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BRAIN INJURY ATTORNEYS

While medical professionals do not have one consistent definition for what constitutes a “severe brain injury”, a brain injury is generally considered to be severe when a significant neurological injury causes physiological changes to the brain, causes a loss of consciousness for more than six hours, or scores a Glasgow Coma Scale of 3 to 8 points.

Severe brain injuries come in different forms and can be caused in any of the following ways:

• Closed Head Injuries: A closed head injury occurs when the brain is injured due to a sudden jolt or blow to the head that causes the brain to hit up against the skull. This type of injury is extremely serious and can cause bleeding, bruising, fluid buildup, and/or tissue damage in the brain.
• Penetrating Head Injuries (aka Open Head Injuries): Penetrating head injuries occur when the outer layer of the meninges is penetrated. This can occur when the skull is fractured or when a foreign object (for example a bullet) enters the brain.
• Anoxic Head injuries: An anoxic head injury occurs when the brain does not receive an adequate supply of oxygen. When this happens brain cells die and serious brain damage can result.

Toxic Head injuries: There are approximately 1,000 substances that are known to have neurotoxic effects. When the brain is sufficiently exposed to one or more of these chemical agents brain cells are killed and a toxic head injury occurs.

When medical practitioners suspect that someone has sustained a brain injury they generally take a detailed neurological examination of the patient in order to determine the severity of the injury. This examination involves a physical inspection, talking to the patient if they are conscious, and taking photos of the brain with brain imaging technology such as a CAT scan, MRI, SPECT, and/or PET scan. Information gathered from the examination helps doctors determine the severity of the brain injury (for example, whether the injury can be classified as mild, moderate, or severe). There are a few different systems that doctors use to rate the severity of brain injuries, the most common of which is the Glasgow Coma Scale.

The Glasgow Coma Scale ranks brain injuries on a 15-point scale based on the patient’s motor responses, verbal responses, and eye-opening responses. To determine a patient’s score, doctors test the patient’s responses in each of these categories and then add all three scores together to determine how severe the patient’s brain injury actually is. The metric used on the Glasgow Coma Scale is outlined below:

Motor Response

6 – Obeys commands fully

5 – Localizes to noxious stimuli

4 – Withdraws from noxious stimuli

3 – Abnormal flexion

2 – Extensor response

1 – No response

Verbal Response

5 – Alert and Oriented

4 – Confused, yet coherent, speech

3 – Inappropriate words and jumbled phrases consisting of words

2 – Incomprehensible sounds

1 – No sounds

Eye Opening

4 – Spontaneous eye opening

3 – Eyes open to speech

2 – Eyes open to pain

1 – No eye opening

Based on the patient’s total score, their brain injury is classified as either:

• Mild: If they score 13 to 15 points,
• Moderate: If they score 9 to 12 points, or

Severe: If they score less than 3 points.

The clinical features (aka the signs and symptoms) of a severe brain injury are generally defined to include a loss of consciousness for more than six hours and a Glasgow Coma Scale rating of three to eight points. Therefore, individuals who suffer a severe brain injury are often initially in a coma, or at least in a state of diminished consciousness, which can last from hours, to weeks, or longer. Additional symptoms of severe brain damage include:

• A reduced ability to respond (via motor responses, verbal responses, and/or eye-opening) to stimuli,
• Difficulty breathing,
• Fluid buildup in the brain,
• Increased intracranial pressure, and
• Poor vitals.

Long-term symptoms of severe brain injuries vary greatly from case to case but often include:

• Cognitive deficiencies (including difficulties with concentration, memory, speed of processing, and impulsiveness),
• Speech and language difficulties (often resulting in problems understanding the spoken word, speaking, reading, and writing),
• Sensory deficiencies (including trouble interpreting temperature, touch, and body positions),
• Seizures,
• Physical changes (including paralysis, chronic pain, loss of bladder control, inability to self-regulate one’s body temperature, and loss of stamina),
• Social and emotional difficulties (including dependent behaviors, lack of motivation, aggression, irritability, depression, and lack of awareness), and
• Lost or diminished senses (such as taste and smell).

