Traumatic brain injury (TBI) continues to be a leading cause of disability in the U.S. Historically, this condition has been overlooked by the medical profession. As a result, there has been little research on the subject and no real medical breakthroughs in treatment. As a brain injury lawyer, I face two heartbreaking consequences of this lack of research and development. First, these injuries carry catastrophic consequences, including permanent disability, loss of wages and benefits, family stress, and overwhelming medical costs, that are not subject to a cure. Second, due to the lack of interest by physicians, it is often difficult to prove that a brain injury has occurred, particularly so-called “mild TBI” (which often carries major consequences). Studies show that brain damage from common causes, like car accidents, truck accidents, falls and explosions, is often overlooked during the first several months following an injury.
In recent years, public attention has been directed to the subject of TBIs by the sports world, as medical research and lawsuits reveal that many football, soccer and hockey players have sustained chronic traumatic encephalopathy (CTE). This attention is both helpful and harmful. Increased public awareness improves sensitivity by the medical profession and interest in finding a cure. The downside is that many people now believe that repetitive injury, i.e., multiple concussions, are required to cause brain injury. In fact, permanent brain damage can occur as a result of a single incident.
This newfound attention to TBIs has led to some interesting medical developments since my last update. For example, one 2018 study confirmed that TBI can occur even when the injured person did not lose consciousness. Insurance companies, defense attorneys and their hired-gun medical examiners have repeatedly argued that loss of consciousness is a necessary component of organic brain damage. Careful physicians have long known that patients can sustain brain injury even in the absence of loss of consciousness or evidence of overt head trauma. Neurologists likewise have accepted that brain injury can occur due to the shearing of brain cells during violent head motion (known as “coup contrecoup”) associated with a “whiplash” type of mechanism or from the percussive effects of an explosion. This study, based on a review of VA charts of military veterans, validates these observations by the medical community.
Another 2018 study showed that certain protein levels were elevated in blood and cerebrospinal fluid following a mild traumatic brain injury. Once refined, these biomarkers may provide compelling objective evidence that a brain injury has occurred. One limitation will be that emergency department personnel will have to be trained to administer the test as a matter of routine, even when there is no overt sign of head trauma. This testing is not currently available for use beyond research.
Other studies from last year point further to a connection between TBI and dementia. As we age our brain begins to naturally deteriorate in size, capacity, and function. It seems logical that individuals who have lost capacity to injury are more prone to dementia as their brain ages. Three new studies confirm this connection. One study showed that the connection between the early onset and severe dementia was greatest in more severe cases of TBI. Another study showed a 56% increase in the rate of Parkinson’s Disease in veterans with brain injury.
Finally, and most sobering, is a 2018 study published by the Journal of the American Medical Association (JAMA) showing that TBI is associated with an increase in the risk of suicide. This devastating personal injury can be so life-altering and depressing that it actually claims lives.
Many of these recent studies simply validate observations by thoughtful physicians and experienced brain injury attorneys. In the future, we can expect to see objective measures of brain incapacitation caused by brain injury, lab tests and imaging that confirm a diagnosis, and vocational data that will show a precise association between the degree of injury and the impact on one’s livelihood. I also expect that further studies will show that many cases of depression and post-traumatic stress disorder (PTSD) are actually undiagnosed brain injuries, particularly in cases of workplace and battlefield explosions, electrocutions and electrical shock, and severe whiplashes. For now, we work with what we have to try to prove that a TBI occurred and to quantify its impact so that our clients can get some justice. No amount of money is a win for a victim of brain injury but the starting point is civil justice, and sometimes civil justice, money justice, is the only justice.
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