Cross-Examination and Traumatic Brain Injury

• Author: Dorothy Clay Sims
• Pages: 517-710

11-1

CROSS-EXAMINATION AND

TRAUMATIC BRAIN INJURY

CHAPTER 11

CROSSEXAMINATION AND

TRAUMATIC BRAIN INJURY

I. WHAT IS BRAIN DAMAGE?

A. Causes of Brain Damage

§11:01 Trauma to the Head

§11:02 Lack of Proper and Immediate Treatment

§11:03 Brain Infections

§11:04 Anoxia

§11:05 Acute Anemia

§11:06 Blast Injuries

§11:07 Electrical Injuries

§11:08 Exposure to Toxins

§11:09 Hypertension or Stroke Secondary to Brain Injury

[§11:10 Reserved]

B. Classif‌ications of Brain Injuries

§11:11 Mild Traumatic Brain Injury

§11:12 Moderate/Severe TBI

C. Common Manifestations of TBI

§11:13 Effect on Brain Function

§11:14 Memory and Attention Issues

§11:15 Physical, Mental, Emotional Manifestations

D. Sequelae of Brain Injury

§11:16 Long-Term Consequences

§11:17 PTSD, Anxiety, Depression, Sleeping Abnormalities

§11:18 Weight Gain/Loss

§11:19 Auditory Disturbances

§11:20 Spatial Disturbances and Claims of Malingering in TBI

§11:20.1 Trauma That Affects the Eye

§11:20.2 Damage to Area of Brain Processing Vision

§11:20.3 Malingering

§11:20.4 The Bottom Line

[§§11:21-11:24 Reserved]

II. IMAGING TECHNIQUES IN TBI CASES

§11:25 SPECT Scans

§11:26 PET Scans

§11:27 fMRI

§11:27.1 Susceptibility Weighted Imaging (SWI)

§11:28 Electrodiagnostic Studies

§11:29 DTI: A Great Way to Prove Mild TBI

Exposing Deceptive Defense Doctors 11-2

CROSS-EXAMINATION AND

TRAUMATIC BRAIN INJURY

III. COMMON DEFENSES

§11:30 Plaintiff’s Symptoms Are Due to Pre-Existing Psychiatric Disorder

§11:31 Mild Injury, Mild Consequences

§11:32 Everyone Recovers From mTBI

§11:33 Normal MRI Means No Brain Damage

§11:34 Accident Was Not Severe Enough to Cause the Injury

§11:35 No Loss of Consciousness Means No Brain Injury

§11:36 Your Client Is Malingering, Not Brain Damaged

§11:37 No Brain Damage Because Not Diagnosed in Emergency Room

§11:38 When a PET Scan Is Abnormal, Ask the DME

[§11:39 Reserved]

IV. TBI IN CHILDREN

§11:40 General Principles

§11:41 ADHD Defense

§11:42 Brain Plasticity Defense

[§§11:43-11:44 Reserved]

V. SAMPLE QUESTIONS

A. Background, Bias

§11:45 Background

§11:46 Bias of “Independent” Medical Examination

B. Challenge DME’s Expertise in Brain Injuries

§11:47 Basic Knowledge of TBI

§11:48 Basic Knowledge of Brain Anatomy

§11:49 Second Impact Syndrome/Repeat mTBI

§11:50 Electrical Injuries

C. Diagnosis & Treatment

§11:51 Mechanism of Injury

§11:52 Diagnosis

§11:53 Diagnostic Imaging: SPECT

§11:54 Diagnostic Imaging: QEEG

§11:55 Treatment

[§§11:56-11:59 Reserved]

D. Testing, Scoring

§11:60 Warm-Up Questions

§11:61 DME Did Not Conduct Adequate Exam

§11:62 Wrong Tests Given

§11:63 Flexible Battery of Tests Given

§11:64 Test Scores—Generally

E. Misinterpreting or Ignoring Tests Administered

§11:65 Folstein MMSE

§11:66 If DME Concludes No TBI Based on MMPI-2

§11:67 MCMI

[§§11:68-11:69 Reserved]

F. Common Defenses

§11:70 DME Claims No TBI or Plaintiff Has Recovered

§11:71 Mild Impact/No LOC/Normal GCS Means No Brain Injury

§11:72 Malingering

§11:73 Normal MMSE Means No Brain Damage

§11:74 Normal CT Scan or MRI Means No Brain Damage

§11:75 Plaintiff’s Behavior Is Drug/Alcohol-Related, Not TBI-Related

G. Ignoring Information in Medical Records That Explain Severity of Plaintiff’s TBI

§11:76 Conditions That May Exacerbate TBI

11-3 Cross-Examination and Traumatic Brain Injury

CROSS-EXAMINATION AND

TRAUMATIC BRAIN INJURY

§11:77 When the DME Denies the Obvious

§11:78 Pre-Existing Conditions Which May Interfere With TBI Recovery

§11:79 Your Client Will Be Just Fine

[§§11:80-11:84 Reserved]

VI. DEFENDING FRYE/DAUBERT MOTIONS CLAIMING PET/SPECT SCANS UNSCIENTIFIC

§11:85 Research the Doctor

§11:86 Gather Scientif‌ic Evidence in Support of PET/SPECT

§11:87 Increase Your Chances of Getting SPECT/PET Into Evidence

[§11:88-11:89 Reserved]

VII. DEFENDING THE USE OF DTI IN TBI CASES

§11:90 Bogus Arguments Commonly Raised by the Defense

§11:91 Responses to Bogus Defense Arguments

§11:92 Sample Cross-Examination Questions

APPENDICES

Appendix 11-A: Annotated List of Recommended Reading—Brain Injuries in Children

Appendix 11-B: American Psychiatric Association Practice Guidelines

Appendix 11-C: Excerpt From American Psychological Association Code of Ethics

Appendix 11-D: CDC Report to Congress (2003) on Mild Traumatic Brain Injury

Appendix 11-E: [Reserved]

Appendix 11-F: QEEG Research List

Appendix 11-G: Comparison Chart: Plaintiff’s Electrical Injury Symptoms v. Sample

Appendix 11-H: Chart: Neuropsychological Symptom Presentation After Electrical Injury

Appendix 11-I: Annotated Bibliography of Scientif‌ic Research re PET/SPECT Scans

Appendix 11-J: PowerPoint Slide Showing Development of Brain in Child With TBI

Appendix 11-K: Literature Supporting Use of DTI for TBI

Appendix 11-L: Order of References

Appendix 11-M: Collection of Sample Aff‌idavits Supporting Use of DTI in TBI Cases Samples 1-6

Appendix 11-N Airbags Can Be a Friend or Foe: What an Attorney Must Know

FORMS

Form 11-1: Order Granting Frye Motion in Limine to Exclude Testimony of Engineering Expert on

Causation/Severity of Plaintiff’s Head Injury

Form 11-2: Opposition to Defendant’s Motion to Preclude Evidence Relating to DTI