Sprains, pains, bruises, cuts, abrasions, and?other obvious injuries are readily diagnosed ?after trauma. Brain injury, however, can easily?go undetected. Whether an accident is minor or major, traumatic brain injury (TBI) can result. By definition, it occurs whenever there is a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain1. MRI and CT scans are generally ordered if a concussion or other head injury is suspected. These tests, however, are not always conclusive of whether the brain has been harmed. If TBI is suspected, referral to a neuropsychologist may yield beneficial treatment, as well as provide documentation of this life-altering injury that a jury can understand.
TBI Statistics—An American Epidemic
The Centers for Disease Control and Prevention (CDC) advises that the leading causes of TBI are falls (28 percent), automobile- traffic crashes (20 percent) and assaults (11 per- cent). According to the CDC, every 21 seconds, someone in the U.S. suffers a TBI. Each year, 1.4 million people suffer a TBI here. Of these injured people, 1.1 million are treated and released by an emergency room, while 230,000 people are actually hospitalized and survive. TBIs kill 50,000 Americans each year.2 A staggering 5.3 million Americans are so profoundly affected by TBI that they require assistance with an activity of daily living for the long term or the rest of their lives. TBI is an epidemic and easily overlooked when not obvious.
Symptoms of Traumatic Brain Injury
There are differing degrees of TBI, from mild to severe. Mild TBI can be difficult to detect or diagnose, and care for it may never be ordered because the symptoms can present subtly. Persons suffering TBI can suffer a broad range of symptoms, including: 3
- memory loss
- lack of concentration
- slowed ability to process information
- double vision or even loss of vision
- headaches or migraines
- loss of smell or taste
- speech impairments
- impulsive behavior
- depression and
- mood swings
Additionally, TBI is believed to cause epilepsy and increase the risk of Alzheimer’s disease, Parkinson’s disease, and other conditions associated with aging.4
The Neuropsychologist and Evaluating TBI
A neuropsychologist works with the cognitive, emotional and behavioral problems related to brain injury or dysfunction. A referral for neuropsychological testing can come from a treating medical provider or counsel if necessary. A medical referral will provide an opportunity to secure insurance coverage for the evaluation and treatment. In contrast, a referral by counsel will most likely be billed to the case. It may also provide an unfair and undesirable avenue of attack by opposing counsel on the impartiality of the examiner and weight of any findings.
In the evaluation, the neuropsychologist should conduct an initial interview of the patient. This will likely include inquiry into pre-injury abilities and functioning, the injury involved, and the complaints and circumstances of the patient’s life since the suspected injury through the time of the inter- view. Family members may also be consulted, along with research into historical indicators of functioning before and after the suspected injury. These indicators may include prior psychological testing, scholastic performance, medical records, work history or evaluations and other indicators of cognitive or physical functioning.
As to the testing administered, there are many different types of standardized tests available to the examiner. The tests are designed to evaluate higher cortical functioning and basic sensory motor processes. Objective results are yielded through analysis of the battery of tests selected by the expert. Both the degree and type of injury are tested. Testing procedures and protocols vary—some experts will design specific testing regimens for the individual patient, while others use specific batteries of tests in the order prescribed by protocol. Analysis of the test results is the critical function of this expert.
Credentialing of the Neuropsychologist
A neuropsychologist is generally?a person with a doctorate in psychology (PhD), and nota medical doctor. Board certifications exist, and a number of national and international organizations support these experts. The American Association of Psychologists has a specific section of membership for Clinical Neuropsychology, and offers certification with?a Diploma of Clinical Neuropsychology.5 The American Academy of Clinical Neuropsychology is
comprised?of experts certified by the American Board of Clinical Neuropsychology and maintains a publicly available database of members listed by name and state.6 One other consideration regarding this expert—there is debate as to whether the neuropsychologist should personally conduct testing of the patient, or whether technicians of varying degrees of credentialing are able to properly do so. The identification of the person actually conducting and interpreting the testing may be an important factor in whether a patient will desire to use that expert or not.
As always, when engaging an expert, be advised to seek references from fellow KJA members or other counsel having previously worked with the expert. Use the KJA’s List-Serv to network and discover helpful information about the person under consideration. Request references?and background information on any expert with whom you are interested inworking. Confirm the pertinent schedule of fees and document terms concerning payment and
billing before engagement. Clearly convey your case timetables with respect to discovery and trial, and leave ample time for the scheduling and preparation of this expert for his or her discovery and trial depositions. Remember, experts can make or break your case. Choose wisely!
- This installment of expert advice is an update of a selection previously appearing in the Fall
- These statistics were extracted from the CDC publication “Facts About Traumatic Brain Injury,” which can be found at the following link: http://www.cdc.gov/ncipc/tbi/FactSheets/Facts_ About_TBI.pdf.
- The Brain Injury Association of America maintains a web presence at http://www.biausa.org. Information for this article was gathered from the tremendous amount of information and resources relating to brain injury avail- able on its web site.
- Ibid and National Institute of Neuro- logical Disorders and Stroke. Traumatic Brain Injury: Hope Through Research, Bethesda (MD): National Institutes of Health; 2002, February NIH Publication No. 02-158.
- The American Psychological Association Division of Clinical Neuropsychologists can be contacted via its website at http://www.Div40.org.
- The American Academy of Clinical Neuropsychology can be contacted at http://www.theaacn.org.
(Originally published in the March/April 2008 issue of The Advocate)