Analysis, Understanding and Presentation of Cases Involving Traumatic Brain Injury.

Over 1,975,000 head injuries occur each year (Kraus). Not long ago, most people who sustained severe traumatic brain injury (TBI) died, There was no such term as "mild traumatic brain injury," only "concussion," for which physicians prescribed a period of overnight observation. The 1980s brought dramatic changes within the medical world, as the technology and training needed to save the lives of people who sustained severe traumatic brain injury were developed. Many lives were saved which might otherwise have been lost--especially with the advent of life flights, "scoop and run" techniques, highly trained emergency medical technicians and paramedics, and trauma centers prepared to treat whatever medical emergency arrived at the door.

Specialized rehabilitation services developed to meet the increasing and unique needs of people with TBI and to maximize the individual's recovery and quality of life. The consequences of mild traumatic brain injury, often life changing, have become better recognized. Thousands of people who were formerly thought to be "crazy," or worse, now have a better chance of proper diagnosis and treatment.

The direct result of these important advancements in medicine, diagnosis, and rehabilitation is a growing number of people with TBI. Once they survive the life-threatening phase of their injuries, many face long-term physical, psychological, and cognitive rehabilitation services. In fact, some estimates indicate that costs exceed $4 million to provide the lifetime medical, health care, and support services needed by one individual with TBI.

The situation of the person with TBI is complicated by the fact that too often the injury and its consequences are not understood by their doctors, treating professionals, insurance company representatives and their lawyers.

While the title emphasizes a focus on the legal aspects of TBI, Analysis, Understanding and Presentation of Cases Involving Traumatic Brain Injury, is a comprehensive guidebook addressing a multitude of topics related to TBI. Each of the 41 chapters is authored by nationally recognized experts who explain the legal, medical, economic, and psychological aspects of TBI. The guidebook has been prepared and written for a wide audience--lay people, health care providers, insurance company representatives and lawyers.

The first chapters of the book focus on the need for accurate diagnosis of TBI. While there are fewer visible symptoms of this "silent epidemic," the physical, physiological, cognitive, and emotional symptoms all play an important role in diagnosis and treatment. Assessment of TBI remains a challenge, so each aspect is examined in the guidebook.

Rehabilitation is another crucial issue to the person with TBI. Appropriate measures to restore the optimal quality of life are explored. D. Nathan Cope, M.D., explains, "Rehabilitation of the [person with TBI] is now known to require a combination of medical and psychological approaches provided over an increasingly extensive length of time. This factor, in turn, has led to the development of an array of specialized categorical programs addressing the aspects of this need".

The effects of a TBI as well as the need for rehabilitative services are often necessary throughout the remainder of the person's life. The economic factors of lost earning capacity, cost of long-term health care, and life care planning are very important considerations for the person with TBI and his or her family. A.M. Gamboa, Jr, Ph.D. and Roger Weed, Ph.D. both contribute chapters discussing the reduction in earning capacity of people with TBI. Gerald W. Bush Ph.D. emphasizes importance of determining and securing adequate payment for long-term health care.

The second half of the book focuses on the legal aspects of TBI. Charles Simkins challenges the legal community as well as warns the person with TBI and his or her family: "It is a very sad fact of life for many persons with traumatic brain injury that they did not receive, or will not receive, adequate compensation for their injuries. This happens because many lawyers do not have enough education, knowledge or experience to be able to analyze, understand, prepare and present a legitimate claim for compensation on behalf of the person with traumatic brain injury. Just as a person with traumatic brain injury needs specialized medical care and treatment, so also do they need specialized legal representation." (Nick Simkins & Anne T. Craig, p. 285.) Criteria for selecting a lawyer to represent the person with TBI are suggested as well as specific questions to ask when making this decision.

The importance of recognizing and differentiating TBI from other disabilities is reemphasized in several legal chapters. Robert D. Voogt, PhD, CRC, asserts "Because many of these people [with TBI] do not show obvious symptoms, their impairments are more difficult to address in the litigation process. But even minor or moderate brain injuries can cause extremely disruptive lifestyle changes, and individuals who have sustained such injuries often require ongoing care. Too often, the need for this care is overlooked by attorneys in tort claims".

A strong emphasis is placed on the testimony of expert witnesses. John K. Powers, J.D., explains the vital roles the treating physician, neuropsychologist, vocational rehabilitation expert, life care planner, economist, and plaintiff serve in fully explaining the significance and long-term effects of the TBI. James C. Peterson further stresses the importance of expert testimony by explaining its role in evaluating hedonic damages.

This guidebook includes chapters that present actual voir dire questions, opening statements, direct examination, and closing statements. Detailed chapters on malingering, accident reconstruction, and rear end car crashes prepare attorneys for specific cases involving TBI.

When traumatic brain injury occurs, the lives of the person who sustains the injury and his or her family may be changed forever. Our legal system affords the opportunity for persons who have been harmed by negligence to pursue and receive compensation for the injury and damage caused. The need for skilled trained attorneys who will not only attain the compensation rightfully owed, but also preserve and protect the benefits to which the individual is entitled will remain of paramount importance. Knowledgeable case managers and representatives of insurance companies, and consumers educated about their rights are also crucial.

Analysis, Understanding and Presentation of Cases Involving Traumatic Brain Injury, examines the myriad of topics vital to the understanding of TBI. With this knowledge also comes the mission to better serve people with TBI. This comprehensive guidebook fully addresses an enormous topic that will surely meet the goal editor Charles Simkins sets forth in his dedication: "I sincerely believe that if this book helps any of us, whether doctor, lawyer, insurance company representative or lay person to move just one step closer toward the sunshine of understanding, compassion, love and respect for the struggle of persons and families surviving traumatic brain injury, then we will have accomplished our purpose."

References

Kraus, Jeff F. (1993). Epidemiology of Head Injury. In Paul R. Cooper (Ed.), Head Injury, 3rd Ed. (pp. 1-25). Baltimore: Williams & Wilkins.

George A. Zitnay, PhD, President and Chief Executive Officer of the National Head Injury Foundation Located in Washington, D.C.