Traumatic Brain Injury


Though closed head injuries are not objectively apparent at the time of an accident, common indications that TBI may result are loss of consciousness, inability to recall events immediately before or after the accident, and alteration in mental state immediately following, such as feeling dazed, disoriented, or confused. After an accident, common symptoms of TBI in adults are the following:

  • persistent neck pain

  • ringing in the ears (tinnitus)

  • lapses in attention, perception, judgment, or information processing

  • difficulty with memory, concentration, or decision making

  • trouble with cognition, abstract concepts, and time and space relationship

  • limitations on reading and writing skills

  • slowness in thinking, speaking, or taking action

  • getting lost or easily confused

  • persistent low-grade headaches

  • feeling tired all the time, lacking energy or motivation

  • problems associated with sleep, such as insomnia or oversleeping

  • reduced strength, endurance, and coordination

  • onset of tremors or swallowing problems

  • feeling light-headed or dizzy

  • onset of seizures

  • volatility in your mood – apathy, irritability, anxiety, and/or depression

  • difficulty maintaining your balance

  • increased sensitivity to sounds, light, or distractions

  • blurred vision

  • reduction of sense of smell or taste

Because children are less aware of their habits and normal functioning than adults, it is important for adults to monitor children carefully if it is suspected that they are suffering from a TBI. Symptoms to look for in children include: 

  • loss of energy or tiring easily

  • reduced interest in favorite toys or activities

  • irritability or crankiness

  • changes in eating or sleeping patterns

  • changes in the manner in which the child plays, both alone and with others

  • difficulties at school

  • deterioration of recently learned skills

  • loss of balance, or instability while walking

The exact effects on an individual who suffers a TBI will vary greatly, depending on the force of impact the brain suffered and the location(s) of the injury on the brain. It is important to obtain a thorough medical examination following any accident so as to immediately determine all injuries received. To appreciate the extent of an injury, it is helpful to understand medical scales used to measure injuries involving TBI.

The Glasgow Coma Scale rates a patient’s ability to open his/her eyes, and respond to verbal commands and responses. Each level of response indicates the degree of brain injury.

The lowest score is a 3 and indicates no response from the patient. A person who is alert and oriented would be rated at 15.

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An array of experts may be involved in caring for and proving traumatic brain injury. Among the many specialists that may either treat victims or be employed by us as experts are the following:

Neurologist – specializes in the medical treatment of the nervous system: the brain, spinal cord, nerves and muscles. A neurologist is first called to make an initial evaluation, diagnose the injury and consult regarding immediate medical care the patient requires.

Physiatrist – combines physical medicine and rehabilitation medicine directed at renewing function. These medical doctors are trained in both neurology and orthopedics.

Neuropsychologist – specializes in evaluating brain function and performs sophisticated tests of brain function necessary to identify specific injuries and to select appropriate rehabilitation efforts.

Respiratory or pulmonary therapists – helps the patient breathe and maintain a ventilator where necessary to insure clear airways.

Physical therapist – focuses on restoring motor function, strengthening muscles, improving coordination, balance, endurance and the movement of joints.

Occupational therapist – provides rehabilitation skills to help the patient perform physical tasks involving both gross and fine motor skills, as well as performing the six activities of daily living: bathing, dressing, toileting, transferring [getting in and out of a chair or bed], continence [voluntary bowel and bladder functions], and feeding.

Speech pathologist – is involved in evaluating and teaching speech, writing, reading and expression skills aimed at both comprehension and communication.

Cognitive therapist – teaches survivors how to learn. The goal is to help survivors identify techniques to improve their ability to remember ideas. Computers are used extensively as a training tool by cognitive therapists.

Vocational rehabilitation counselor – identifies skills, aptitudes, and abilities that will help restore the patient to the world of work. To determine the level of vocational functioning the counselor also evaluates the patient’s ability to follow instructions and social skills. Testing helps determine the survivor’s ability to learn and make judgments, and helps to evaluate productivity, punctuality, reaction time, distractibility and tolerance for frustration.

Educational therapist – teaches the basic skills needed to return to school or work and arranges for a special educational environment that will develop reading, writing or math skills.

Social worker – provides the important connection between the health care staff, rehabilitation professionals, family, school, work and often the insurance carrier funding the rehabilitation. The chief task for the social worker is to prepare a detailed background study and normally includes the patient s pre-injury personality, lifestyle, emotional and financial resources, educational history, work and leisure interests, special relationship and previous problems. Long-term and short-term goals are usually developed with the social worker. Because the family will be in regular contact with the social worker, they will seek advice and will share confidences with the social worker. It is important for the patient s legal representatives to have a strong and responsible working relationship with the social worker. The social worker’s background study is one of the most significant documents in the rehabilitation chart.

Therapeutic recreational specialist – evaluates interests and hobbies and integrates them into therapy goals of the survivor. The focus is to develop physical, cognitive and social skills so leisure activities can once again be enjoyed.

Rehabilitation case manager – coordinates the goals of the patient, family and rehabilitation staff as an advocate for the patient and oversees the overall treatment plan. The case manager is routinely in charge of reporting to the insurance carrier, if any, funding the recovery program.

Pediatric neurologist – explains how injury interrupts growth and development and why children need specialized rehabilitation services now and in the future.

Research psychologist – educates the jury concerning the long-term effects of head injury, the impact on the family, and the need for lifecare planning. The attractive child with a severe impairment will generate compassion and understanding from his/her environment, but once the adolescent years begin the tasks of dealing with sexual drives, peers, alcohol and drugs in the TBI survivor are grossly complicated. Living unsupervised in the community will result in exposure to police and courts, which creates a whole additional range of problems that are important to understand.

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