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Delayed Discovery of Mild Traumatic Brain Injury: Finding Medical and Legal Help

February 4, 2010

As a leading cause of disability among young adults and children, traumatic brain injury has been referred to as a “silent epidemic” by the National Head Injury Foundation. Up to an estimated 1.4 Million people every year suffer traumatic brain injury. Exact numbers are not known because many persons who suffer brain injuries go undiagnosed.

Too many cases of mild traumatic brain injury are not initially diagnosed. The reasons are many and diverse, including but not limited to: 

  • The patient presents in the emergency room with trauma that requires immediate orthopedic, medical-surgical or burn treatment to stabilize or save the life of the patient. 
  • Pharmacological intervention with narcotics which mask the neurocognitive impairments during acute care, and sometimes for weeks or even months after injury.
  • Periods of hospital and home convalescence following injury, during which cognitive and functional demands are limited.
  • Incomplete testing of persons who display no obvious injury to the head. 
  • Failure to seek treatment immediately after injury or during the weeks that follow, during which symptoms of cognitive impairments manifest and become problematic.
  • Inability of diagnostic equipment typically utilized in emergency departments (CT, MRI, EEG) to detect the presence of mild brain damage. 
  • Misunderstandings among even some medical providers that brain damage can exist even where there has been no impact or direct trauma to the head. 
  • Timing of arrival of paramedics to the scene of an accident or timing following an accident in seeking initial medical care. If the joint medical assessment (paramedic or emergency room physician) is delayed, initial assessments and Glasgow Coma Score determination may be different than immediately after the injury. 
  • There are many, many factors that affect whether a traumatic brain injury is initially diagnosed.

Any or some combination of these factors can result in an undiagnosed and therefore, untreated, mild traumatic brain injury. This is the silent epidemic-the large numbers of people who are left to suffer impaired abilities to succeed at work, or to work at all, and engage in social and family relationships at the levels they did before they were injured. Widely accepted symptoms of mild traumatic brain injury, even if only noticed weeks after initial injury include:

  • Impaired attention/concentration
  • Impaired memory
  • Slowed information processing         
  • Difficulty in word finding
  • Impaired executive function-planning, thinking  
  • Headache
  • Easily fatigued             
  • Slurred Speech
  • Problems with vision             
  • Easily frustrated
  • Emotional swings (anger/sadness/euphoric)  
  • Sleep Disturbance
  • Fine motor impairments         
  • Tinnitus
  • Anxiety                 
  • Depressed mood

All brain injuries are serious. Traumatic brain injury survivors suffer emotional and psychological issues and loss of self-esteem and self-worth. Often, it is a downward spiral in which dysfunctional coping responses lead to more dysfunction, alienation from co-workers, friends and family, and depression. They and their family are lost and bewildered. The lack of diagnosis and treatment for the mild traumatic brain injury leave them rudderless and without hope. This downward spiral can result in serious depression, loss of relationships and loss of self. The longer it is unaddressed and untreated, the more difficult it becomes to treat. Layers of psycho-emotional dysfunction are laid on, and can result in a destroyed life.

There is help. There is hope. The first step is to recognize that help is needed.

If the injury was caused by the fault of another person-whether an auto accident, boating accident, explosion, burn injury with anoxia or inhalation injury, or injury at work, it is important to locate and retain legal help with an attorney who understands the dynamics of mild traumatic brain damage and is experienced and well-studied in how to successfully prove the existence and impact of this “silent” but devastating injury. In choosing an attorney, it is important to consider whether the attorney will support, and be a part of, the treatment team. The attorney then must understand not only the goals of the treatment modalities (psychological, neuropsychological, psychiatry, occupational therapy, neurological, social work, etc.) but must support and facilitate the client’s compliance with and consistent participation in, the treatment regimens and plan. 

An invaluable resource is the family physician. Our experience has seen these dedicated and caring physicians serve as the gateway to verification of diagnosis and treatment weeks and months after injury onset. The family physician can initiate referrals to neuropsychological testing, psychiatry, and/or neurological care. Where necessary, the attorney can assist in facilitating referrals for help if the traumatic brain injury survivor is without a family physician or primary health care provider.

Even where weeks or months have elapsed since the initial injury, it is not too late to seek help. The good news is that there is hope and help available. The recovery process can be long and the extent of recovery will vary case by case. But, it is a road that must be traveled. There are many caring and dedicated people who understand the struggles endured by the traumatic brain injury survivor and his/her family. The enemy of the traumatic brain injury survivor is inaction. Frequently, it is the family, friend or co-worker who must provide the initial energy to intervene and take the first step to seek help. Most often, it is a step that can save quality of a life.

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