1.  Driving without texting

2.  Driving without making or receiving cell phone calls.

3.  Making sure to call or text parents  or friends before they start driving to let the parents or friends know when they’ll arrive at their destination.

4.  Turning the cell phone off or to silent when driving alone.

5.  Pulling over to a safe location if they must make or receive a call or text.

6.  Deputizing passengers to make/receive calls/texts and to handle the music selections when they are driving.

7.  Not eat while driving.

8.  Not adjust music while driving (just set the CD, iPad, iPhone or other device in advance)

9.  Not apply makeup or reach for things in the back seat while driving

10.  Asking the driver to drive safer (e.g., not text and drive) if they are the passenger in the car.

The 10th choice posed the biggest challenge to this group of kids.  They were surprisingly willing as passengers to speak up to friends who where not driving safely.  The difficult scenario the kids face is when they are a passenger in a vehicle being driven by a friend’s parent or a friend’s older sibling.  It’s tough at age 16 to get up the nerve to tell someone else’s parent that their unsafe driving is making you uncomfortable.

We adults need to stop setting such bad examples.  When we  text, check emails, or speak on the phone while driving, we are telling kids and their friends that distracted driving is acceptable.  At 55 mph , if one takes only 4.6 seconds to open a text and respond to it, one has traveled the length of a football field without watching the road.  That is not acceptable.   Let’s not put other people’s kids in the position of having to ask us not to drive distracted while they are our passengers.

Not being able to see underlying damage leads to frustration for patients and doctors alike, says Dr. Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke.  Some people experience memory loss, mood changes or other problems after what was deemed a mild concussion, only to have CT scans indicate nothing’s wrong.

Repeated concussions raise the risk of developing permanent neurologic problems later in life, a concern highlighted when some retired football players and also the family of Dave Duerson sued the National Football League.  But Dr. Koroshetz says there’s no way to tell how much damage someone is accumulating, if the next blow “is really going to cause big trouble.”

In a report published Friday in the Journal of Neurosurgery, the authors described a promising diagnostic tool called high-definition fiber tracking.  Brain cells communicate with each other through a system of axons, or nerve fibers, that acts like a telephone network. They make up the white matter of the brain, and run along fiber tracts, cable-like highways containing millions of connections.  The new scan processes high-powered MRIs through a special computer program to map major fiber tracts, painting them in vivid greens, yellows and purples that designate their different functions. Researchers look for breaks in the fibers that could slow, even stop, those nerve connections from doing their assigned job.

Daniel Stunkard of New Castle, Pa., is among the first 50 TBI patients in the high- definitionfiber tracking testing. The 32-year-old spent three weeks in a coma after his all-terrain vehicle crashed in late 2010. CT and regular MRI scans showed only some bruising and swelling, unable to predict if he’d wake up and in what shape.

When Stunkard did awaken, he couldn’t move his left leg, arm or hand. Doctors started rehabilitation in hopes of stimulating healing, and researchers say the high-def fiber tracking predicted what happened. The scan found partial breaks in nerve fibers that control the leg and arm, and extensive damage to those controlling the hand. In six months, Stunkard was walking. He now has some arm motion. But he still can’t use his hand, his fingers curled tightly into a ball. Those nerve fibers were too far gone for repair.

The new tool promises a much closer look at nerve fibers than is now possible through a technique called diffusion tensor imaging, says Dr. Rocco Armonda, a neurosurgeon at Walter Reed National Military Medical Center.  “It’s like comparing your fuzzy screen black-and-white TV with a high-definition TV,” he says.  Dr. Armonda soon will begin studying the high-def scan on soldiers being treated for TBI at Walter Reed, to see if its findings correlate with their injuries and recovery.

Let’s hope this and other technology evolves to help doctors rehabilitate victims of brain damage.

Doctors have long experimented with amantadine hydrochloride to treat severe brain injuries, with mixed and uncertain results. Previous studies suggested some benefit, but the numbers were small and experts were unsure of the findings.  The new experiment put those doubts to rest, by testing the drug against a placebo in two large groups of patients.  A consortium of researchers from 11 clinics enrolled 184 patients who recently had a traumatic brain injury from a car accident or from blows to the head. Some were in a vegetative state, breathing, their eyes open when awake, but unresponsive to commands or prompts. Others were in what is known as a minimally conscious state, able to track objects and follow commands once in a while, but not predictably.

