Brain injuries are caused by blows to the head or penetrating head injuries that disrupt the normal function of the brain. Common causes of brain injury include traffic accidents, falls, physical assault, and accidents at home, work, outdoors, or while playing sports. The leading causes of brain injury are:

Falls. Slip-and-falls account for approximately 28 percent of new brain injuries each year. Falls are the leading cause of brain injury for children under age four or adults over age 75 years.

Motor vehicle accidents. Auto accidents account for 20 percent of brain injuries.

Struck by/against events. Struck by/against events, in which the head is jolted by a collision with a moving or stationary object, account for 19 percent of brain injuries.

Assaults. Violent encounters (often involving gunshot wounds) account for 11 percent of brain injuries.

Statistics provided by the National Center for Injury Prevention and Control.

 Contact the brain injury attorneys who can assist you or a loved with your case.

Brain injuries are devastating, life changing, and they generally are not obvious to the casual observer. In fact, traumatic brain injuries are called the “silent epidemic” and the “invisible injury” largely in part because victims sometimes aren’t even aware that something is wrong.

Traumatic Brain Injury (TBI) is not like any other injury. Sadly, because many of the symptoms of “mild” to “moderate” traumatic brain injury are subtle, and because the injury commonly avoids detection on our most sophisticated hospital imaging equipment, it is common for victims to go undiagnosed. This is especially so in the emergency room.

Due to the invisible nature of the injury, victims of traumatic brain injury only rarely receive prompt treatment for their physical and cognitive impairment. Not uncommonly, victims’ early medical charts are devoid of any mention of “head injury” or “cognitive impairment”. It is only later, if lucky, that a health care professional validates the victims” injury, and treatment finally ensues.

As with most misunderstood injuries, society and “old school” health care practitioners, are apt to label the TBI victim a malingerer, or worse. Because victims of traumatic brain injury appear outwardly just as they did before the injury, it should come as no surprise that many victims describe their post-injury experience as including progressive social isolation together with alienation from even immediate family.

“Left to fend for themselves, the victims of traumatic brain injury, already confused by their inability to be the people they were prior to the injury, now face the daunting task of demonstrating that an injury they do not understand and cannot comprehend is producing the confusion they cannot communicate.”

Practically, victims of TBI are unable to process information at pre-injury rates of speed. Nor is the range of subject matter about which an individual can think the same for a victim of traumatic brain injury. Accurate judgment becomes difficult, at best.

Communication is oftentimes stifled, and the ability to conform behavior is impaired. Violent behavior may manifest as a result of frustration and inability to respond in a pre-morbid (pre-injury) manner. Headaches are common, and smell and taste can be affected. Memory and recall are often times profoundly affected.

Conscious or unconscious awareness of the situation becomes the private “hell” of the victim, who is alone and unable to diagnose or resolve the injury. Describing this unfortunate circumstance, Dr. Antoinette R. Appel has stated: “Left to fend for themselves, the victims of traumatic brain injury, already confused by their inability to be the people they were prior to the injury, now face the daunting task of demonstrating that an injury they do not understand and cannot comprehend is producing the confusion they cannot communicate.”

