This is the third part of a series of blogs on Winning Strategies for Handling a Mild to Severe Brain Injury Case. The first part of the series explained the anatomy of the brain, an understanding of which is essential in order to appreciate what happens to the brain after a traumatic brain injury. The second part explained the ways a brain can become injured. This part considers the challenges that Plaintiff’s counsel encounters when representing an individual who has suffered a traumatic brain injury.
Difficulties a Plaintiff’s Counsel Faces in Proving a Traumatic Brain Injury
There are a number of difficulties Plaintiff’s counsel faces in trying to prove the existence and severity of a traumatic brain injury. One of those difficulties is that most brain injuries, unlike other injuries such as a broken arm or an amputated leg, are invisible to the naked eye. X-rays, CT scans and MRIs can detect fractures, hemorrhages, swelling, and certain kinds of tissue damage, but they cannot always detect injury to a person’s brain. This is because traumatic brain injury, especially in its milder forms, often involves subtle traumas to the brain that cause chemical and physical changes to brain tissues. These changes often cannot be found with standard imaging procedures.
Another difficulty for any Plaintiff’s lawyer in a brain injury case is establishing that the traumatic event caused ongoing organic damage which affects the person’s ability to function in the real world. This is often difficult to prove because many brain injured individuals appear “smart.” They are articulate and can perform many of the tasks they did before they were injured. It is difficult for most of us to understand how a person may retain, for example, a high IQ after suffering a traumatic brain injury and still perform very poorly on certain neuropsychological tests and in real life. It is hard for us to understand that deficits do not occur in all areas of the brain and that indeed, many parts of the brain remain intact while the person’s ability to function in many aspects of his or her life is significantly reduced.
A third difficulty is that in the months after suffering a traumatic brain injury, many individuals are in denial. They insist they are fine and have told all their treating health professionals that they are fine. They may tell their treating health professionals the only reason they are seeing him or her is that of ongoing pain resulting from a back injury suffered in the collision.
For these reasons, proving the existence of a traumatic brain injury, and the consequences of that injury to your client can be difficult. However, as Plaintiff’s counsel, that is your job.
This is the second of a series of blogs on Winning Strategies for Handling a Mild to Severe Brain Injury Case.
We first discussed the anatomy of the brain, including the structure of neurons. Here we will discuss the ways that our brain can be injured and the implications that flow from the various kinds of injuries.
The brain is very delicate and is considered to be the consistency similar to that of gelatin. If a brain is suddenly jolted or banged or twisted, it will cause a traumatic impact that ripples through the entire brain and can cause complications. The brain is made up of billions of neurons that can be damaged by trauma to a person’s head.
Some of the ways damage can occur to a human’s brain is as follows:
Mild Traumatic Brain Injury or Concussion
The term mild traumatic brain injury is used interchangeably with the term concussion. A concussion is caused by a blow or jolt to the head that disrupts the function of the brain. Unlike more severe traumatic brain injuries, the disturbance of brain function from a concussion is caused more by dysfunction of brain metabolism rather than by structural damage. The current understanding of the neuropathophysiology of a mild TBI involves a paradigm shift away from a focus on anatomic damage to an emphasis on neuronal dysfunction involving a complex cascade of ionic, metabolic and physiologic events. After an impact causing a concussion, there is an increase in glucose metabolism, and then a subsequent reduced metabolic state. These events interfere with the neuronal function in the brain and may lead to cell death after the injury.
Diffuse Axonal Shear
In a diffuse axonal shear injury many of the nerve cell pathways (axons) may be torn apart or stretched. This can cause a loss of connection between brain cells and can lead to a breakdown of overall communication among neurons in the brain. Information processing may be disrupted. A diagram demonstrating the process of axonal shear appears below:
Coup – Contre-Coup
A coup contre-coup injury to the brain occurs when there is a sudden impact to the head, which causes the brain to first slam into one side of the skull wall, then bounce off that wall and slam into the wall on the opposite side of the skull. Continue reading
This is the first of a series of blogs on Winning Strategies for Handling a Mild to Severe Brain Injury Case.
To begin, an understanding of brain anatomy is essential to gain some knowledge of what happens to the brain after a traumatic brain injury. It is one of the responsibilities of counsel in a traumatic brain injury case to educate the judge and jury on the anatomy of the brain.
Interestingly, the brain is not a hard muscle-like substance, but rather a soft gelatin-like organ that sits within a rough and bony skull. The brain is covered by three thin protective layers called the meninges. The space between the meninges and the brain is filled with a clear liquid called cerebral spinal fluid. This fluid works to keep the central nervous system healthy. The brain is innervated by a sophisticated system of blood vessels which carry blood to and from the heart.
Within these two hemispheres there are four lobes – frontal, parietal, temporal, and occipital, and each lobe is responsible for specific functioning. The brain stem and cerebellum also play a significant role in the brain’s functioning.The outermost and largest part of the brain is called the cerebrum and it controls things like thoughts and actions. It has a wrinkled surface and is divided it into two halves, known as the left and right hemispheres.
- Frontal Lobes – deals with reasoning, planning, self-control, some speech and emotion functions, and problem solving. The frontal lobes also play an important part in memory, intelligence, concentration, and are responsible for executive functions.
- Parietal Lobes – are involved with movement, and also help people to understand signals received from other areas of the brain such as vision, hearing, sensory and memory. A person’s memory and sensory information received give meaning to objects and “put it all together”.
- Occipital Lobes – found at the back of the brain, receive signals from the eyes, process those signals, allow people to understand what they are seeing, and influence how people process colours and shapes.
- Temporal Lobes – are located at around ear level, and are the main memory centre of the brain, contributing to both long-term and short-term memories. The temporal lobe is also involved with understanding what is heard, and with the ability to speak. The left temporal lobe is involved in verbal memory and aids in understanding language, where the right temporal lobe is involved in visual memory and helps people recognize objects and faces.
- Brain Stem – is responsible for maintaining the body’s most basic functions such as breathing, heartbeat, and blood pressure.
- Cerebellum – it is divided into two halves, with the main function of controlling and regulating the body movement of the muscular skeletal system.
The brain and nervous system also consist of billions of tiny cells called neurons. Neurons are the “communicators” and each neuron has three main parts:
- Cell body: the central station that sends out impulses
- Axon: long, slim “wire” that transmits signals from one cell body to another via junctions known as synapses
- Dendrites: networks of short “wires” that branch out from an axon and synapse with the ends axons from other neurons.
The neurons receive and transmit information in a relay where electrical impulses alternate with chemical messengers. The electrical impulses flow through nerve cell pathways along the axons and dendrites. Neuro-chemical transmitters leap the synaptic gaps between each neuron’s axon and the other neurons with which an axon makes contact. Each neuron is its own miniature information center which decides to fire or not fire an electrical impulse depending on the thousand or so signals it is receiving every moment.
Stay tuned for the next part in the blog series on the ways a brain can be damaged.This is a basic overview of the anatomy of the brain. It is important that lawyers understand the functions of the brain to better understand how injury to a particular area of the brain can impact your client.