The research team divided the patients into two groups, carefully matched for the severity of their injuries. Members of one group got two doses of amantadine a day, given through their feeding tubes. Members of the other group received placebo pills.  The study was “blinded,” meaning that the therapists providing the usual daily care — moving limbs, stimulating the senses and giving medical support — did not know who was on the drug and who was not.  After four weeks, the researchers analyzed the patients’ progress, using a standard scale that rates abilities in such areas as coordination and communication. The scale ranges from zero, for no disability, to 29, for a state of total unresponsiveness, and is scored regularly at bedside.

Almost all of the patients improved somewhat during the four weeks. This was expected; their injuries were recent, and in the first year after a traumatic brain injury most people recover some function, even if they do not always regain full awareness later on, scientists say.  But the group receiving amantadine showed more improvement, by two points on the disability scale. Two points is not a dramatic difference, but it occurred in just a month, a short period of time in terms of recovery.

“The main finding is that on every single behavioral domain measured, we had a higher incidence of recovery in the amantadine group than in the placebo group,” said Dr. Joseph T. Giacino, a leader of the research team.  When doctors took patients off the drug, the rate of recovery slowed down. “In the next two weeks, the placebo group caught up,” said Dr. Whyte, another team leader. “So we know that the drug accelerates recovery, but we can’t say whether it alters the trajectory entirely.”

Dr. Ramon Diaz-Arrastia said the results were welcome news in a field that has seen many failed efforts. He is director of clinical research at the government’s Center for Neuroscience and Regenerative Medicine, which works with the military and government scientists on brain injury research.  “It’s an important step toward developing better therapies,” he said.

Since amantadine is so commonly used, he said U.S. troops with severe brain injuries in Iraq or Afghanistan should probably get it, or should get it now. Since 2000, some 233,000 troops have suffered traumatic brain injuries, including about 6,100 serious cases, many of them from bomb blasts or shrapnel.

Before the recall, Johnson & Johnson maintained that the high rate of failure for their device was due to improper installment by surgeons.  Ms. Plouhar’s email seems to contradict this claim.  Not only did she and DePuy know about the FDA’s findings, she states in her email that there had been “a significant number of revisions (corrective surgeries) in the ASR (study) group compared with very few in the control group.”  It is estimated that 30,000 devices were sold in the United States prior to the recall and around 90,000 internationally.  Johnson and Johnson claims that the recall was a result of declining sales of the product rather than a flawed design.  According to the President of DePuy, the recall “was purely a business decision.”

P.S.  Over at the InjuryBoard blog, an interesting blog by Brett Emison about the internal DePuy email appeared the day after we published this blog.  Brett’s blog links back to a series of blogs on the DePuy ASR hip implant recall.

“Distracted driving is a dangerous and deadly habit on America’s roadways — that’s why I’ve made it a priority to encourage people to stay focused behind the wheel,” LaHood said.

Distracted driving deaths totaled 3,092 in 2010.  LaHood’s agency believes the total could be higher due to the unwillingness of drivers to always admit behavior, lack of witnesses to a crash in some cases, or the death of the driver.  Most U.S. motorists surveyed last year acknowledged few situations in which they would not use a cellphone or text while behind the wheel. However, they supported measures to curb both practices, the Transportation Department said.  The proposal recommends disabling in-vehicle electronic devices that the driver could use when a car is moving.  This would cover text messaging, Internet browsing, and access to social media.

The proposal is a compromise for LaHood, who stopped short of ordering that General Motors, Ford Motor, Chrysler and other manufacturers restrict hands-free and other dashboard advances popular with consumers and key selling points in new vehicles.  National Transportation Safety Board Chairman Deborah Hersman said in December that certain hands-free and other communications devices should be banned in cars.  The proposed guidelines are subject to a 60-day public comment period. The National Highway Traffic Safety Administration will hold hearings in March in Los Angeles, Washington and Chicago.

I happen to think that education rather than more federal government regulation is the way to attack this serious problem.  That’s why I’ve joined with hundreds of other lawyers who’ve volunteered to speak to teenagers at their schools, drivers’ ed classes, or wherever we are invited to educate them on the dangers of distracted driving.  The program is called 60 For Safety and you can read about it at the preceding link.  We all know that teenagers think they are invincible and have superior reflexes that can get them out of any motor vehicle problem.  Thus, when a law is passed banning texting while driving, studies show that teens will simply hold the phone lower so the police cannot see it.