Historically, words such as “mild”, “moderate”, and “severe” were utilized to define brain injury. For many years, these terms were utilized based on duration of loss of consciousness.
Today, it is universally accepted that brain injury can occur without loss of consciousness,without direct external trauma to the head, and without positive findings on CT, MRI, or other sophisticated diagnostic testing.
Acknowledging this latter point, in the 1995 Journal of Neurotrauma it is stated:
“Although current computerized tomography (CT) and magnetic resonance imaging (MRI) techniques have shown great utility in diagnosing various aspects of traumatic brain injury, damage resulting from mild diffuse brain injury often goes undetected with these procedures.” (Emphasis added). [Smith, D.H.; Meaney, D.F.; Lenkinski, R.E.; Alsop, D.C.; Grossman, R.; Kimura, H.; McIntosh, T.K.; Gennarelli, T.A.; (1995) New Magnetic Resonance Imaging Techniques for the Evaluation of Traumatic Brain Injury. J.Neurotrauma 12(4): 573-577]
We at Shaked, P.A. find it repugnant to utilize terms such as “mild” or “moderate” to describe a permanent brain injury. However, until the lexicon of health care practitioners, experts, and others change, we seem destined to face use of these terms to describe brain injury. We must, therefore, assist all those seeking assistance, and even those who are not, with the true meaning of the words “mild” and “moderate” as they pertain to brain injury. When it describes a brain injury, we believe the word “mild” is synonymous with “serious”.
The Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitative Medicine define mild traumatic brain injury as follows:
DEFINITION:
“A patient with mild traumatic brain injury is a person who has had a traumatically induced physiological disruption of brain function, as manifest by at least one of the following:
1. Any period of loss of consciousness;
2. Any loss of memory for events immediately before or after the accident;
3. Any alteration in mental state at the time of the accident (i.e., feeling dazed, disoriented, or confused); and
4. Focal neurological deficits that may or may not be transient; but where the severity of the injury does not exceed the following:
* Post-traumatic amnesia (PTA) not greater than 24 hours;
* After thirty minutes, an initial Glasgow Coma Scale (GCS) of 13-15;
* Loss of consciousness of approximately thirty minutes or less;
COMMENTS:
This definition includes:
1. The head being struck;
2. The head striking an object;
3. The brain undergoing an acceleration/ deceleration movement (i.e., whiplash) without direct external trauma to the head. It excludes stroke, anoxia, tumor, encephalitis, etc. Computed tomography magnetic resonance imaging, electroencephalogram or routine neurological evaluations may be normal. Due to the lack of medical emergency, or the realities of certain medical systems, some patients may not have the above factors medically documented in the acute stage. In such cases, it is appropriate to consider symptomology that, when linked to a traumatic head injury, can suggest the existence of a mild traumatic brain injury.
SYMTOMOLOGY:
The above criteria define the event of mild traumatic brain injury. Symptoms of brain injury may or may not persist, for varying lengths of time, after such a neurological event. It should be recognized that patients with mild traumatic brain injury can exhibit persistent emotional, cognitive, behavioral and physical symptoms, alone or in combination, which may produce a functional disability. These symptoms generally fall into one of the following categories, and are additional evidence that a mild traumatic brain injury has occurred.
1.Physical symptoms of brain injury (e.g., nausea, vomiting, dizziness, headache, blurred vision, sleep disturbance, quickness to fatigue, lethargy, or other sensory loss) that cannot be accounted for by peripheral injury or other causes;
2.Cognitive deficits (e.g., involving attention, concentration, perception, memory, speech/language or executive functions) that cannot be completely accounted for by emotional state or other causes; and
3.Behavioral changes and/or alterations and degree of emotional responsivity (e.g., irritability, quickness to anger, disinhibition, or emotional lability) that cannot be accounted for by a psychological reaction to physical or emotional stress or other causes.
COMMENTS:
Some patients may not become aware of, or admit, the extent of their symptoms until they attempt to return to normal functioning. In such cases, the evidence for mild traumatic brain injury must be reconstructed. Mild traumatic brain injury may also be overlooked in the face of more dramatic physical injury (e.g., orthopedic or spinal cord injury). The constellation of symptoms has previously been referred to as minor head injury, post-concussion syndrome, traumatic head syndrome, traumatic dephalgia, postbrain injury syndrome and post-traumatic syndrome.” J Head Trauma Rehabil 1993:8(3):86-87

Unfortunately, as could be expected, the failure to properly diagnose and even define brain injury compromised the accuracy of early studies, whose goal was to track the frequency of traumatic brain injury in the United States of America. These studies are commonly referred to as “epidemiological studies“.

For example, many of the early studies (1935-1981) required one or more of the following criterion for inclusion: (i) loss of consciousness; (ii) hospital admission; and/or (iii) positive neuro-radiological findings. Moreover, these earlier studies sporadically did not include cases in which the patient actually died before reaching the hospital.

Nonetheless, even utilizing the outmoded, inaccurate criterion of the past, frequency rates of traumatic brain injury were found as high as 10 per 175 patients, and only as low as 10 per 600 patients.

Modern studies focusing on the frequency of traumatic brain injury (1981-present) have attempted to resolve inaccurate definitional difficulties and have looked beyond hospital discharge coding problems. These studies tend to be much more accurate and demonstrate an alarming frequency rate of traumatic brain injury.

Based on the modern studies, it is likely that the annual incidents of new head injuries treated in hospitals in this country is 400 per 100,000 patients treated. Accordingly, more than 1,000,000 new head injuries are treated in hospitals each year. Even these studies, however, ignore the numerous cases of “mild” traumatic brain injury in which the patient is never hospitalized.

