Understanding Traumatic Brain Injuries: A Conversation with TBI Attorneys Part 1

0:00:03 - Hey, I'm Shane from Shane Smith Law. I'm here today with John. He's one of our TBI attorneys from the TBI Law Group here at Shane Smith Law, and we're going to talk about just generally traumatic brain injuries. That's what we mean when we use the term TBI as traumatic brain injury. So we're going to talk about sort of the long-term effects one of these cases can have. And, john, when I hear TBI or traumatic brain injury, that sounds like something scary and horrendous and almost devastating. Is every one of them like totally severe or does some start smaller? What's sort of the range?

0:00:33 - Yeah, absolutely, Shane. So, with traumatic brain injuries, they encompass a wide range of injuries that can occur to the brain, ranging from a more minor concussion, what they deem a mild TBI, all the way to a moderate and severe TBI, and death even.

0:00:50 - Wow, okay, so mild TBI can mean something similar to a concussion?

0:00:55 – Correct

0:00:56 – So, these football players, they get two or three concussions, or boxers get a concussion, or somebody in a car accident gets a concussion. All of that is some type of TBI then.

0:01:08 - That is correct and typically in motor vehicle accidents and slip and falls things we see, the type of head injury that occurs is called a closed head injury, because there's other types of traumatic brain injuries can occur, like a rod through the head or an impalement or a broken skull, but a lot of the injuries we see are closed head injuries, where the brain is actually injured inside the skull.

0:01:33 - Now as a closed head injury. If I split my head open but the skull is the same as that, that's a closed head injury. That's correct. So if your child were to, you know have kids trip sometimes and they bust their scalp open, but they could have a closed head injury as well. That's one of the things they could be checked out for.

0:01:49 - That's right. That is something that the emergency room typically or the first responder will screen for.

0:01:53 - Are first responders, are they the best ones to identify head injuries?

0:01:57 - You know, typically there are more emergency personnel. The actual determination is going to be made, probably by a medical doctor who has the appropriate diagnostic tools, and that's usually where we see the first diagnosis.

0:02:10 - How do they screen these out, kind of then.

0:02:13 - Typically, a concussion or head injury comes with a lot of symptoms and we'll get into that here in a little bit where, depending on the area of the brain that you injure, you'll see certain symptoms and the doctors will screen for this same with things like emergency paramedics and personnel. They'll use something called the Glasgow Coma Scale, where they'll look for certain indicators showing the severity of the injury, like responsiveness, loss of consciousness. Is the injured person not making sense when they speak? These are all big indicators of a potential head injury and they usually will be followed up and triaged accordingly with certain protocol, like doing things like CT scans, MRIs, interviews with the victim at the ER.

0:02:58 - Does somebody have to lose consciousness to have a head injury?

0:03:00 - Believe it or not, shane, they don't, and that's the surprising thing but a lot of people are surprised when they find that out is that there's other ways of determining if the head injury has occurred. Sometimes it's disorientation, dizziness, other things can present. You don't actually have to black out.

0:03:16 - What are some of the other common symptoms that, like a triage person might be looking for?

0:03:20 - Sometimes people will show with ringing in the ears is a very common one Balance issues, so what has been called vertigo, when you feel like you're gonna lose your balance and you may lose your footing. That's a very common one. Loss of memory or short-term memory, being disoriented. Sometimes people will describe the sensation as I felt like I knew I was there and what was going on, but I didn't know where I was going, where I needed to go, and sometimes I'll drive to work after an accident and coworkers will then have to intervene and be like look you need to go to the hospital because you're acting differently.

0:03:53 - Okay, wow. And we say sometimes in car wrecks, when people are like I just don't remember anything at all about the accident, right, even though they technically don't lose consciousness, they lose that moment of time or whatever.

0:04:04 - That's right and that's when we start to look at the different classifications of the traumatic brain injury. When you just don't remember things for 30 minutes to sometimes up to a day, that usually falls more in line with a more moderate to severe TBI.

0:04:19 - Okay, so that's no longer the mild one. It's moved on to more serious, and I would guess the more serious the TBI, the more you expect it to have a significant impact on the person's life.

0:04:32 - That is correct. And you know, those initial kind of symptoms can be a good or bad indicator of what's to come for the victim and the person who sustained the injury.

0:04:40 - Now a lot of people think concussion. They think they just it just goes away and they're totally better. Is that always the case? Is that not always the case? Or is that not even relevant as far as whether somebody has a TBI?

0:04:51 - So we actually have some studies and information on this. Basically, some of the studies show that the outlooks look where, basically a good recovery. Well, actually, the study pulled and tested a few hundred people and those studies show that, you know, a good outlook and recovery was about 31%. Some people experienced moderate disability. That kind of accounted for about 14% of the injuries. Severe disability actually was about 24% Well, okay, and then a vegetative state was a very small percentage and death was 29%. So when we talk about the long-term outlooks of a severe or moderate to severe TBI, it's very serious, very serious consequences In the outcomes a lot of times are not good for people and we see that and that's why and some of the statistics show that you know, there's numbers. While the reporting can vary, it's expected that about 40% of cases have some degree of head injury or involvement. So the number is much higher than you would expect.

0:05:55 - So 40% of accidents, be it slip and fall, be it car accidents, be it just other accidents, 40% of them there's some kind of component with the head.