When I speak to teens, I try not to sound like a hypocrite- I try to educate.  I admit that I am sometimes a distracted driver, but that I’m working at changing my habits.   I tell them that if they hold their phone low for 6 seconds at 55 mph, their vehice traveled 120 yards while they were not looking.   I show them testimony of survivors who’ve lost a loved one who got run over by a distracted driver.  Big brother isn’t going to change our kids’ habits.  They get those habits from watching us.  We need to change our habits and educate our kids.  At the same time, the automakers might think twice about selling young people on cars bassed on how easy it is to Facebook or text while driving that car.

Applications that prevent people from using their mobile phones while a vehicle is moving also are gaining popularity with corporate fleet managers. And, a  new federal regulation that took effect January 1st  penalizes commercial truck and bus drivers up to $2,750 each time they’re caught reaching for or dialing a phone while driving.

Here is a list of  the kind of  available technology:

 •Software that uses on-phone GPS or in-vehicle Bluetooth systems to determine when the vehicle is moving.  The mobile device is disabled by the software when the vehicle is moving.  On example is iZup, which costs only $20 per year to block a cellphone when driving.  It saves voice calls to voice mail and holds text messages and other data interactions while a vehicle is moving.

•Devices that connect with the vehicle’s on-board diagnostics port or integrate into vehicle electronics or infotainment platform, shutting off gadgets while the vehicle is moving. They include Cellcontrol, Key2SafeDriving and Taser International’s Protector.

 •Detection, jamming, monitoring and sensors. They include Trinity-Noble’s Guardian Angel, which locks the keys of a cellphone when a vehicle is going over a pre-set speed.

Any parent who thinks that any of the above technology will be an easy panacea is naive.  The technology currently does not distinguish between drivers and passengers.  This means that parents have to be willing to ban cell phone use by their teens even when the teen is a passenger in the parents’ vehicles.  OMG, you might have to put down your own cell phone and talk to your kids.

We’ve all seen these drivers.   They are oblivious to their surroundings.  They may be driving in the passing lane going 20 miles below the speed limit and have no clue that there is a line of cars behind them.  Whenever I pass such a vehicle, the driver is either talking on the mobile phone or texting.  It’s maddening.

Thirty five states ban texting while driving, yet one in every 100 drivers on the road is texting, emailing, searching the internet, or talking on the phone.  So, what is the solution?  First, parents need to stop setting a bad example for their kids.  Kids who’ve watched mom and/or dad text or check emails while driving are going to do the same when they drive.  They’ve learned from their own parents that this is an acceptable behavior.  Young drivers already over estimate their abilities.  They don’t need to be taking their eyes off the road to read a text or email.  Parents need to get tough about this.  Take away the cell phone or the car the first time your did breaks your rules about using the phone while driving.  Get an app that disables your child’s cell phone when the vehicle is traveling above a certain speed limit.  These are just a couple of options.  Neither will make you popular with your child.  But, would you rather be unpopular or mourning the loss of your child?

“We are being asked by our customers what to do on this sort of thing, especially since October … when President Obama issued the federal order banning federal employees from texting while operating government-owned vehicles,” says Stacy Chisum, Manage Mobility’s vice president of sales.

 Thirty states and the District of Columbia have banned the practice, but the laws are difficult to enforce. The national movement to discourage it — aimed mostly at young drivers — is spreading to corporate employees and the U.S. government.  Unfortunately, laws banning texting while driving may simply result in drivers holding their phones at lap level while texting so that the phone is not visible to police, thus creating an even more dangerous situation.

 Several applications disable cellphones when a vehicle is moving, preventing texting or surfing the Web. These apps, including iZup, tXtBlocker, ZoomSafer and CellSafety, use a phone’s GPS to determine when a vehicle is moving, and block the ability to text when the car is going faster than 5 or 10 mph. Some apps have opt-out features for passengers. The apps do not work on the iPhone.

This technology should be on every parents’ wish list.

 Federal authorities estimate that distracted driving caused 5,474 deaths in 2009, 995 of which were from using cell phones.  The National Highway Transportation Safety Administration (NHTSA) has performed extensive research that lead to the conclusion by NHTSA that there are three types of driver distractions: visual, manual and cognitive.  That is, even when a motorist is looking straight ahead, the cognitive demand of a phone conversation may cause “inattention blindness,” or a failure to respond to visual cues because the mind is somewhere else.