Corroboration for these numbers comes from the most recent data from the Center’s for Disease Control and Injury Prevention (CDC): It is now estimated that there are 5.3 million children and adults living with the consequences of sustaining a traumatic brain injury in the United States. This number represents nearly 2% of the population.

TBI does not discriminate. It can happen to a child or adult of any age, gender, race, religion, or socio-economic status. The risk of TBI is highest among adolescents, young adults and persons over the age of 75. In comparing the national prevalence rate for TBI with other more commonly cited and discussed disabilities, it is easily understood why TBI is often referred to as the “silent epidemic”. Examples of other prevalence rates (from CDC) follow:

400,000 with Spinal Cord Injuries;

500,000 with Cerebral Palsy;

2.3 million with Epilepsy;

3.0 million with Stroke disabilities;

4.0 million with Alzheimer’s Disease;

5.3 million with TRAUMATIC BRAIN INJURIES;

5.4 million with Persistent Mental Illness;

and 7.2 million with Mental Retardation.

An estimated TWO MILLION people receive a traumatic brain injury each year and someone will sustain a brain injury every fifteen seconds. An estimated ONE MILLION people are treated for TBI and released from hospital emergency departments each year. Each year 230,000 Americans are hospitalized (longer than ER booking) as a result of TBI. Each year 80,000 Americans experience the onset of long-term disability as a result of sustaining a TBI. More than 50,000 people die every year as a result of TBI.

Vehicle crashes are the leading cause of brain injury. They account for 40% of all TBI’s Falls are the second leading cause of TBI and the leading cause of brain injury in the elderly. In 1990, Congress responded to the reported increase in TBI by amending the Individuals with Disabilities Education Act (PL 101-476) to include TBI as a separate disability category. [See also, Code of Federal Regulations, Title 34, Section 300.7(b)(121)].

In response to recommendations of the Interagency Head Injury Task Force, Representative Jim Greenwood introduced the first version of the TBI Act during the 103rd Congress. He was later joined by Henry Waxman as lead co-sponsor in the House. Senator Orrin G. Hatch and Senator Edward M. Kennedy introduced similar legislation in the Senate. The Legislation was re-introduced in the 104th Congress and signed into law as PL 10-166 on July 29, 1996. This Legislation provides for CDC surveillance of occurrence and cause of TBI (hence the statistics above), as well as development of medical treatment and prevention. Grants and other public funding mechanisms are also included in the legislation. In introducing S-96 on January 4, 1995, Senator Hatch stated: “Sustaining a traumatic brain injury can be both catastrophic and devastating. The financial and emotional costs to the individual, family, and community are enormous. Traumatic Brain Injury is the leading cause of death and disability among Americans under the age of 35. In the State of Utah, for example, the main affected age is 28, which is often the beginning of an individual’s maximum productivity * * *.”

Senator Kennedy’s introductory statement included the following: “In 1988, Congress recommended the Secretary of Health and Human Services establish an Interagency Head Injury Task Force to identify gaps in research, training, medical management, and rehabilitation. This legislation responds to the prevention, research, and service needs identified by the Task Force. This Bill will promote coordination in the delivery system and assure greater access to services for victims suffering from the disabling consequences of these injuries. By improving the quality of care, we can reduce severely the disabling effects and reduce the heavy toll from these injuries”.

Unfortunately, while this legislation may help, the public (taxpayer) cannot foot the entire bill resulting from these injuries, especially where the injury results from the negligent or intentional wrongs of another. Moreover, due to advances in medical technology, especially in the diagnostic areas of medicine (PET, MRI, etc.), brain injury is likely to be diagnosed at greater rates than ever before. It is not necessarily that there are more brain injuries occurring today, but due to poor diagnostic capabilities in the past, these injuries were simply overlooked, and unfortunately, left untreated for the most part.

Survivors of traumatic brain injury are likely to receive hospital and rehabilitative care from a wide range of professionals. Indeed, a multi-disciplinary treatment and rehabilitative approach is justified in cases of traumatic brain injury. A very brief summary of the role each professional may play follows. Note, however, that the needs of each patient are unique, and many of the following specialists may not therefore be required. Likewise, still other patients may require the services of orthopedics, otolaryngologists, and others, not discussed below.

(a) Neurosurgeon. Physician specialist trained in the surgical intervention of the nervous system, including the brain, spinal cord, nerves and muscle.often- times the team coordinator in cases of “moderate” to “severe” traumatic brain injury.

