Brain Injury FAQ
MYTH #1 - Striking of the Head is Required for Traumatic Brain Injury
The reality is a rapid or violent movement if the head is enough to cause traumatic brain injury. Mild closed head injury can occur after a severe neck trauma, even without the head actually striking any surface. Rapid deceleration of the head commonly causes non-contact brain injuries. Deceleration injuries occur when the head itself is moving rapidly and rapidly decelerates, often from striking an object. The deceleration then thrusts the brain forward in the cranium. A common example of a non-contact deceleration injury is a whiplash injury where the brain rapidly decelerates, but “without actually striking another object."
MYTH #2 - Loss of Consciousness is Required to Sustain TBI
The reality is loss of consciousness is NOT required to sustain a traumatic brain injury. There is really no room for debate on this issue. One study found that 35 percent of the people studied in the current scientific literature suffered traumatic brain injury without reported loss of consciousness.
MYTH #3 – Describing a Traumatic Brain Injury as “Mild” or “Minor” Equates with Insignificant
The reality is the word "mild" in describing a traumatic brain injury is a misnomer and does not mean insignificant. “Mild” is never used in my verbiage in presenting a traumatic brain injury case to a jury. It is much like refusing to use the word accident and using words like crash or collision. In presenting a brain injury case, there is no such thing as a mild brain injury. In general language, mild connotes trivial and plays into this myth and the typical defense strategy. Any injury can have severe consequences for a person. Even in the “mildest” of cases the injured victim sustains organic brain damage that causes problems in attention, concentration, memory, and judgment. For the most part, they recognize these deficits and are disturbed by them.
MYTH #4 – This Traumatic Brain Injury Case Involves Only Unrelated Nonorganic Problems and There is no Basis for Ongoing Organic Complaints
The reality is traumatic brain injury is serious even if it involves only ongoing nonorganic psychiatric or psychological problems. This is a common defense used in most cases, because it allows the defense to say there is no “real” basis for the client's complaints and, therefore, it must be an overreaction, an emotional problem unrelated to brain injury (and likely related to previous depression or other life stress) or even malingering. Psychiatric or psychological problems usually accompany traumatic brain injury. These issues problems often remain after the brain heals. Psychological responses vary from person to person and depend on who the person was before the brain injury. We all have different backgrounds and personalities that make us who we are and how we will react to a given traumatic situation.
Myth #5 - The Cognitive Impairments Identified in Neuropsychometric Testing do not Fit Within a Specific Pattern of Cognitive Impairment Following Traumatic Brain Injury
The reality is that cognitive impairment identified in testing will often vary in a person with a traumatic brain injury. When the defense neuropsychologist finds cognitive impairments in the testing but has no other way to explain those impairments, this myth is frequently used to explain away those findings. Brain damage manifestations differ from person to person and vary depending on the nature, extent, location of the brain damage, age, sex, physical condition of the person, their upbringing, past life history, personality, and educational level.
MYTH #6 – Traumatic Brain Injury is not Affecting the Person as the Intelligence Scores Remain High
The reality is smart people can have brain injuries too. In the case of an intelligent person with a brain injury, the client will still score higher on the neuropsychometric testing than most people. Defense neuropsychologists continually say that because the scores were above average or still in the superior range, there is no brain injury. It is important to understand that high test scores do not mean there has been no brain injury. A “mild” traumatic brain injury can be debilitating for a person who was previously functioning at a high level.
MYTH #7 – There Must be Objective Findings on the CT Scans and/or MRI of the Brain to Support a Traumatic Brain Injury Diagnosis
The reality is CT Scans and/or MRI of the brain can be normal even with a valid and legitimate traumatic brain injury. Anybody can handle a brain injury case where there is a large subarachnoid hemorrhage or subdural hematoma. The hard part is convincing a jury where there are no objective findings on any diagnostic scans. Just like in most injury cases, jurors like to see evidence of findings on scans or x-ray which show a demonstrable and objective injury.
MYTH #8 – Traumatic Brain Injury Cannot be Diagnosed Through Neuropsychometric Testing if There is no Previous Testing to Compare
The reality is, in most cases, your client will not have undergone neuropsychometric testing prior to the trauma. If your client had previous testing, then it is likely he or she has suffered a previous brain injury and you will be arguing an aggravation case. To combat this myth, preaccident employment, schooling, work records, etc., must all be taken into account when interpreting the results of the neuropsychological testing. It is important to do adequate background work up of your client. If certain cognitive requirements are necessary for a specific job and a person is functioning in that capacity and then no longer is able to do so, it is more likely the traumatic brain injury would be supported. The whole brain is not injured in each traumatic event. It is likely many of the areas still function normally but you may see a pattern in testing.
MYTH #9 - Plaintiff Continues Working at Her Same Job and Therefore the TBI Has not Affected Her Ability to Earn a Living
Even though your client is working at the same place, find out how her ability to complete her job has changed. Many activities which were previously handled automatically and easily, however, may now require a full measure of concentration and effort, with some tasks beyond current capabilities. How the person responds will depend on personality features, external stressors, and provided information and support. Some persons will remain calm and work within their limitation, gradually increasing neuropsychological demand in their lives as their capabilities return, and ultimately making adjustments for any permanent psychological deficits. For others, however, the reaction may be one of alarm, a hypersensitivity to errors, and intensified efforts to compensate and function normally. Working less efficiently the individual may work longer hours to keep up, and sacrifice times for relaxation and rest. Work may continue under a mantle of fear and frustration over seemingly inexplicable changes in psychological functioning. It is not uncommon for affected person to misinterpret cognitive changes as symptoms of a major psychiatric disorder, with this fear adding to their decompensation.
MYTH #10 - Client Scored Well on All Memory Tests and Therefore There is no Objective Support for Complaints of Memory Loss
Often with frontal lobe traumatic brain injuries, a client has difficulty with attention and concentration. However, most memory functions are controlled in the temporal lobe. The defense neuropsychologist will often testify that your client has no problem with memory as all the tests for memory went well and hence there was no temporal lobe injury. Accordingly, the memory complaints noticed by the injured victim, family and friends are dismissed. To counteract this testimony, one must carefully establish the true source of what appears to be memory loss. Memory problems reported by the client and other lay people are often actually caused by processing problems manifesting themselves as memory problems. Rather than having trouble with memory, the TBI client is never taking the information in and processing it due to attention and concentration issues from a frontal lobe injury.32 Someone might say “I told you this same thing 20 minutes ago.” This type of comment leads the lay person to believe that the TBI client has forgotten what was said when actually the brain injured person never really got the information in their brain to begin with. So to the client and to those that deal with the client on a daily basis, there appears to be a memory issue, when it is actually a concentration and attention problem.
(Article reprinted with permission.)
Brain injuries are among the most serious of all. They can happen in a simple slip-and-fall.
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