Scientific Proof of Brain Injury

• Author: Jim Wren
• Pages: 599-618

21-1

21. Proof of

Injury

Chapter 21

Scientific Proof of Brain Injury

I. General Points on Mild Traumatic Brain Injury (mTBI)

§21:01 The Importance of Understanding the Science

§21:02 Teaching Brain Science to Jurors

§21:03 The Incidents of Brain Injuries

II. Understanding mTBI

§21:10 Definition of mTBI

§21:11 Possibility of Recovery

§21:12 Causes of mTBI

§21:13 Acute Concussion Evaluation (ACE)

§21:14 Difficulties in Diagnosing mTBI

§21:15 Preexisting Risk Factors

§21:16 Useful Resources

III. Diagnostic Options for Identifying mTBI

A. Evaluation Methods

§21:20 Glasgow Coma Scale

§21:21 American Congress of Rehabilitation Medicine Definition

B. Neuroimaging

§21:30 Categories and Use

§21:31 Dealing With No Observable Changes

§21:32 Defense Attacks on Neuroimaging Results

§21:33 Computed Tomographic (CT) Scan

§21:34 Magnetic Resonance Imaging (MRI)

§21:35 Functional MRI (fMRI)

§21:36 Diffusion Tensor Imaging (DTI)

§21:37 Single Photon Computed Tomography (SPECT) and Positron

Emission Tomography (PET)

§21:38 Magnetic Resonance Spectroscopy (MRS)

§21:39 Electroencephalography (EEG), Quantitative EEG (QEEG), and

Brain Electrical Activity Mapping (BEAM)

C. Other Techniques

§21:50 Blood-Based Biomarkers

§21:51 Effort Testing/Malingering Tests

[Note: This chapter has been authored with the help of Ben Smith and John Taylor

Starkey, M.D., whose significant contributions and assistance are gratefully acknowledged.]

§21:01 Proving Damages to the Jury

21-2

21. Proof of

Injury

I. General Points on Mild Traumatic Brain Injury (mTBI)

§21:01 The Importance of Understanding the Science

At some level, we all fear an injury to our brain function. Simultaneously, jurors also fear

being manipulated. These two fears highlight the importance of understanding the science of

mild traumatic brain injury (mTBI), and then accurately communicating that science to jurors.

When the impact of mTBI is fully grasped by jurors, jury verdicts properly escalate.

Similarly, when mTBI is recognized by insurers, settlements escalate. Conversely, when jurors

are suspicious of a claim of mTBI, a plaintiff can end up being punished by the disbelieving

jurors. This suspicion may arise because the plaintiff looks normal enough on the surface and

the jurors don’t have what they need to understand the existence and impact of mTBI.

§21:02 Teaching Brain Science to Jurors

When done right, the teaching of brain science grabs the attention of jurors. A good

teaching expert, such as a neurologist or neuropsychologist, will be able to engage jurors

with the hands-on examination of physical models of the brain while explaining brain

anatomy and normal brain function. The discussion of normal brain function can be

followed with an explanation of the mechanism of injury.

Often mTBI occurs despite the lack of a direct blow to the head. Jurors need models and

diagrams to see what happens to the brain as biomechanical forces whip the brain about and

slap it against the skull.

Obviously, it is crucially important to define and demonstrate the severity of injury in a

mild TBI case. To do this, you must understand the available diagnostic options for mTBI.

Whereas a severe TBI is quantifiable, a mild TBI is far more difficult to quantify because

much of the damage may go undetected in routine tests.

§21:03 The Incidents of Brain Injuries

When mTBI is present, clients cannot afford for their attorneys to ignore it. Annually, an

estimated 1.4 million to 1.7 million people in the U.S. suffer from some form of traumatic

brain injury (TBI) resulting in death, hospitalization, or emergency room visits. [Rutland-

Brown, Wesley; Langlois, Jean A.; Thomas, Karen E.; Xi, Yongli Lily, “Incidence of

Traumatic Brain Injury in the United States, 2003,” Journal of Head Trauma Rehabilitation,

Vol. 21, Issue 6, pp. 544-548 (2006); U.S. Department of Health and Human Services,

Centers for Disease Control and Prevention, “Heads Up: Facts for Physicians About Mild

Traumatic Brain Injury (MTBI),” p. 2, and cited sources therein, available at http://www.

cdc.gov/headsup/providers/index.html; http://www.cdc.gov/TraumaticBrainInjury/data/

index.html, accessed 9/21/15.]

The National Institute of Neurological Disorders and Stroke (part of the National Institutes

of Health), states: “Half of all TBIs are due to transportation accidents involving automobiles,

motorcycles, bicycles, and pedestrians. These accidents are the major cause of TBI in people

under age 75.” (http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm#169963218, accessed

9/21/15.

The results of catastrophic traumatic brain injuries are dramatically apparent. The effects