September 21, 2014

Jordan Miles Civil Trial – Day 5 Court Blog – 23 July 2012

By Nigel Parry, with Helen Gerhardt

Jordan Miles, his mother and grandmother, arrive at court on July 23rd, 2012. (Photo: Nigel Parry)

Dr. Maria Twichell, physiatrist, outside the courthouse.

Today we saw the end of the video testimony of Dr. Fenton, the UPMC Shadyside EMT who treated Jordan a day after the assault, within a few hours of him being released from jail. Dr. Fenton confirmed multiple contusions (various levels of bruising) on Jordan’s body and face, as well as subconjuctival hematoma, bleeding in Jordan’s right eye. Dr. Fenton reported that the CT scan did not show intercranial injury or skull fracture.

Helen Gerhardt reports:

Key testimony regarding the long term impacts that Jordan has suffered was provided by Dr. Maria Twichell, Clinical Director of Treatment and Rehabilitation for UPMC’s Sports Concussion program, who also practices physiatry (a specialization in the rehabilitation of neurophysiological systems, often confused with the very distinct practice of “psychiatry”) She also serves as physiatrist for the University of Pittsburgh Physicians Department of Physical Medicine & Rehabilitation,  and as private consultant.

After Jordan’s attorney covered her education, experience and qualifications, Dr. Twichell began by explaining her daily work as a rehabilitation specialist focused mainly on trauma, brain injury, and concussion. She regularly examines, performs assessments and helps to develop rehabilitation plans for an average of forty to fifty patients each week. Her work often involves teaching follow-up patients how to cope with the traumas and damages caused by neurophysiological injuries and traumas so that they may regain at least partial function in whatever areas of competency have been affected.

Dr. Twichell confirmed that concussions are not usually diagnosed by emergency room physicians such as earlier medical witness, Dr. Fenton, who are tasked with detecting and treating immediately life-threatening injuries. MRIs and CT scans do not show concussion – in fact, Dr. Twichell noted that part of the diagnosis of concussion is that such scans do not show cranial fractures or hematomas.

Dr. Twichell first saw Jordan Miles for an evaluation in October of 2011, where he first summarized the history of the incident. She reported that he was quiet and polite, answered questions appropriately, and did not seem to exaggerate his account of his “altercation with police officers.” He did not remember all details of the event, but especially remembered a very hard blow to the right side of the head with a hard object, after which he became dazed. Many of the symptoms he reported that he still suffered at the time of her first examination are consonant with the long-term symptoms of concussion: headaches, dizziness, confusion, nausea, memory loss, loss of ability to concentrate, decreased ability to comprehend, mood swings, depression.

She confirmed during direct and cross-examination that some of these and other reported symptoms such as nightmares and flashbacks are subjectively reported by patients, and some are also symptoms of Post Traumatic Stress Disorder (PTSD.)  Such overlapping symptoms also often require treatment by a psychiatrist; such care was provided for Jordan by psychiatrist, Dr. Jay Leathers, (whose later testimony is summarized here.)

However, Dr. Twichell noted objective measures of physical dysfunctions characteristic of nerve damage and post-concussive symptoms. Numbness in the face indicated damage to the maxillary branch of the trigeminal nerve, as well as damages to proprioception and the vestibular systems of balance, as measured by the Romberg Test. She also consulted with Dr. Gorski, who administered an in-depth, four-hour neuropsychological exam designed to fully evaluate the functioning of various subsets of patient cognition, neurophysiological health and integration of information.

Both during direct and cross examination, Dr. Twichell emphasized that such exams are meant to detect and counter false or exaggerated subjective reporting by patients with objective measures of neurological and physiological functioning. She stated that the symptoms reported by Jordan Miles regarding impaired cognition, memory, and integration of vision and physical balance systems were corroborated by all objective validity measures. She also stated that such  damages clearly could have been caused by a hard impact to the right side of the head, such as the blow described by Jordan Miles during his testimony.

Dr. Twichell saw Jordan Miles again in March of 2012. Review of symptoms indicated that Jordan had made improvement or showed slight typical fluctuation of performance and symptoms in some areas, but, by objective measures, he was still suffering from problems with balance, proprioception,  eye-focus, and integration of sensory systems. He reported continued difficulty with concentration and basic math skills, such as counting in the stock-room that he was responsible for inventorying. (The neurolpsychological exam by Dr. Gorsky had indicated that Jordan’s math skills had regressed to the fifth grade level.)

Dr. Twichell also noted worsening of such subjectively reported symptoms as anxiety, depression, and stress, partly because of the increased difficulties in functioning caused by what Dr. Twichell indicates may be long-term neurological damages of a post-concussive condition.

When Jordan’s attorney, Kerrington asked about ongoing needs for costly medical care and future impacts of these damages on the ability to complete further education, as well as on his future earnings power, Dr. Twichell replied: “We see the most improvement in the first month [after a concussive injury], then usually more slow improvement over about two years…further improvement is much slower…I would anticipate that Jordan would need ongoing psychological and psychiatric care, [as well as] vestibular and cognitive therapies…assistance with classes…job coach. [Continued experience of post concussive symptoms would] tend to be rather static given the point we are now in the trajectory of his recovery. [In the] typical course, where Jordan is now is what we can expect to see going forward.”

DAY 5, VIDEO UPDATE, 12:30PM

At the end of the day, the cops sneak out a back way to wait for their ride…

(Photo: Nigel Parry)