(b) Neurologist. Physician specialist trained in medical treatment of nervous system, including brain, spinal cord, nerves and muscles. May be called upon to diagnose injury and consult on immediate medical care. Seek neuropsychologist opinion if injury called “mild” or “short-term”

(c) Physiatrist. Physician specialist with emphasis both in physical medicine and rehabilitative medicine. Directed at renewing function, these doctors are trained both in neurology and orthopedics.

(d) Neuropsychologist. Psychologist specialist trained to assess brain function through test batteries designed to measure cognitive deficits. Thereafter,selects and conducts rehabilitative efforts.

(e) Respiratory/Pulmonary Therapist. Trained therapist that assist the pulmonary needs of a patient, including maintenance of ventilators employed to insure clear airways, especially on comatose patients.

(f) Physical Therapist. Trained therapist whose focus is on motor function, coordination, balance, and endurance. Physical therapists actually work with the patient exercising and strengthening muscles.

(g)Occupational Therapist. Trained therapist teaching rehabilitation skills to the patient. The focus is on both gross and fine motor skill within the context of daily living. Areas of training may include bathing, toileting, feeding, and dressing.

(h) Speech Pathologist. Trained specialist whose sole focus is on speech and communication deficits. Depending on severity of deficit, oral communication, written communication and computer training may be utilized and/or analyzed.

(i)Vocational Rehabilitation Counselors. Trained counselors, whose task is to identify, generally through comprehensive testing, those transferable skills, which will help restore the patient to the work force. Tests can include the Crawford Small Parts Test, the Bennett Hand Tool Test, the Purdue Peg Board Test, the Wrest Packaging Test, various motor coordination tests, manual dexterity test, form perception test, problem solving test, visual speed and accuracy test, verbal comprehension test, and weight lifting and carrying test. Victims of traumatic brain injury face almost insurmountable challenges to job re-entry. Vocational rehabilitation counselors are key to their re-entry to the work force.

(j) Rehabilitation Case Manager. Generally a rehabilitation case specialists” job is to coordinate the goals of the patient and patient’s family. The case manager coordinates rehabilitative staff and serves as an advocate for the patient. Case managers” work directly with the family and often times deal with the intricacies of insurance and funding for treatment

Emotional distress following a traumatic brain injury can be both real and debilitating. Often times, severe emotional distress will mimic many of the characteristics of organic brain dysfunction. It is the treatment that differs in each case, however.

In the litigation setting, it is common for insurance companies, and their lawyers, to contend that the dysfunction and deficits experienced by the victim did not result from any trauma sustained, but rather from pre-existing emotional difficulties. So standard is this defense that it is encountered in virtually all cases of “mild” traumatic brain injury. Therefore, for purposes of treatment, and in order to prevail over unmeritorious defenses, it is important to understand the distinction between an organic brain injury and a debilitating emotional injury.

(a) Post-Traumatic Stress Syndrome. Perhaps the most common emotional injury following trauma is that of post-traumatic stress disorder (PTSD). The most comprehensive definitions of PTSD can be found in the Diagnostic and Statistical Manual – IV (DSM-IV). Therein, PTSD is defined as follows:

“The essential feature of post-traumatic distress disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. The person’s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent re-experiencing of the traumatic event, persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, and persistent symptoms of increased arousal. The full symptom picture must be present for more than one month, and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

Onset and duration of post-traumatic stress disorder have been classified into three general areas: (1) Acute – when the duration of symptoms is less than three months; (2) Chronic – when the symptoms last three months or longer; and (3) With Delayed Onset – where at least six months have past between the traumatic event and the onset of symptoms.

The traumatic events found sufficient to give rise to PTSD are not insignificant. These events include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, and severe automobile accidents or other life threatening events.

Victims of PTSD often re-experience the traumatic event in various ways. Many times, the victim has recurrent and intrusive recollections of the event or recurrent distressing dreams during which the event is replayed. In certain rare instances, victims actually experience dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at the moment.

Avoidance is common for victims with PTSD. Victims tend to avoid anything associated with the trauma, making a conscious effort to avoid thinking about, experiencing feelings related to, or even talking about the traumatic event. Amnesia may even develop for some or all aspects of the trauma. Victims of PTSD often times become “numb” experiencing “emotional anesthesia” identified by decreased responsiveness to the external world.