According to the Centers for Disease Control and Prevention’s (CDC) Report to Congress in 1999, traumatic brain injury is the leading cause of death and disability among American children and young adults. The CDC’s report indicates that each year approximately 1.5 million Americans suffer a traumatic brain injury and that as a consequence every year 230,000 people are hospitalized and survive, 50,000 people die, and 80,000 to 90,000 people suffer a long-term disability.

As you can see, severe brain injuries are quite prevalent in the United States. But how do brain injuries generally occur? The Centers for Disease Control and Prevention reports that motor vehicle accidents are the leading cause of traumatic brain injuries that result in hospitalization in the United States, and that car accidents alone are responsible for approximately 60 percent of the total number of brain injuries that occur each year in our country. Additionally, work-related accidents, sporting accidents, and assault-related incidents also cause many severe brain injuries each year.

Yes, studies have consistently shown that both seat belts and airbags help greatly to save lives and prevent brain injuries during car accidents. While seatbelts and airbags can not guarantee that your brain will stay safe during a crash, it is important to utilize these and other safety measures whenever possible while engaging in risky activities that commonly lead to traumatic brain injuries. For example, following certain preventative safety measures can greatly reduce the risk that you or your loved ones will suffer a traumatic brain injury. Suggested safety measures include:

While in the Car:

• Always wear your seatbelt,
• Make sure that young children traveling in your car are secured in an appropriate child safety seat, and
• Never drive while impaired by drugs or alcohol.

While Engaging in Sports:

• Always wear a helmet while riding a bike, motorcycle, scooter, snowmobile, etc.,
• Always wear a helmet while participating in contact sports,
• Always wear a helmet while horseback riding, and
• Always wear a helmet while skiing, snowboarding, or skateboarding.

Around the Home:

• Use the rails when climbing or descending stairs,
• Make sure that stairways are adequately lit so that people can more easily watch their steps,
• Make sure that windows are secured so that young children can’t fall out of them, and
• Do not leave items in walkways where they may pose a tripping hazard.

While Handling a Gun:

• Always keep guns in locked cabinets away from the reach of children,
• Never store a gun loaded, and
• Store ammunition apart from guns.

A severe brain injury can greatly impact an injured individual’s life. If the injured person survives their injury, they will likely experience psychological, cognitive, emotional, physiological, and behavioral changes. For example, severe brain injury survivors often have a hard time walking, controlling their hand-eye coordination, accessing memories, speaking, and controlling their emotions. However, it is important to note that no two brain injury cases are exactly alike and that these types of injuries affect different individuals in vastly different ways. Additionally, it is also important to keep in mind that a particular brain injury patient may experience different symptoms of their injury during the initial recovery phase than they will during the long-term phase of their recovery.

While it is impossible to accurately guess how a severe brain injury will affect an individual without looking at the facts of their case, there are some factors that doctors commonly use to predict how great the long-term impact of a particular brain injury will be. BrainLine.org points out that some of these telling factors include:

• The severity of the initial injury,
• The rate and completeness of the individual’s physiological healing,
• The types of functions that were affected by the injury,
• How the individual views their new “limitations” in regards to their life and in the context of their roles, values, and goals, and
• The resources available to the injured individual to aid in their recovery process.

Individuals who survive a traumatic brain injury all generally follow a somewhat similar process to recovery. The first stage, referred to as the “initial treatment stage”, occurs immediately following the accident and after the injured individual is rushed to the hospital. During this initial stage, the patient generally needs medical attention in order to stabilize their vitals and is then hooked up to a variety of medical equipment that will manage their basic life systems. During this initial stage, many severe brain injury patients will need to undergo neurosurgery in order to control bleeding in the brain, repair damaged brain tissue, drain fluid that has gathered in the brain, and/or relieve pressure in the brain. These surgeries are led by a trauma surgeon who will work to respond to life-threatening changes in the brain until the patient is stabilized.

