RE-THINKING THE LONG TERM EFFECTS OF TRAUMATIC BRAIN INJURY

The recent highly publicized NFL Concussion Settlement (In Re: National Football League Players’ Concussion Injury Litigation, No. 2: 12-md-02323 (E. D. Pa)) has brought to public attention the potentially devastating long term effects of repetitive mild brain injury.  However, there is growing evidence and recognition that there can be long term effects form non-repetitive traumatic brain injury (TBI).  Approximately 1.7 million people suffer TBI each year.  Motor vehicle accidents are the cause of about 60% of these injuries.

TBI is rated as mild, moderate or severe.  Obviously, long term effects are more likely with severe TBI but future problems can occur even with mild TBI.  Many injuries to the brain involve an injury to the frontal lobe of the brain.  This is especially true in cases involving head-on or offset frontal motor vehicle collisions.  These can be classified as closed head injuries – meaning that there is no fracture or opening in the skull – but the brain tissue impacts the inside of the bony skull.  This can result in bleeding, tissue damage, intra-cranial pressure, fluid buildup and possible neurochemical changes.  There can also be penetrating brain injuries which involve open fractures of the skull.  Penetrating injuries tend to result in more tissue loss and therefore more severe TBI.

Brain injuries can also be caused by anoxia, meaning that a reduction in the amount of oxygen in the brain causes brain cells to die.  Loss of an airway post-surgery can result in an anoxic brain injury.  This type of injury is rare but can be devastating.  Anoxic blindness and loss of fine motor control can result.  Exposure to certain chemicals can cause a toxic brain injury when the chemical crosses the blood-brain barrier.

Whatever the type or cause of TBI you are confronted with, when evaluating and/or prosecuting a case involving TBI, a lawyer should consider the long term effects of the client’s injury.  These include seizures, depression, aggression, cognitive deficits, anger management problems, dementia, Alzheimer’s disease, Parkinsonism, hypopituitarism and premature death.  Language and communication skills are also likely to develop.  Aphasia, dysarthria and dysphagia can occur.  Aphasia is the loss of the ability to understand speech or to speak.  Dysarthria is the inability to articulate speech.  Dysphagia is a difficulty swallowing.  TBI can also result in physical weakness, depending on what part of the brain is damaged.  There is also a condition associated with TBI known as heterotopic ossification which is a pathologic problem located in the soft tissue around the joints.  This can cause range of motion problems and pain.

All of these are problems that can develop months or even years after the injury.   At one time, the conventional wisdom was that victims of TBI had an approximate two year window of time in which to improve and that after that their condition would be static.  What has been discovered, however, is that the condition of a TBI victim is rarely static.  They can improve and then develop other problems later.  That is why it is important to help clients to be properly evaluated.  A neurophysiological assessment is very important.  This type of assessment will compare the client’s functioning pre and post injury.  A functional capacities evaluation should also be considered.  Likewise, a rehabilitation counselor and life care planner might be consulted.

At Jinks, Crow and Dickson we will continue to bring all of our experience and resources to bear when representing victims of traumatic brain injury.  These are challenging cases that require a high degree of specialized knowledge and experience.

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