Since the development of PTSD can be influenced by a victim’s previous history, such as childhood upbringing, personality, pre-existing mental problems, etc., it is common for insurance companies and their lawyers to methodically search for pre-existing stressors, rather than the trauma itself, which could give rise to the claim. However, the severity, duration, and proximity of a victim’s exposure to the traumatic event tend to be the most important factors affecting the likelihood of developing this disorder. Accordingly, competent neuropsychologists must spend considerable time analyzing all aspects of a victim’s experience before diagnosis.

(b) Organic Brain Injury. The Diagnostic and Statistical Manual – IV (DSM IV) describes underlying organic injury as “dementia” due to head trauma. DSM IV defines dementia due to head trauma as follows:

“Dementia Due to Head Trauma: The essential feature of Dementia Due to Head Trauma is the presence of a dementia that is judged to be the direct pathopsysiological consequence of head trauma. The degree and type of cognitive impairments or behavioral disturbances depend upon the location and the extent of the brain injury. Post-traumatic amnesia is frequently present, along with persisting memory impairment. A variety of other behavioral symptoms may be evident, with or without the presence of motor or sensory deficits. These symptoms include aphasia, attentional problems, irritability, anxiety, depression or affective lability, apathy, increased aggression, or other changes in personality * * *.”

In distinguishing PTSD from organic brain dysfunction, the neuropsychological assessment becomes key. Through neuropsychological assessment cognitive abilities are typically evaluated through a variety of testing. Since the criteria for diagnosis of dementia requires impairment in “occupational” or “social functioning”, and since there must be a “decline from a previously higher level of functioning”, neuropsychological assessment greatly aids in the diagnostic process.

Generally, the cause of PTSD is thought to be functional or psychologically based. In contrast, the cause for organic brain injury involves an actual change in the brain tissue itself.

Treatment modalities differ markedly between the two. PTSD is commonly treated through psychotherapy or through the use of medications to control anxiety and stress. Depending upon the pre-existing characteristics of the individual, treatment for PTSD can be prolonged and the progression gradual.

In contrast, maximum recovery from organically based brain injury, at least in terms of thinking skills, typically occurs soon after the event in question, with gradual recovery continuing throughout the first year to two years post-injury. Although technology changes with each day, treating cognitive problems due to brain tissue changes with medications has not proved highly fruitful thus far.

Perhaps the easiest manner of determining whether a particular victim is suffering from PTSD – related symptoms only, versus organically based brain impairments involves analyzing the overall pattern of neuropsychological assessment results. For example, if the victim demonstrates problems with motor or sensory abilities isolated on one side of the body (or other abilities governed by one hemisphere of the brain), such injuries are more likely to be the result of actual organic brain damage than due to interference in efficiency of thinking due to PTSD or other emotional distress.

The problem is often times not nearly so clear. Making matters worse, a victim may be experiencing both PTSD and organic brain injury. In these cases, a synergistic result can occur heightening dysfunction both in everyday life and on formal testing.

What must be recognized is that deficits can result from either organic brain injury or post-traumatic stress syndrome. Neuropsychological assessment can do much to identify the etiology of the deficits thereby allowing prompt treatment to ensue.

Did you know that a person can have a serious, permanent and disabling traumatic brain injury, even though:

1. The person is not knocked out at the scene of the accident.
2. The person may be walking, talking and even exchanging his driver’s license at the scene of the accident
3. The person did not sustain any cuts, broken bones or major injuries in the accident.
4. The person may have a negative MRI, CT scan or EEG.
5. The defense doctor, or the insurance company, will find that the person is neurologically sound despite future findings of brain damage.
6. There was not a “big car crash” and that even a low speed or low impact car crash can exert sufficient force on the brain to cause a traumatic brain injury and resulting brain damage.
7. That the delay in diagnosing the brain damage is not the patient’s fault, but may be because of lack of education on this subject by the medical community.
8. The injured person gave different versions of what happened in the car accident. This is sometimes to be expected, because a person with a traumatic brain injury is a very poor historian when it comes to recalling the facts.
9. The patient only related two or three problems following the car crash and family members and close friends relate twenty or thirty problems including personality changes.
10. The person was able to continue working, but if he/she is given a new responsibility, promoted, transferred to another job or obtains new employment, he/she may have tremendous difficulty and end up getting fired.
11. The term “post concussion syndrome” may mean traumatic brain injury.
12. Attention or concentration problems following an accident may mean that the person suffered traumatic brain injury or brain damage.
13. Changes in personality or behavior following an accident, may also mean that the person suffered a traumatic brain injury
14. New brain damage symptoms may appear days, weeks or months following an accident.
15. The person has a perfect neurological exam, since this exam does not reveal the neuropsychological deficits associated with traumatic brain injury.
16. The diagnosis of traumatic brain injury, closed head brain injury, or brain damage is based on the entire battery of tests and the entire examination and not the patient’s answe

Those who sustain concussion, hemorrhage, significant loss of consciousness, coma, and/or skull fractures are typically diagnosed as having sustained a “moderate” to “severe” traumatic brain injury.