0:06:03 - That's right. The numbers that we have in the data sometimes point to about 800,000 plus yearly. However, we think that that number is probably vastly under reported. We think that it may be even a greater, bigger problem than we know. Because you think about, sometimes people just don't go to the hospital, so it's not documented, or they try and just tough it out. You know, you and I would probably have we all probably know a friend or family member that just won't go see the doctor. No matter what, and they're just not gonna go and unfortunately, with head injuries, it means that we're not getting the full, accurate picture. And 800,000 a year is already a lot, but it's probably a lot more.

0:06:41 - Yeah, when we say we, who's the we in that that context? That thinks there's a lot more than 800,000. Is that like you? Is that like lawyers? Is that like doctors? Is it school counselors? Who is it?

0:06:51 - This is going to be the smart medical pupil that compiles all this data yeah. And give us those nice, you know peer reviewed reports that we all rely on, because if we're just relying on our own experiences, we may not get the full picture. But when we have numbers to back up stuff, as lawyers we really focus on the hard data, the hard numbers, to know what we're dealing with.

0:07:14 - And you know, when you talk about that friend or family member, that just toughs it out, it always makes me think of the people who play sports. You know they take a hard hit or they get knocked down and next thing you know they're like put me back in, coach, let me get back in. A lot of times I don't even want to ever step out of the game at all. I know they've changed a lot of the rules along that in the last 10 years or so for fighters. You know I watch UFC, so there are rules for them, there are rules for all this. And is it because of these head injuries? That's the main thing, and people are not sort of acknowledging how bad they are. So now we're, I guess, acknowledging it and making changes.

0:07:44 - Absolutely, Shane, and big steps have really been taken in this area of medicine. I mean, we think about space and other things. The great frontier. Medical researchers actually describe the brain as one of the big frontiers, because we know a lot but we know so little and, as we see it in the news, it does a great job to move the dial forward. So think of, like the NFL and the concussion stuff that we've seen get advanced, or recently, same with the MMA fighting and the more strict concussion protocols we have. Now, back in the day it just wasn't taken as seriously because we just didn't know. And now we have different ways to diagnose. We have tests that are, you know, 10 times more powerful than a CT scan, where we can see the brain injury on a microscopic level and we can track which area of the brain was injured and then pair that up with the symptoms. So it gives us real good, objective evidence of the injuries. And it's just by virtue of things like the NFL and it being in the public media. It benefits victims that are injured in car accidents, because a lot of those injuries like that you see football players sustain are similar to the types of forces that occur in a motor vehicle crash or a slip and fall. Very similar forces on the brain.

0:09:06 - You know, I just was thinking about everybody's nose, the boxer who in the early days of their career was articulate and well-spoken and then by the time they got older and they'd taken so many concussions, you know the damage is there, I guess.

0:09:20 - Absolutely. No better case than, you know, the late Great Muhammad Ali, who in the early portion of his career had, you know, the gift of gab and later on in life he suffered from serious cognitive decline and, to the point where he was hard to understand, slurring his speech. These are all common symptoms and unfortunate end results from repeated head trauma.

0:09:40 - Well and I know, John, you want to talk about a couple of things today as well. Let's go in and sort of your first, first topic you want to talk about.

0:09:47 - Sure. So the I mentioned here and I have a small diagram here of the brain and what we do as attorneys and medical doctors is we want to try and identify the area of the brain that was injured, and that's usually done through diagnostic tests, things like what's called a DTI, which is a diffusion tensor imaging, a form of an MRI that can show different areas of the brain. We can actually see, through 3D coding and imaging, the part of the brain that is injured. And so what we do, and what can be sometimes scary for people that are involved in these accidents, is depending on the area of the brain that is injured. It affects whatever part of the brain and motor function is controlled by that part. So if you were to hit the back of the head which we see very commonly when forces of whiplash cause someone to go forward and back and strike the back of their head against the seat all of a sudden that person who sustained that brain injury will have problems with vision, because that's what part of the brain controls, so it might be blurry vision. Sometimes you'll have to see a specialist called a neuro ophthalmologist, which is literally a brain eye doctor. Very specialized, but it's more than just going to your optometrist and getting a new pair of glasses. It's like you hurt the part of your brain that sees. So I've had clients in the past that have noticed when scanning something that it seemed like the eye wasn't tracking where they wanted to look and you can imagine that's a scary thing. When your eyes aren't listening to your brain, it can be disoriented. If you've ever had trouble with vision, it can be kind of nauseous or make you dizzy.

0:11:29 - Yeah, so that's all of that would be associated with just striking the back of your head. There you go Because of the vision part, that nausea and all that kicks up because the brain's into there.

0:11:39 - That's right And with the frontal lobe. This is a bit another big strike zone, because you think the front of the brain. That's where, if the airbags deployed, your face is taking the brunt of the blow. Unfortunately, the airbag didn't deploy. Well, you know you're going to be hitting the steering wheel or the windshield or whatever Exactly.

0:11:57 - Hey, this has been part one of traumatic brain injuries and their long-term consequences. Stay tuned for part two, where we go a little bit further in the detail and we talk about a little bit about the other areas of the brain that can also be injured in a collision or other accident as well, and like and subscribe for more future updates from the TBI podcast.

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