HANDLING NON-CATASTROPHIC BRAIN INJURY CASES Part III: Definition of Traumatic Brain Injury

The definition of Traumatic Brain Injury:

It is suggested that rather than referring to your client as having suffered a head injury, that it is more accurate and less confusing to refer to your client as having suffered a traumatic brain injury (TBI).  In 1986, the National Head Injury Foundation (NHIF), which recently changed its name to the Brain Injury Association (BIA), adopted the following definition which constitutes a useful point of departure for attorneys handling a traumatic brain injury case:

Traumatic brain injury is an insult to the brain, not of a degenerative or congenital nature but caused by an external physical force, that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning.  It can also result in the disturbance of behavioral or emotional functioning.  These impairments may be either temporary or permanent and cause partial or total functional disability or psychosocial maladjustment.

 Does this definition describe your injury? Contact Thomas C. Doehrman to discuss your injury and symptoms.

Click here to learn more about Traumatic Brain Injury and your legal rights in the state of Indiana. 

          In addition to the BIA definition, at least two state legislatures have enacted statutory definitions of traumatic brain injury similar to the one adopted by the BIA.  For example, the state of Michigan defines TBI as:

An insult to the brain, not of a degenerative or congenital nature, that may produce a diminished or altered state of consciousness, and which results in impairment of cognitive abilities or physical functioning.[1]

Similarly, the state of Georgia defines TBI as:

[T]raumatic insult to the brain and its related parts resulting in organic       damage thereto which may cause physical, intellectual, emotional, social, or vocational changes in a person.[2]

The state of Indiana has not yet adopted a statutory definition of traumatic brain injury.

          One widely-accepted definition of mild traumatic brain injury (MTBI) had been developed by the American Congress of Rehabilitation Medicine (ACRM).  Important aspects of this definition include the following:

1.       Loss of consciousness is not required for there to have been a traumatic brain injury.

2.       If loss of consciousness does accompany a traumatic event, it is for a period of time of 30 minutes or less.

3.       Some altered state of consciousness at the time of the occurrence is expected (dazed, disoriented, and/or confused).

The traumatic events that can cause an MTBI include:

1.       The head being struck;

2.       The head striking an object; and,

3.       The brain undergoing an acceleration/deceleration movement (i.e. whiplash) without direct external trauma to the head.

This definition excludes brain damage caused by stroke, tumor, and anoxia.[4]

          The American Academy of Neurology (AAN) has not adopted a definition of MTBI; however, they are working on practice parameters for MTBI which are in the draft stage and should be published within the next year.  Significantly, the AAN’s practice parameters for the management of concussion in sports include the following statement:

Definitions.  Concussion is a trauma-induced alteration in mental status that may or may not involve loss of consciousness.  Confusion and amnesia are the hallmarks of concussion.  The confusional episode and amnesia may occur immediately after the blow to the head or several minutes later.  Close observation and assessment of the athlete over some period of time is necessary to determine whether evolving neuropathologic change associated with concussion will lead to a confusional state or to the development of memory dysfunction.  A history of recent head trauma outside the sports setting, such as a motor vehicle accident, should be considered in the evaluation of an athlete with concussion.[5]

Grade 1 and Grade 2 concussions occur with no loss of consciousness, and a Grade 3 concussion occurs with any loss of consciousness, whether it be for seconds or minutes.[6]

          It is important for the attorney handling a non-catastrophic brain injury case to understand that often such brain injuries cause dysfunctions which do not show up on standard medical brain imaging tests, such as the CT or MRI evaluations.[7]  In fact, the definition developed by the American Congress of Rehabilitation further defines a mild traumatic brain injury as one where loss of consciousness does not exceed thirty minutes, where posttraumatic amnesia is not greater than 24 hours, and where CTs, MRIs, EEGs, or routine neurological examinations may be normal.[8]  Therefore, a health care provider or attorney has to listen to the symptoms or complaints of the individual before the possibility can be considered that the client may have sustained an MTBI.  Many times, unfortunately, the emergency room evaluation of individuals who have sustained an MTBI is very cursory.  Often, the exam will include the following notations: “Ø LOC, oriented x 3,” suggesting a history of no loss of consciousness and that the patient was oriented to person, place, and time.  An attorney should not be misled into believing that these findings preclude the possibility that the patient sustained an MTBI if the patient reports symptoms consistent with such an injury.

          Medical literature indicates that the persistent symptoms at times associated with an MTBI result from the micro shearing of nerve tissue and abrasions to the brain which are not demonstrable using common brain-imaging techniques.  These symptoms are present in MTBI patients because of diffuse axonal injury, which is a wide-spread disruption of axons in various areas of the victim’s brain.[9]  Postmortem examination can reveal physical damage to the brain that was not detected by brain-imaging techniques.[10]