Injuries of this nature are generally detectable on CT, MRI, and other imaging devices. In many instances, the patient’s very survival is an issue. Brain swelling, contusion and edema are likely complications. In virtually all cases, quality of life is a premier end goal.

The resulting impairments suffered by the “moderate” to “severe” traumatic brain injury victim can generally be related to the original insult, although in case after case insurance companies and their lawyers contest these relationships. Physical consequences of “moderate” to “severe” traumatic brain injury are diverse and vary from patient to patient. They may include: paralysis, sensory losses, decreased muscle control, including hemipareses, weakness, seizures, sleep disorders, speech and eating disorders, as well as memory and recall difficulties.

Individuals, while in coma, represent the “severe” end of traumatic brain injury. This is not to infer that one need be comatose to be classified as having sustained a “severe” traumatic brain injury, but comatose individuals have clearly sustained a “severe” traumatic brain injury irrespective of its potential transient nature.

Family members of comatose patients are often times left with nothing but hope, as health care professionals too, must wait as the human recovery process begins. It is no less important for family members to seek assistance from support groups during the recovery process.

A multi-disciplinary treatment and rehabilitative approach can be justified in virtually all cases of “moderate” to “severe” traumatic brain injury.

The threshold question in many situations involving the law is whether you can “do it yourself” or whether you need a lawyer to advise you on your rights or handle the matter for you completely.

While many “minor” disputes can adequately be handled without need of a lawyer – using Small Claims Court or Alternative Dispute Resolution – if you, a friend, or loved one sustained a catastrophic personal injury such as a traumatic brain injury, there can be no question but that you are in need of the services of a competent lawyer.

Unfortunately, we live in a day and time where millions of dollars have been spent persuading the general public (prospective jurors) that should an injured victim exercise their fundamental constitutional right by bringing suit, that individual is merely adding to an already “sue happy” society. Nothing could be further from the truth.

Where a lawsuit is not pursued, unless the injured victim is independently wealthy, the taxpayers will bear the brunt of financial responsibility. Indeed, in catastrophic cases the victim may end up institutionalized unless sufficient funds are secured in order to meet the victim’s medical and support needs.

Complicating matters further, many victims of traumatic brain injury, especially mild traumatic brain injury, are in a state of denial regarding the profound impact of the injury itself. While victims of “mild” TBI have not sustained the “catastrophic” injuries, which may cause an individual to be institutionalized, they have nonetheless sustained injuries which will have a significant impact on their vocational capabilities. In denial, job after job is lost.

Combining denial with the current disfavor regarding lawsuits may very well prove to be a recipe for disaster for the injured individual. Only a lawyer can assess the “legal health” of the injured victim – by investigating the facts, researching the latest developments in the law, applying his or her legal training and experience, and then advising the victim of his/her alternatives. A good lawyer can spot the “jagged rocks” that may lie below the waters of a seemingly simple dispute and can help the victim plan a course of action to avoid them.

The sad truth is, however, that all lawyers are not created equal. It is a very sad fact of traumatic brain injury life that many survivors will not receive adequate recompense for their injury because their lawyer did not have enough experience to know how to analyze, prepare and present a legitimate claim for damages. Many times, the blame is directly traceable to the attorney who is not forthright in the first place regarding his/her lack of experience handling cases involving traumatic brain injury. Time after time the inadequate result rests with the attorney who did not understand the seriousness of the injury simply because of its “invisible” nature.

Unfortunately, even where an injured victim has overcome denial, and has further overcome the social stigmas associated with bringing a lawsuit, s/he may nonetheless experience further “hurt” due to an association with a lawyer having no idea how to properly present claims involving traumatic brain injury. BEWARE: EDUCATION, TRAINING, AND EXPERIENCE VARIES BETWEEN LAWYERS.