The evidence includes a study by the Insurance Institute for Highway Safety that found that drivers are four times more likely to be in an automobile crash when they are talking on the phone, whether using a hand-held or hands-free device.  Researchers at the University of Utah found that cellphone conversations slow driver’s reactions as much as having a blood alcohol level at the legal limit of .08 percent.  Moreover, in some fatal cellphone crashes, there is anecdotal evidence that drivers were simply talking — not dialing or groping for their phones.

Auto makers are reacting to this dangerous phenomenon in a contadictory way.  On the one hand,  Ford Motor Co. is sponsoring clinics at  high schools to urge teens to heed traffic laws and avoid distractions behind the wheel.  As part of its “Driving Skills for Life” program, Ford also recently awarded $25,000 to students who created the best music video about the hazards of distracted driving.  Likewise, BMW  launched ‘Don’t Text and Drive,’ a series of TV ads to dramatize the risks of distracted driving.  And the Alliance of Automobile Manufacturers, an industry trade group, is teaming with the American Academy of Orthopaedic Surgeons in a similar campaign. 

 That’s all good.  The problem is that at the same time these companies are telling drivers to pay attention to the road, they are trying to increase sales by appealing to the young consumers’ appetite for cutting-edge infotainment systems that encourage distracted driving.  

Ford’s SYNC system, for example, enables drivers to use voice commands and touch screens to make and receive calls, listen to their text messages, and choose from a menu of replies. BMW’s ConnectedDrive provides calling, e-mail and text read-backs, and displays headlines of the messages on a screen.

General Motors advertised its infotainment technology with a Super Bowl ad of a young Chevy Cruze owner whose face lights up as he drives away and plays back the Facebook message: “Best first date ever…’’

Auto executives are counting heavily on edgy, high-tech features to boost sales, especially to younger buyers. David Mondragon, president of Ford Canada, put it bluntly: “The biggest turnoff to a twentysomething consumer is to put their life on hold when they sit in a car,” he said in a speech to the Canadian Marketing Assn.  “And what does it mean to put their life on hold? To get disconnected when they get in the car, to have a system that will not allow you to sit there and e-mail, read your BlackBerry, talk on the phone. So you have to have a seamless transition from your home to your transportation device, to your workspace. Or to your play space.” 

 This marketing position flies in the face of Ford’s stated policy of urging young drivers to avoid distractions behind the wheel.  Are the auto makers simply paying lip service to distracted driving in order to guard against tough criticism of their built-in infotainment systems?  In the time it takes to look down at a text message, a child could run out into the road in front of your vehicle.  Parents should lead by example and never use their cell phone in the car, particularly in front of their children.  This may seem harsh at first, but children parrot what their parents do, so changing the habits of older drivers may be the most important step to creating safer young drivers.

According to Adm. Michael Mullen, chairman of the Joint Chiefs of Staff, ”The data we are getting from theater demonstrates how important it is to get to the root of the problem early in order to attack it.”  Under the rule, troops caught within about 165 feet of a blast must be pulled from combat for 24 hours and examined for signs of concussion. The data on the results of that policy are from August 2010 — when the treatment plan for concussions was initiated — through June.

Alarmingly, of the 9,000 service men and women who were pulled from combat in Iraq and Afghanistan and examined, nearly 1,400 were found to have mild traumatic brain injury.  These are folks who had no obvious wounds.

Kudos to the military for implementing this policy.  Research showing that a second concussion could be exponentially more dangerous and could cause permanent brain damage helped pave the way for this policy.  Prior to the policy, the servicemembers would likely have stayed in the fight because it was common practice to try to shake off the effects of a blast and keep fighting, said physician Michael Kilpatrick, a Pentagon health official.

Injured troops were often moved to special concussion treatment centers, Grimes said where they were monitored and treated until doctors concluded that their brain injuries had healed, a period that usually lasted about a week. Those with persistent problems were sent home.  That’s the other important aspect of the military’s new policy.  They recognize that while most people recover from a mild brain injury in a short period of time, some do not and suffer from persistent, long-term problems.  The troops in the later category need to be sent home for rehabilitative care.  “There’s just a greater awareness nationally that this is a much more serious thing than we’ve taken it for in the past,” Kilpatrick said, “that it’s not just a badge of courage to get knocked out, get up and keep going, but get the care you need at the time and then go forward.”