One of the most controversial, yet persistently disabling injuries involved in litigation is Mild Traumatic Brain Injury (mTBI).
Mild Traumatic Brain Injury is typically defined as an injury to the head resulting in brief-or-no loss of consciousness, post-traumatic amnesia, and negative neuroimaging scans. Those suffering mTBI typically experience a range of impairments and levels of disability that are often (sometimes poorly) associated with injury severity. Few neurological disorders are as prevalent as mTBI, which has an estimated incident of 350,000 new cases each year. According to the National Center of Health Statistics, approximately 85% of all traumatic brain injuries are classified as mild. While most go unnoticed by the legal community, a large number of claimants seek legal representation for compensation of their sufferings.
BRAIN DAMAGE VS COGNITIVE DYSFUNCTION
In personal injury litigation, the presence, extent and nature of cognitive dysfunction may be central to an individual’s claim of damage. It is erroneous to assume that any and all kinds of brain damage lead to similar, predictable behaviors. Limitations in function are not always due to the severity of damages.
It is crucial to distinguish between brain damage and cognitive dysfunction. Brain damage is a pathological alteration of brain tissue identified by brain imaging techniques. It implies clear and structural injury to the brain. Cerebral dysfunction is defined as changes in brain physiology that are not evidenced by structural modification of the brain.
You may have had the misfortune of buying a brand new plasma television that did not work (despite having no physical damage). Typically, a technician is called to evaluate and test the parts causing it to malfunction. As in the case of the technician, the expert neuropsychologist administers tests sensitive to even mild cognitive impairments.By administering these standardized tests, we can document the areas of brain malfunction and their effects on the subject’s quality of life. While the neuropsychologist’s job is more complicated than that of a television technician, the principle task is the same; to determine the cause and extent of dysfunction.
The brain controls how we think, behave and feel. If there is no structural damage to the brain, there may still be cognitive dysfunction or disability. A person may have negative neuroimaging scans and continue to experience cognitive or behavioral difficulties. Neuroimaging scans cannot explain why some find it difficult to return to work, manage daily responsibilities, or make decisions. The forensic neuropsychologist, trained and experienced in assessment of cerebral dysfunction and its impact on quality of life may answer those and other questions. When a patient sustains a mTBI from an accident, the consequences could still be catastrophic; even when there seems to be no or minimal physical damage to the brain.
BRAIN TRAUMA 101
Traumatic brain injury occurs in many forms; a fall or blow to the head, a gunshot (or other penetrating wound), or an automobile/motorcycle impact. There are constellations of neurological, psychological, affective, cognitive and behavioral symptoms produced by different kinds of injuries. An impact to the head will cause the scalp, skull, meninges (the covering of the brain) and the brain itself to respond in different ways.
This phenomenon is sometimes called “waterfall” because the physical event may produce primary injuries to one or more components of the brain. As a result of primary injuries, secondary injuries may appear which may or may not be resolved over time. Those injuries produce various types of events, such as increased intracranial pressure, compromised blood circulation and decreased oxygen in the brain. This domino effect may prevent resolution of the primary injury or complicate consequences of the original traumatic event.