The movie Concussion explores an issue that has become familiar to all of us—traumatic brain injury (TBI) suffered by professional football players. Of course, playing football is not the only way to sustain a TBI or its harsh effects. Any time the brain hits the inside of the skull with sufficient force to cause brain cells to lose blood flow, a brain injury, and cognitive changes, can result. This force does not have to be very high—enough to cause a bruise. The head does not have to strike anything—the brain just needs to impact with the inside of the skull.
Auto collisions often cause traumatic brain injuries. In fact, they are the second leading cause (falling is number one). Most medical providers, especially in emergency room settings, seem well aware of this possibility, and generally take care to screen for TBI, treat it, and document its consequences on an injured driver or passenger.
The cognitive losses resulting from a TBI can be the most devastating injury from a collision, yet also the hardest to see or prove. Within a couple years of starting my legal career, I visited with a mother of four young children. A year had already passed since the collision she was in, but she had not been able to resolve the matter with the insurance company, so she was in my office for help. As I spoke with her, l learned that she had hit her head on the driver’s window during the side impact, but that a CT scan had not shown any damage to her brain, so there had been no follow-up care for TBI. But she was clearly experiencing cognitive losses since that impact. For example, she could no longer do the math to balance her checkbook—and she was a Math Major! I asked her to go back to her family doctor to report any cognitive losses she had experienced since the collision. That doctor sent her to a neuropsychologist for testing. The tests showed that she had certainly lost cognitive function, giving her the assurance that she was not imagining these changes, and helping her show more accurately what had happened to her because of the collision.
Neuropsychologists and neurologists are often confused with each other outside the medical community. Neuropsychologists are usually PhD-level psychologists, with training emphasizing the relationship between the brain and behavior. Neuropsychologists are trained to apply certain extensive testing procedures that can, with surprising reliability, detect whether a person has had a shift in their cognitive abilities—which can happen from a TBI, even if there is no damage visible on a diagnostic test (like an MRI, CT, or PET). Neurologists, on the other hand, are medical doctors or osteopathic doctors, and are the professionals who, for example, would read the results of a brain CT scan and do surgery if necessary. Both specialists may be involved in diagnosing and treating TBI. Medical procedures or retraining exercises can sometimes restore some or all of the lost function, sometimes not.
Cognitive losses reported by our clients sometimes manifest themselves in disturbing ways: A college student working a shift as a server suddenly could not remember why she was standing in the middle of a restaurant; a young lady studying to be a teacher could no longer remember written material without 4 or 5 times more repetitions than before; a West Point graduate and war veteran, turned business professor, could no longer develop curriculum plans, as he had done for years. Unfortunately, modern medicine can fix a blown out knee much easier than a damaged brain, and the doctors could do little for these losses. I hope we continue to get better at preventing and treating such injuries, anywhere they arise. If you have any other questions, please feel free to contact Attorney Kevin Fine with Davis Miles McGuire Gardner at (480) 733-6800 or via email kfine@davismiles.com.