How to Diagnose Clients with TBI During the Interview
In efforts to help my fellow traumatic brain injury lawyers, this is another blog with information from several TBI legal seminars I’ll be speaking at in the near future. I always say that the first step in helping anyone who has suffered a traumatic brain injury from a car accident or truck accident is to find it. Unfortunately, this usually requires many years of experience for lawyers already familiar with TBI law and cases. So I’ve put together this checklist for lawyers to use during the client interview when they suspect traumatic brain injury. Remember that most emergency rooms routinely miss the diagnosis of traumatic brain injury. If you or a loved one suspects brain injury, you can also administer these questions to yourself and then talk to your doctor.
A brain injury can arise in any case — whether there was impact of the client’s head on an object or not. This said, however, the stronger cases are obviously those which include a positive altered state of consciousness. To determine if a concussive episode occurred at the time of the accident, the following questions should be asked:
1. Do you remember the accident? What happened just before impact? Do you recall the impact itself? What about immediately following the accident?
2. Did you hit your head on anything inside the vehicle such as the steering wheel, headrest or window?
3. Did you feel dazed or confused at any point after the accident to the time you arrived at the hospital or went home?
4. Did you feel nauseous or sick to your stomach?
5. Did you feel overly tired in the hour or two immediately following the accident? Did you go to bed especially early the night of the accident?
These initial questions will give the attorney an immediate indication if a concussion (by definition, a closed-head injury) occurred. But even if the answers to all of these questions is “no,” a TBI cannot be ruled out. Regardless of the answers to these questions, the attorney must then learn about any current TBI symptoms the client may have. The detailed coverage of these symptoms is important, because many are dismissed if standing alone and/or may be attributed by the client and her doctors to other, physical injuries.
Traumatic Brain Injury Symptoms Checklist
The following is a checklist of both clear and subtle symptoms of a person suffering from an early traumatic brain injury:
Headaches — Headaches can be a good indicator of a TBI. Focus on where the headaches generally begin. Headaches that form behind the client’s eyes, at the client’s forehead or on the top of the skull are usually indications of a traumatic brain injury. Headaches that tend to form at the base of the skull can either be from a TBI, or a consequence of a neck injury. Likewise, headaches beginning at the temples may be a TBI symptom or a result of a TMJ injury coming from the client’s injured jaw disc.
Sensory sensitivity — When a person is suffering from a traumatic brain injury, her senses may become either overloaded or incredibly dulled. The client should be asked if she is experiencing any of the following:
o Sensitivity to bright lights;
o Ringing in the ears (tinnitus);
o Lack of taste, or funny tastes (usually metallic) or smells; or
o Loss of balance, clumsiness or dropping objects.
Emotional changes — A car accident is a traumatic event, so most people will naturally have an influx of emotions in the weeks and months following the crash. To distinguish these natural reactions from those emotional distress changes which are amplified by a traumatic brain injury, ask the client these questions:
o Are you having crying spells?
o Have you lost interest in people, relationships, sex?
o Do you lack motivation to perform even simple tasks?
o Do you have nightmares, flashbacks and/or changes in your sleeping patterns?
o Has your appetite changed?
o Are you experiencing unusual or irrational fears?
Cognitive changes — Perhaps the most telling, but illusive symptoms of brain injury is a change in the client’s cognitive functioning. These symptoms usually lead the attorney to send the client to a neuropsychologist, who can document the cognitive deficits suffered by the client. An attorney can try to uncover early changes however, by asking a few simple questions:
o Are you having trouble remembering things? Do you go into rooms and forget why you went there? Do you have to write things down or keep a checklist for simple tasks?
o Are you having trouble concentrating or staying focused on a single task?
In addition to these questions, the attorney can usually get a sense for memory difficulties by asking the client the name of any doctors she has seen already or giving the client a telephone or name to remember, and then asking the client to repeat what she was just said. If a client repeatedly asks you the same question or cannot recall your instructions a few seconds after you give them to her, a short-term memory dysfunction may be indicated.
A checklist of possible closed-head injury symptoms, such as the Philadelphia Head Injury Questionnaire, can be a good indicator of whether a truck accident caused a traumatic brain injury. But even if the responses are negative, the list should be returned to at regular intervals to see if brain injury is reactive to your client’s injuries.
— Steve Gursten is a member of the American Association for Justice Traumatic Brian Injury Group and lectures on TBI throughout the country. He was recently invited to become the first Michigan traumatic brain injury lawyer to serve on the legal committee for the Sarah Jane Brain Project. In 2008, Steve received a trial verdict of $5.65 million for a TBI victim; the largest reported auto negligence verdict in Michigan for the year according to Michigan Lawyers Weekly.
Michigan Auto Law exclusively handles car accident, truck accident and motorcycle accident cases throughout the entire state of Michigan. We have offices in Farmington Hills, Detroit, Ann Arbor, Grand Rapids and Sterling Heights. For more information, please refer to our law firm quick facts.