After the patient is stabilized, they will generally be transferred to a specialized intensive care unit where a team of medical professionals will monitor the patient’s vitals and will provide the patient with whatever medical equipment the situation requires (for example the patient may need oxygen or to be put on a respirator). Additionally, during this stage, many tests will be run in order to determine the extent of the patient’s brain damage. Depending on the extent of the damage, the patient may come out of the initial stage conscious, minimally conscious, in a vegetative state, or in a coma.

The next stage is termed the “recovery stage” and varies greatly from case to case. At the beginning of the recovery, stage doctors may still not be able to predict what the long-term effects of the brain injury will be. However, it is generally assumed that the shorter the coma, the shorter the amnesia, and the younger the patient (as long as they are more than two years old), the better the prognosis will be. During the recovery stage patients often experience a period of confusion and disorientation. They may have trouble remembering, speaking, and controlling their bodies and emotions. This stage may last days, weeks, or months depending on the case. Next, the injured individual will likely need the assistance of both physical therapists and psychologists in order to recover as fully as possible.

There are many factors that together determine how much a particular person can expect to recover from a severe brain injury. Soon after a brain injury occurs there is a window of time that medical professionals refer to as the “spontaneous recovery period” during which the brain tries to recover and repair itself. However, this process can take weeks or even months. Severe brain injury survivors generally see the fastest improvement during the first six months or so of their recovery. Many patients will continue to improve after the six-month mark for another year and a half or so but the rate of recovery during this period is generally not as dramatic as it was during the first six months of recovery. After the two-year mark improvements for severe brain injury survivors generally slows down substantially, however, it is important to keep in mind that the rate of improvement after a brain injury varies greatly depending on the person, the area of the brain that was injured, the extent of the injury, and whether or not the individual has access to and participates in rehabilitation.

Rehabilitation can help brain-damaged individuals learn to stimulate the brain and retrain neurons to take over the functions of those that have died. Via rehabilitation injured individuals can also relearn physical skills, such as walking, that they may have lost due to their brain injury.

As noted above, the Centers for Disease Control and Prevention reports that traumatic brain injury is the leading cause of disability and death among children in the United States. However, the good news is that the prognosis for a child over the age of two who survives a severe brain injury is generally better than that for adults with comparable injuries. This tends to be true because children are highly resilient and often bounce back fast than adults do. Children are often able to train their healthy neurons to take over the functions of those that have died much more easily than adults can. However, this is not to say that severe brain injuries in a child are not incredibly dangerous. Severe brain damage can greatly impact a child’s life, much in the same ways that it can impact an adult, and often causes cognitive problems, psychological problems, and behavioral problems in children. Even with intensive rehabilitation these lingering issues often stay with a child for years, and some never go away completely.

The brain stem controls many physiological systems in the body and plays an important role in enabling a person to focus, become aroused, and stay conscious. Additionally, all information that passes between the brain and the rest of the body must pass through the brain stem. Therefore, a brain stem injury can have devastating effects. An injury to this part of the brain often results in mobility and motor control problems, and in more serious cases, comas and/or death.

Injuries to the brain stem generally occur either because the brain suffered a prolonged loss of oxygen, or because some trauma caused the brain to violently collide with the skull. Regardless of the cause, brain stem injuries can range from mild to moderate, to severe. A mild brain stem injury (often referred to as a concussion) is often characterized by a brief loss of consciousness, minor memory loss, and minor neurological deficits. Mild brain stem injuries are sometimes hard to recognize as the injured person may seem to be alright initially. On the other hand, moderate brain stem injuries are usually much more noticeable. Someone who suffers a moderate brain stem injury is usually confused for a few days or weeks and experiences physical and behavioral impairments that persist for a few months. A moderate brain stem injury can also render an individual unconscious for a few hours. However, if the injured individual is unconscious for many hours, or slips into a coma, then they have experienced a severe brain stem injury.

The frontal lobe is located mostly behind the forehead and is the part of the brain that is in charge of controlling emotions, initiation, motivation, and inhibition, as well as many other cognitive and behavioral functions. Therefore, people who sustain injuries to the frontal lobe often exhibit a low level of tolerance for frustration and quickly become aggressive when provoked. Additionally, they may also become more promiscuous or more lethargic than they previously were. Furthermore, multitasking can become almost impossible after a severe frontal lobe injury as this part of the brain enables us to prioritize and think multiple steps ahead.

