians traveling to space, there is increased interest in understanding what happens to our brains when we leave earth.
Dr. Mahncke[/caption]
Dr. Mahncke earned his PhD at UCSF in the lab where lifelong brain plasticity was discovered. At the request of his academic mentor, he currently leads a global team of more than 400 brain scientists engaged in designing, testing, refining, and validating the computerized brain exercises found in the BrainHQ app from Posit Science, where he serves as CEO.
Earlier this year, MedicalResearch.com interviewed Dr. Henry Mahncke about the BRAVE Study he led, which showed a digital health app (BrainHQ) was effective in addressing chronic cognitive issues in servicemembers who had been diagnosed with “mild” Traumatic Brain Injury. This week, MedicalResearch.com interviews Dr. Mahncke again about a new independent study among civilians showing similar results in patients with all kinds of Brain Injuries.
MedicalResearch.com: What is the background for this study?
Response: The Centers for Disease Control (CDC) estimates that about 5.3 million people currently live with a chronic disability from a Traumatic Brain Injury (TBI). While most people who suffer a blow to the head recover in a couple days or weeks, for some (estimated as high as 15 percent) the injury persists with a variety of life-disrupting symptoms, including impairments in cognitive abilities, behavior, emotions, and motor function affecting work, relationships, and daily function.
TBIs have been the signature injury of recent wars. Nearly 400,000 service members have been diagnosed with TBIs, of which 82% were diagnosed with so-called “mild” TBIs from concussions and blast injuries. More than a decade ago, we began being asked by military and Veterans organizations, to study whether our brain exercises – which had shown positive effects in measures of cognition, everyday function, mood, and motor function in healthy older adults – could have an impact on people with chronic symptoms from TBIs.
We talked earlier this year, when an 83-person, gold-standard, randomized controlled trial on mTBI (called the BRAVE Study) announced quite positive results from using BrainHQ exercises. That study was funded by the Department of Defense and run as five military and Veterans medical centers. The BRAVE Study found the BrainHQ group showed a statistically and clinically significant improvement on a standard measure of overall cognitive function (compared to a computer games control), and this benefit persisted for at least 12 weeks after training completed. Cognitive function improvements were nearly four times larger in the BrainHQ group than the control (as measured immediately following training) and grew to nearly five times larger (when measured again 12 weeks after training ended). On average, participants in the BrainHQ group improved on the cognitive performance composite measure by 24 percentile ranks – as though they went from the 50th percentile to the 74th percentile.
One large question left unanswered from the BRAVE study was whether this approach might also work for other categories of TBIs, such as moderate and severe TBIs. A new study from independent researchers at NYU answers that question.
Dr. Schmidt[/caption]
William K. Schmidt, Ph.D.
Senior VP Clinical Development
Dr. Schreiber[/caption]
Darren Schreiber JD PhD
Senior Lecturer
Exeter
MedicalResearch.com: What is the background for this study?
Response: My co-authors and I saw an opportunity to match existing functional brain imaging data with publicly available voter registration data so that we could look for patterns that distinguish brain activity in nonpartisans from partisans. While a number of studies have found differences in both brain structure and function between partisans on the left and right and there is a massive amount of scholarship in political science on partisans and polarization, no brain imaging work had focused on nonpartisans. Around 40% of Americans do not affiliate with a political party and one important campaign strategy has been to persuade these voters to support party candidates. However many political scientists are skeptical about voters claims to be nonpartisans and will instead treat them as if they were merely covert partisans.
Dr. Factor[/caption]
Stewart A. Factor, D.O.
Professor of Neurology
Director of the Movement Disorders Program
Vance Lanier Chair of Neurology
Emory University School of Medicine
MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by OFF episodes.
Response: Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disease characterized by motor symptoms, including tremor at rest, rigidity and impaired movement, as well as significant non-motor symptoms, such as cognitive impairment, psychiatric symptoms and autonomic symptoms (i.e. urinary issues, constipation, low blood pressure). It is the second-most common neurodegenerative disease after Alzheimer’s disease and it is predicted that the prevalence of Parkinson’s disease will double by the year 2040. The symptoms of PD are in substantial part, due to loss of dopamine nerve cells in the brain. The current standard of care for PD includes replacing the dopamine loss by the use of oral carbidopa/levodopa. Levodopa is a precursor of dopamine, converted in the brain.
OFF episodes have been a significant unmet need in Parkinson’s disease since the emergence of levodopa. Initially, levodopa controls PD symptoms in a continuous fashion throughout the day. With time the response becomes less predictable and patients experience a re-emergence or worsening of PD symptoms. These episodes are what we mean by OFF episodes. OFF episodes can be characterized, in part, by re-emergence of motor symptoms including tremor, stiffness or slowed movement that can happen at any point during the day. OFF episodes typically begin within the first five years of treatment and occur at the end of a dose. This is referred to as end of dose failure or wearing off. Within the first four to six years after diagnosis, regardless of disease severity, up to 60 percent of people with PD experience OFF episodes. With time these episodes become longer, more severe and disabling, more frequent and less predictable as PD progresses. They can take up more than half the day
OFF episodes may alter a persons’ ability to perform everyday activities by slowing or even precluding their completion. The result is significant burden and distress for people living with Parkinson’s disease (PD) and their care partners.
CTH-300 was a Phase 3, 12-week, randomized, double-blind, placebo-controlled, parallel group, study examining the efficacy, safety and tolerability of apomorphine hydrochloride sublingual film (KYNMOBI) in people with levodopa-responsive PD complicated by OFF episodes. The primary endpoint was a mean change in the score from pre-dose in the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III Motor Examination at 30 minutes after dosing at the 12-week visit of the maintenance treatment phase. The key secondary endpoint was the percentage of people with PD with a patient-rated full ON (or best) response within 30 minutes at the 12-week visit of the maintenance treatment phase.