At the Scarlett Law Group, we represent injured victims on a contingent fee arrangement. This means that we do not receive any fee or payment unless money is recovered on behalf of the injured person, and then the attorney fee is paid as a percentage of the amount recovered. [Contingent Fee].

What this means is that you have the absolute ability to hire the most qualified attorney specializing in representing individuals sustaining traumatic brain injury. Through the use of the Contingent Fee Agreement, and given that there are excellent attorneys around the United States willing to advance the expenses in connection with the prosecution of a TBI case, injured victims have the ability to hire the most qualified attorneys and need not settle for or accept inexperienced attorneys to handle their cases.

Through the contingency fee, you have the ability to hire a qualified attorney in a crucial situation, and you need not pay that attorney unless they successfully perform. This is a powerful position to be in. Do not underestimate your position. After all, the results of your lawsuit will have an important and long-term impact on your quality of life. Just as you would not rush to purchase any item of consumer goods, nor should you hastily choose a lawyer to represent you.

We at Shaked, P.A., are committed to handling claims of individuals sustaining traumatic brain injury. We are committed to spending the time with you and your family members to gain a deep understanding for each and every way the injury has affected your life. We are committed to spend the necessary time in order you understand your rights in the progress of your case. Our staff is committed to trying to make your life easier, and we will endeavor to put you in contact with support groups and treating doctors as your case may require.

Given the importance of your choice of counsel, you should be prepared to meaningfully question prospective lawyers in order to ascertain his or her qualifications to handle your case.
You are about to embark on one of the most important decisions of your life, to wit: The choice of the right lawyer to represent you. You are armed with a powerful tool, the Contingency Fee Agreement. This Agreement allows you to retain experienced counsel without having to pay hundreds of dollars per hour up front. Please, do not make your decision cavalierly. Ensure that you are comfortable with the counsel of your choice. Ensure that counsel has the confidence and experience to properly handle your case. The path is a difficult one, and the choice of counsel can make all the difference in the world.

 Traumatic brain injury or a closed head injury can occur when the head is subjected to a direct external impact. Likewise, injury can occur when the head is subjected to a sudden acceleration and then is suddenly stopped. A sudden acceleration/deceleration often follows a violent flexion – extension movement of the head. This response is extremely common in rear-end vehicle collisions.

Condensed to its most simplistic, there are three major mechanisms which contribute to traumatic brain injury.

These include: (a) impact of the brain against the skull; (b) shear between layers of the brain; and (c) cavitation.

(a) Brain v. Skull. Depending upon how the impact occurred, be it a rear-end collision or other source, the head starts its movement to the rear while the brain resists, thereby leaving a space at the back of the skull. As this force progresses, a centrifugal force lifts the brain thereby leaving spaces between it. Both inertia and centrifugal force causes the brain to impact against the skull. This impact may cause damage to the brain.

“Condensed to its most simplistic, there are three major mechanisms which contribute to traumatic brain injury. These include: (a) impact of the brain against the skull; (b) shear between layers of the brain; and (c) cavitation.”

While the skull provides considerable external protection because of its strength, its inner-contours are not smooth and are characterized by sharp, bony proturbences. When a blow is dealt to the head, the brain is flung against these bony proturbences and is bruised and torn, resulting in brain damage.

(b) Shear – Diffuse Axonal Shearing. Another mechanism of brain injury is that of shear. Shear is based on rotational acceleration/deceleration, and a sliding effect of one layer of the brain upon another. Shear occurs within the brain because of the difference of density in layers.

Axonal shearing can occur where an axon transverses between two or more layers of the brain which are subject to shearing forces. Often times, damage to the axons is diffuse and degeneration happens throughout the brain rather than in specific clusters. Diffuse axonal shearing is a common cause of “miild” traumatic brain injury, and is rarely visible upon imaging.

(c) Cavitation. Cavitation occurs when mass moves rapidly through fluid. The pressure in front of the mass is high and the pressure behind the mass is low. Vapor filled bubbles form in low pressure. When a mass returns in the opposite direction, the bubbles collapse. If this occurs often, the brain can be injured.

Many times, injuries are found opposite the point of impact. This type of injury is called the “countre-coup”, a French term meaning “against the blow”. Cavitation is the most commonly accepted explanation for this type of injury.

Work-up of the biomechanics of injury are especially required in the proper trial presentation of any traumatic brain injury case. The Shaked Law Firm, P.A., works with the top experts in the world on this subject.

Contact us if you or a loved has suffered a brain injury and are in need of legal help.