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Traumatic Brain Injury

Frequently Asked Qustions

What is a traumatic brain injury (TBI)?

What types of cognitive and communication problems can result from TBI?

How is TBI detected?

Is TBI always properly diagnosed?

How is a TBI treated?

How prevalent are TBIs?

Do I have any legal rights for my traumatic brain injury?


What is a traumatic brain injury (TBI)?

A traumatic brain injury is sudden physical damage to the brain resulting from the head forcefully hitting an object. The major causes of traumatic brain injuries are from motor vehicle accidents. Other causes include falls, sports injuries, violent crimes, and child abuse.

Physical, behavioral, or mental changes are dependent upon which areas of the brain are injured. Most often focal brain damage is done, which is damage confined to just a small area of the brain usually where the head has hit an object. Closed head injuries often times causes scattered brain injuries or damage to other areas of the brain. Diffuse damage is the result of an impact causing the brain to move back and forth against the skull.

Frontal and temporal lobes, responsible for speech and language, are often the most affected because they sit in the areas of the skull that allows more room for the brain to shift and sustain injury. Speech and language is therefore affected, as well as voice, swallowing, walking, balancing, and coordination difficulties and changes in the ability to smell and in memory and cognitive skills.

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What types of cognitive and communication problems can result from TBI?
Cognitive and communication problems that result from traumatic brain injury vary from person to person, dependent on many factors, which include an individual's personality, pre-injury abilities, and the severity of the brain damage.

The traumatic brain injury effects are generally greatest immediately following the injury. However, some effects from traumatic brain injury may be misleading. The newly injured brain often suffers temporary damage from swelling and a form of "bruising" called contusions. These types of damage are usually not permanent and the functions of those areas of the brain return once the swelling or bruising goes away. Therefore, it is difficult to predict accurately the extent of long-term problems in the first weeks following traumatic brain injury.

Focal damage, however, may result in long-term, permanent difficulties. Improvements can occur as other areas of the brain learn to take over the function of the damaged areas. Children's brains are much more capable of this flexibility than are the brains of adults. For this reason, children who suffer brain trauma might progress better than adults with similar damage.

In moderate to severe injuries, the swelling may cause pressure on a lower part of the brain called the brainstem, which controls consciousness or wakefulness. Many individuals who suffer these types of injuries are in an unconscious state called a coma. A person in a coma may be completely unresponsive to any type of stimulation such as loud noises, pain, or smells. Others may move, make noise, or respond to pain but be unaware of their surroundings. These people are unable to communicate. Some people recover from a coma, becoming alert and able to communicate.

In conscious individuals, cognitive impairments often include having problems concentrating for varying periods of time, having trouble organizing thoughts, and becoming easily confused or forgetful. Some individuals will experience difficulty learning new information. Still others will be unable to interpret the actions of others and therefore have great problems in social situations. For these individuals, what they say or what they do is often inappropriate for the situation. Many will experience difficulty solving problems, making decisions, and planning. Judgment is often affected.

Language problems also vary. Problems often include word-finding difficulty, poor sentence formation, and lengthy and often faulty descriptions or explanations. These are to cover for a lack of understanding or inability to think of a word. Many have difficulty understanding multiple meanings in jokes, sarcasm, and adages or figurative expressions. Individuals with traumatic brain injuries are often unaware of their errors and can become frustrated or angry and place the blame for communication difficulties on the person to whom they are speaking. Reading and writing abilities are often worse than those for speaking and understanding spoken words. Simple and complex mathematical abilities are often affected.

The speech produced by a person who has traumatic brain injury may be slow, slurred, and difficult or impossible to understand if the areas of the brain that control the muscles of the speech mechanism are damaged. This type of speech problem is called dysarthria. These individuals may also experience problems swallowing. This is called dysphagia. Others may have what is called apraxia of speech, a condition in which strength and coordination of the speech muscles are unimpaired but the individual experiences difficulty saying words correctly in a consistent way.

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How is TBI detected?
The assessment of cognitive and communication problems is a continual, ongoing process that involves a number of professionals. Immediately following the injury, a neurologist or another physician may conduct an informal, bedside evaluation of attention, memory, and the ability to understand and speak. Once the person's physical condition has stabilized, a speech-language pathologist may evaluate cognitive and communication skills, and a neuropsychologist may evaluate other cognitive and behavioral abilities. Occupational therapists also assess cognitive skills related to the individual's ability to perform "activities of daily living" (ADL) such as dressing or preparing meals. An audiologist should assess hearing. All assessments continue at frequent intervals during the rehabilitative process so that progress can be documented and treatment plans updated. The rehabilitative process may last for several months to a year.

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Is TBI always properly diagnosed?
Some TBI cases are difficult to detect because even a CT scan can show proper brain functioning when there is in fact brain damage. Brain damage is not just a result of unconsciousness, and headaches and mood swings are both symptoms that can come from a closed head injury. Some symptoms may not appear until much after the injury. Often times neurologist reserve their time for only serious head injuries and a regular physician may not catch a problem in a routine office visit.

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How is a TBI treated?
It is best to begin treatment early when cognitive and communication problems arise from a TBI. If a hospital visit resulted from the injury treatment usually begins there. A therapist will work with the individual to help them focus on improving their orientation to the surrounding situation and to stimulate speech and understanding. Oral motor exercises are used when there is speech and swallowing problems. Long-term rehab can be assessed by the individual’s injuries and needs. There is rehab specific to people with traumatic brain injury, including speech language pathologists, physical therapists, occupational therapists, and neuropsychologists.

Rehab will help a TBI sufferer reach the highest level of independent functioning that they can, depending on the seriousness of the accident. Therapy works on restoring lost skills. Some people lose abilities after a traumatic brain injury and will have to learn to compensate for them. The most difficult part of traumatic brain injury is receiving the proper treatment. If a head injury does not result in a hospitalization and the injury is a closed head injury, failure to diagnose a problem during an office visit may result.

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How prevalent are TBIs?
Every 15 seconds someone in the U.S. sustains a traumatic brain injury according to the Brain Injury Association. The traumatic brain injuries leave about 80,000 Americans with long-term disabilities every year, causing permanent cognitive and emotional problems. There are currently an estimated 5.3 million Americans suffering from disabilities because of a traumatic brain injury.

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Do I have any legal rights for my traumatic brain injury?
Traumatic brain injury patients face large medical, legal and financial issues. Some TBI sufferers may appear unharmed, especially with a closed head injury, but may need physical, cognitive, and emotional treatment. The Brain Injury Association estimates hospital and fatal injury costs relating to traumatic brain injuries in the U.S. exceed $48 billion. If you have questions regarding a traumatic brain injury that you, or a family member, have suffered from, please contact us.

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