Methods to Determine TBI

Interviewing Friends, Family, and Colleagues at Work

Because busy doctors and diagnostic studies can easily miss the signs of Traumatic Brain Injury, the neurologists and rehabilitation physicians with whom we have worked over the years have taught us that often the most powerful way to determine or rule out TBI is to ask our clients’ loved ones whether they have noticed a difference in our clients before and after their traumatic injuries. Even as experienced traumatic brain injury lawyers, we generally meet our clients for the first time only after they were injured. We therefore need to rely on others who knew the client before the accident to comment on the client’s before and after behavior. We will often ask our clients who present with potential traumatic brain injuries to talk to their family, spouses, workmates, partners, or close friends to see if they notice differences in you before and after your accident. Such histories can often make the difference between a small recovery and a larger monetary recover that is appropriate for this type of injury.

These are never easy conversations to have for us, for the client, and for the loved ones involved. But getting through these challenging explorations and helping our clients get to the bottom of whether or not that TBI may be part of the reason that you are not feeling yourself ever since your accident can make all the difference. It can help you get the economic recovery you need in the event your ability to support yourself and your family and enjoy the simple pleasures of life may have been impacted by TBI in ways your physicians may not have immediately identified.

One of our cases provides a perfect example of why the interview of loved ones and workmates is so crucial to the process of making sure that your case is not resolved without fully understanding to what degree, if any, problems you are having may be at least partially explained by the fact that you have suffered a traumatic brain injury. In this case, our client fell off his bicycle and struck his head on the street, shattering his helmet. There was minimal or no demonstrated loss of consciousness at the scene. His friend with whom he was riding came back to him immediately and he was talking. Despite a long stay in the ICU for a number of bone fractures and other trauma, the CT scan taken in the hospital was negative for any inter-cranial bleeding (bleeding inside the skull).

The client was understandably traumatized by the horrible accident and the effort that surgeries and medical appointments required. He had some minor concerns about some changes he noticed at work, but he did not seek any medical treatment or psychological care or counseling for these concerns. We encouraged the client to obtain neuropsychological evaluation, which his medical insurance covered. The testing came back positive for mild traumatic brain injury in some of the testing results but did not identify dramatic weaknesses below the average performance across the population. The testing was shared with the defendant in the case. We mediated the case but were unable to get close to an agreement. We felt the defendant was simply not valuing the potential that our client suffered a traumatic brain injury that might affect his life going forward.

After the first mediation, we persuaded the client to let us speak to a person who had supervised him at his job he held after the accident, but who was no longer with the company. The client was understandably reluctant. However, talking to a former supervisor who was no longer with the client’s employer minimized the chances that interviewing the supervisor would cause negative effects at the client’s current workplace. When Carter Zinn had a long, thoughtful conversation with the former supervisor, the supervisor in fact reported substantial patterns in the client’s performance in certain detailed aspects of his job requirements that he felt could only be explained by trauma suffered in the accident. We had the supervisor write a short, two-page letter about his impressions and shared this letter with opposing counsel after an initial attempt to mediate the case was unsuccessful. Shortly after this letter was shared, we mediated again. This time the case ended up settling for more than a $1 million more than the defendant had considered offering prior to receiving the letter from the former supervisor.

Evaluation by a Neuropsychologist

Depending on our clients’ symptoms and recovery pace from their TBI, it often makes sense for them to be evaluated by a trained neuropsychologist. Neuropsychologists study and test the structure and function of the brain as they relate to specific psychological processes and behaviors. A skilled neuropsychologist testing for potential TBI will take a thorough psychological and medical history and will also administer a number of tests that are geared to detecting changes in cognitive performance and memory that could be related to injury to the brain, as opposed to other factors. The process can take most of the day or be spread out over several days.

Through our years of experience in representing clients who have suffered traumatic brain injuries in lawsuits, we have found that not all neuropsychologists in the San Francisco Bay Area are created equal. If you are considering obtaining neuropsychological evaluation of your potential traumatic brain injury, it is a good idea to consult with an attorney experienced in representing clients with TBIs. You do not want to make the mistake we have seen many of our clients make over the years prior to contacting us: namely of being evaluated by an inexperienced neuropsychologist who may not be highly skilled in administering the testing or interpreting the scoring and who may issue a report that missed subtle signs of injury in your testing performance that becomes part of your medical records the defense can obtain through subpoena. The Zinn Law Firm has contacts with highly skilled, objective neuropsychologists who are willing to testify and be retained by both the injured person and the defendant and who will test accurately.

Specialized Magnetic Resonance Imaging (MRI) Studies

Most trauma centers that suspect potential TBI will first order computed tomography (CT) scans of the brain to see if any gross bleeding or swelling of the brain is present. However, we have had a number of cases where CT scans of the brain have come back completely negative (i.e., showing no sign of injury) in which our clients have gone on to suffer serious TBI symptoms. In cases like this, our clients’ physicians will often order a magnetic resonance imaging (MRI) brain study to try to find more subtle damage to the brain that a CT scan on its own is incapable of detecting. There are a number of specific types of protocols the neuroradiologist performing the brain MRI should be sure to run to make sure that the chances of detecting more subtle tissue injury are maximized.

These imaging techniques include: techniques to understand brain structure (High-Resolution Structural MR Imaging) and tissue architecture (Diffusion Tensor Imaging), techniques to understand regional blood flow (Dynamic Susceptibility Contrast MR Imaging, Arterial Spin Labeling, Single Photon Emission Tomography), techniques to evaluate microhemorrhages (Susceptibility-Weighted Imaging), and, finally, techniques used as indirect measures of neuronal activation (Functional MR Imaging) and brain metabolism (Positron-Emission Tomography, MR Spectroscopy).

Some of these techniques are widely accepted for use in TBI litigation. Some of the other techniques, such as Diffusion Tensor Imaging, are still considered by some medical professionals to still be in the research stage and not repeatable nor reliable tests upon which to base forensic testimony in a personal injury case. The important point is, if you believe you have suffered a traumatic brain injury due to an bicycle accident, automobile accident or some other injury that was not your fault, you need to hire an attorney that understands how to guide you to obtaining the most reliable, accurate methods of proving this injury. Proving Traumatic Brain Injury is not as simple as proving a broken arm or leg.

If you have suffered a TBI due to an accident that was not your fault, please consider contacting The Zinn Law Firm. Our attorneys have the knowledge and experience to determine if indeed you do have a TBI, and if so, to obtain full, fair value for the harms and losses you have suffered as a result. We are here to help.