Therefore, as you may have guessed, individuals who sustain a frontal lobe injury are sometimes able to “function” in society better than people who suffer different types of brain damage. However, those who suffer from a frontal lobe injury are often not able to manage as well in society as they used to before their accident due to the fact that their ability to plan, multitask, assess risk, and navigate complex social interactions may have been impaired.

Frontal lobe injuries are generally caused either by the brain moving in a back and forth motion and striking the front of the skull or by a sideways movement that twists the front of the brain. As with most types of traumatic brain injuries, most frontal lobe damage arises from car accidents, work-related accidents, sports-related accidents, and firearm accidents.

A traumatic brain injury is generally classified as a mild brain injury (also sometimes referred to as a “subtle brain injury”) if the injured individual’s loss of consciousness and/or state of confusion and disorientation lasts less than 30 minutes. In some instances, it may not even be readily apparent that someone has suffered a mild brain injury as some individuals do not exhibit external symptoms of distress and appear to be just fine directly after the accident. However, common symptoms of a mild brain injury include:

• Headaches,
• Blurred vision,
• Short-term memory loss,
• Dizziness,
• Nausea,
• Ringing in the ears,
• Hypersensitivity to light and noise,
• Irritability, and/or
• Seizures.

While these symptoms may not sound too terribly bad, it is important to realize that any brain injury is serious and that even mild brain injuries can result in detrimental cognitive, psychological, and physical symptoms. In fact, there are even long-term consequences associated with mild brain injuries that are sometimes overlooked. For example, some people who suffer a mild brain injury experience depression, anxiety, frustration when interacting with others, and trouble thinking clearly even years after the trauma occurred.

Individuals who survive a traumatic brain injury are often eager to know when they will be able to get back to work. However, this question is very difficult to answer as the timeline for returning to work depends greatly on what type of work the injured individual does, as well as the type and severity of brain injury sustained. Whenever the recovering individual does decide to return to work, they should be aware that doing so may prove to be more difficult than expected.

Many patients recovering from a brain injury become overwhelmed when they eventually return to work because they find the cognitive aspects of their jobs much more challenging than they remember them to be. Additionally, returning to work can be psychologically challenging as co-workers may not be understanding of recovering workers who have experienced a personality shift as a result of their brain injury. However, these common hurdles can often be overcome with the help of an effective rehabilitation program. Successful rehabilitation programs often involve a specialized psychologist conducting vocational assessments, job coaching, and periodic reassessments. Unfortunately, some recovering brain injury plaintiffs will have to come to terms with the fact that they may never be able to return to the vocational roles that they occupied before they were injured, but in many instances, a good rehabilitation program will be able to help these people seek out a new fulfilling role in life.

While the medical community does not have one succinct definition to describe what an acquired brain injury is, many share the Brain Injury Network’s position that an “acquired brain injury” (ABI) includes traumatic brain injuries, strokes, brain illnesses, and any other kind of brain injury that an individual acquired after birth. However, this definition does not encompass degenerative brain conditions (for example, Alzheimer’s Disease or Parkinson’s Disease, or congenital defects). Essentially, it is fair to think of an acquired brain injury as any brain injury that is not congenital, caused by birth trauma, hereditary, or degenerative in nature. Common examples of acquired brain injuries include:

• Traumatic brain injuries (either open or closed head),
• Aneurysms, hemorrhages, brain stem strokes,
• Hypoxic events are caused by a lack of oxygen to the brain, and
• Intracranial tumors.

