Sacramento Brain Injury Attorneys
Head and Brain Injuries

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Brain And Head Injuries

Mild Traumatic Brain Injury (MTBI) is characterized by one or more of the following symptoms: a brief loss of consciousness, loss of memory immediately before or after the injury, any alteration in mental state at the time of the accident, or focal neurological deficits. Due to the complexity of our brains, every brain injury is different. Depending on the severity of the injury, some symptoms may appear right away, while others may not show up for days or weeks. Sometimes the injury makes it hard for people to recognize or to admit that they are having problems. Signs of a concussion can be very subtle and early on problems can be missed by doctors and loved ones. Some people suffer long-term effects of MTBI, known as post-concussion syndrome (PCS). Persons suffering from PCS can experience significant changes in cognition and personality.

Below is a diagnostic protocol for Mild Traumatic Brain Injury (or closed head injury) developed by The Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine from the Journal of Head Trauma Rehabilitation (8) 3, 86-87.

Definition:

A patient with mild traumatic brain injury is a person who has had a traumatically induced physiological disruption of brain function as manifested by at least one of the following:

1. any period of loss of consciousness;
2. any loss of memory for events immediately before or after the accident;
3. any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused);
4. focal neurological deficit(s) that may or may not be transient but where the severity of the injury does not exceed the following:
   1. loss of consciousness of approximately 30 minutes or less;
   2. after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15; and
   3. posttraumatic amnesia (PTA) not greater than 24 hours.

General:

• Determine whether or not consciousness was lost.
• Determine duration of unconsciousness.
• Determine whether or not there was an alteration of consciousness.
• Determine duration of altered consciousness.
• Characterize, in detail, the specifics of how the injury occurred.
• Determine the history of previous head injury or concussion by interview with the patient and family.
• Determine previous alcohol use.
• Determine previous substance use.
• Determine previous vocational pursuits, positions, and durations.
• Determine previous leisure pursuits, to include hobbies, athletics, and other recreational pursuits.
• Determine and, if possible, obtain academic record and rule out pre-existence of attention deficit disorder or learning disabilities.
• Determine social/legal history.

Medical:

• Determine current sleep patterns -- time to bed, time to sleep, times awake, activities during wakefulness, rise time, and restedness upon awakening.
• Determine dietary habits.
• Determine exercise routine.
• Determine caffeine usage and chronicle any changes since injury.
• Determine past medical history.
• Determine family medical history.
• Determine past medications.
• Determine current medication; chronicle changes in medications.
• Correlate symptomatology with medications and side effects. Determine use of over-the-counter medications/vitamins/supplements.
• Review EEG's.
• Review CT scans of the head.
• Review skull x-rays.
• Review cervical x-rays, CT's, and MRI's.
• Review headache history. Characterize headaches to differentiate for sinusitis, tension, TMJ dysfunction, medication/substance withdrawal, migraine. Headaches should be fully characterized and described.
• Characterize and describe all visual complaints. Differentiate blurred vision from diplopia. Evaluate visual fields and ocular motor skills. Determine presence of photophobia, image suppression, image persistence.
• Characterize and describe all pain complaints as well as past/current treatments for same.
• Characterize complaints of dizziness, imbalance, and dyscoordination.
• Evaluate balance by single-foot standing, Romberg, star-march.
• Evaluate history of balance in low-light conditions.
• Evaluate for perilymphatic fistula, cupulolithiasis, and cervical dizziness.
• Evaluate cardiac status and serum glucose levels as possibly contributory to dizziness.
• The term "concussion" should be avoided and replaced with the term "mild traumatic brain injury" (MTBI) (American Congress of Rehabilitation Medicine, 1992[3]).
• Review ENG's.

ADL (Activities of Daily Living):

• Characterize the individual's daily routine.

Vocational:

• Fully describe the individual's vocational history.
• Fully describe the individual's current job description. Include whether or not the work is full-time, part-time, and seasonal.
• Determine the presence or absence of a supplemental disability insurance income.
• Determine workers' compensation TD payment level.
• Determine presence of salary continuation agreement.
• Determine status vs. wage loss compensation.

Psychosocial:

• Evaluate for anxiety, depression, panic attacks, somatization, hypochondriasis, malingering.
• Evaluate for issues of secondary gain.
• Evaluate for family system adaptation/adjustment.
• Differentiate psychiatric symptoms from iatrogenic or seizure-induced symptoms.

Physical Therapy:

• Evaluate for overall fitness and conditioning, muscular strength, range of motion, sensation, proprioception.
• Characterize pain complaints.
• Balance/coordination diagnostics.

Testing:

Tests to be considered: MMPI-II, Beck's Depression Inventory, Taylor-Johnson Temperament Analysis, FIRO-B, Woodcock-Johnson Psychoeducational Battery, Detroit Tests of Learning Aptitudes, Booklet Category Test, Wisconsin Card Sort, Trails-A, B Neuropsychological Battery, Wide Range Achievement Test, Motor Free Visual Perception Test, Test of Visual Perception Skills, and the Santa Clara Valley Perceptual Motor Evaluation. Copyright 1992, Centre for Neuro Skills

Click here for CDC's Brain Injury Fact Sheet >>

For more information on brain injuries, click here to visit the CDC's Website or click here to visit the Brain Injury Association Website.

How Can You Prevent A Traumatic Brain Injury?

1. Wear a seatbelt ! - A person not wearing their seatbelt is 8.4 times more likely to sustain a traumatic brain injury with loss of consciousness in a car wreck. The average hospital bill for an unbelted person in an auto accident is $2,400; for the individual wearing a seatbelt it is $753. Hospital stays following an auto accident are 2.6 times longer for unbelted people.
2. Don't mix alcohol and driving - 50% of motor vehicle crash fatalities involve alcohol. 37% of fatally injured drivers were intoxicated at the time of their crash.
3. Wear a helmet when you're bicycling or riding a motorcycle - A properly fitted helmet reduces the risk by 85% from having a head injury if you happen to fall off of your bike.

According to a national study, 64% of brain injuries occur from motor vehicle accidents. Brain injury victims face medical bills, loss of wages, physical pain, emotional distress and loss of enjoyment of life. If injuries are severe or permanent, families suffer economic loss, mental anguish and the loss of companionship in caring for an injured family member. In the event of death, families are torn apart without any warning.

Regardless of whether fault has been established for an accident or not, all involved parties should immediately consult with an attorney. It is important to know what to do to protect the legal rights of yourself and your loved ones. Time is of the essence in serious injury cases because physical evidence may be destroyed or lost, witnesses' memories may fade, and recovery of out of pocket expenses can be delayed.

Selecting the right attorney is an important decision. You should choose someone who is experienced, aggressive and dedicated to working to get fair compensation for your injuries. That is why you should contact The Law Offices of Frederick J. Sette. We have successfully represented thousands of accident and injury victims over the past decade.

IF YOU OR A LOVED ONE HAS BEEN INJURED IN AN ACCIDENT,
IT IS IMPORTANT TO PROTECT YOUR LEGAL RIGHTS.

PLEASE CALL US TOLL- FREE AT 1-888-516-6262
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