As there are a variety of different types of acquired brain injuries, medical professionals have categorized their symptoms into four different main categories in order to simplify things: cognitive symptoms, perceptual symptoms, physical symptoms, and emotional systems. Some examples from each category are outlined below:

• Cognitive Symptoms:
  • Increased processing times,
  • Shortened attention span,
  • Difficulties speaking or understanding language, and
  • Having trouble multitasking.
• Perceptual Symptoms:
  • Poor balance,
  • Hypersensitivity to pain,
  • Decreased vision or hearing, and
  • Spatial disorientation.
• Physical Symptoms:
  • Headaches,
  • Seizures,
  • Paralysis,
  • Hypersensitivity to light, and
  • Fatigue.
• Emotional Symptoms:
  • Easily irritable,
  • Decreased inhibitions,
  • Heightened emotional responses, and
  • Inability to manage stress.

While there is some debate as to the precise definition of what constitutes an “acquired brain injury” versus a “traumatic brain injury”, the Brain Injury Network (BIN) has done extensive research on the subject and has produced definitions that are widely accepted by the medical and scientific communities. The Brain Injury Network defines an acquired brain injury as any brain injury acquired after birth, including traumatic brain injuries, strokes, and brain illnesses (excluding congenital defects and degenerative brain conditions). Additionally, the BIN defines a traumatic brain injury as a traumatically induced structural injury and/or physiological disruption of brain function caused by an external force that is characterized by a period of lost or decreased consciousness, memory loss, and altered mental state, and neurological deficiencies. In other words, a traumatic brain injury is always a type of acquired brain injury, but an acquired brain injury does not always qualify as a traumatic brain injury.

How long a brain injury lasts is highly dependent on the severity of the initial damage, the age, and health of the injured individual, the quality of the rehabilitative resources that are available during the patient’s recovery phase, and a variety of other factors. Additionally, it is important to keep in mind that recovering from a brain injury is an extremely slow process for most people. While most brain injury survivors see the most rapid improvement within the first six months of their recovery, many severe brain injury patients continue to see slow improvement for years. Some brain injury survivors are able to recover very quickly, some see slow improvement over the years and are eventually able to improve to the point where their brain injury no longer plays the main role in their day-to-day life, and unfortunately some brain injury survivors never fully recover.

While it is important to remember that no two brain injury recovery timelines are the same, you may still be interested in reading some statistics about how long, and to what extent, the day-to-day lives of brain injury survivors are generally impacted two years after sustaining a brain injury. The Model Systems Knowledge Translation Center reports that people with moderate to severe traumatic brain injuries who receive medical care and inpatient rehabilitation services at their facilities fit the following statistics two years after their injury occurred:

• Most people continue to show decreases in disability,
• 34 percent require some sort of supervision,
• 93 percent are living in a private residence,
• 34 percent are living with a spouse or a significant other,
• 29 percent are living with their parents, and
• 33 percent are employed; 29 percent are unemployed; 26 percent are retired, and 3 percent are students.

As discussed above, brain injuries can range from mild to severe, however, the head and the brain are generally able to survive mild hits just fine. If you hit your head hard enough your brain will likely bruise, but minor bruising is something that most brains are able to handle without much effort or side effects. While bruising your brain sounds like a big deal, doctors often liken a minor brain bruise to the little bruise that you’d get on your leg if you run into a coffee table. However, don’t get me wrong, the severity of a brain injury depends greatly on the location of the injury and on your particular brain’s ability to compensate. All head injuries, no matter how seemingly inconsequential, should be taken seriously and be examined by a medical professional if possible. Remember that even a mild brain injury can have devastating effects and should be treated right away.

It can be tempting to assume that you’re fine after sustaining a seemingly mild blow to the head. You may have a little headache but be tempted to just carry on with your day. Is this wise? Prevention.com provides a useful guide designed to help determine whether or not an individual who has been hit in the head needs to seek medical attention, and if so, what type of medical attention they should seek. According to the guide, you should:

CALL YOUR DOCTOR if you have any of the following symptoms:

• Headache,
• Dizziness,
• Trouble concentrating,
• Feeling overstimulated by lights and noises, or
• Memory loss

CALL AN AMBULANCE if you experience any of the following:

• Temporary loss of consciousness,
• Vomiting,
• Severe headache,
• Trouble speaking or seeing clearly,
• Numbness in your limbs, or
• Your symptoms persist or worsen.