Do Cognitive Tests Accurately Measure the Loss Resulting from a Traumatic Brain Injuries?

Many people with TBI have problems with basic cognitive skills: learning, remembering, thinking. It’s more than a mere loss of "intelligence." TBI victims may find it hard to pay attention or concentrate, and they might have trouble learning new material. A TBI can also cause the victim to think more slowly, or to get easily confused. Sometimes these skills are described as “executive functions” because they require a higher level of thinking, such as planning, understanding abstract ideas and conceptualization. People with TBI may become impulsive, or develop unusual habits. Things that were once easy — like talking and listening — may become difficult or impossible.
 

Because the brain regulates our emotional and psychological lives, a TBI can alter a victim’s sense of mental wellness. The TBI might cause a personality change, or introduce mental problems. A person with TBI may have mood swings, depression, irritability, aggression, or disinhibition. 

To assess the extent of the victim’s deficit, a neuropsychological evaluation may be recommended. The person conducting the evaluation interviews the victims and then administers a series of tests. The majority of the tests are pencil and paper standardized tests, meaning that they are given in the same manner to all patients and scored in a similar manner time after time. The tests must be administered by a neuropsychologist or a trained, skilled test administrator. 

The test giver will rarely, however, give a test that was specifically designed for someone who suffered a TBI.  For that reason, the cognitive test scores – alone-- seldom paint the full picture of the TBI victim's deficits

When dealing with a TBI victim, the test administrator should personally observe and evaluate the victim’s behavior during the test.  The test administrator's observations may corroborate the reports of close friends and family members that the victim's behavior has changed as a result of the injury.  In fact, interviews of friends and family are critical sources information concerning the loss the TBI victim has suffered.  

Regardless, cognitive testing is not designed to evaluate all behavioral changes that may result from a TBI.   Cognitive test results cannot be relied on as a sole measure of the TBI victim's loss.
 

Proving Mild Traumatic Brain Injury

Most victims of a Mild Traumatic Brain Injury recover fully within one year of their injury. But, sometimes, victims can be left with long-term cognitive problems that affect both their jobs and MRI - Braintheir family lives for years to come.  Despite the potentially devastating effects of a mild brain trauma -- also known as a " concussion " -- the injury seldom appears on X-Rays, CT scans, or other common imaging techniques.  Without such objective proof, the wrongdoer who caused the injury invariably argues that its victim suffered no brain injury at all, and that the victim is simply making up his symptoms.

One sure way to prove that a victim suffered a brain injury is to prove that the accident caused the victim to lose consciousness, or "black out."  Though an accident victim can suffer a brain injury even without losing consciousness, doctors agree that if an accident causes a victim to lose consciousness, however briefly, brain injury has always resulted. Unfortunately, many victims who black out never realize it, and so insist to paramedics or doctors at the hospital that they did not. Therefore, the first challenge for a lawyer representing the victim of a Mild Traumatic Brain Injury is proving that the brain injury even exits.

Brain specialists can help. A neurologist can conduct sophisticated tests, such as PET scans and SPECT studies.   These studies may show an impairment in brain functioning that doesn't appear on an MRI.  A neuropsychologist can administer objective tests of memory, attention, problem-solving, sensory perception, planning, organization, and other cognitive functioning. The results of such testing can sometimes prove that the accident victim, does, in fact, suffer from a brain injury.

When confronted with proof -- from either cognitive test results or PET/SPECT studies -- that there is a brain injury, wrongdoers argue that the victim's symptoms are attributable to a previous accident and not the one that they caused.  And, in fact, many of those who suffer long term effects from a Mild Traumatic Brain Injury have a prior concussion in their medical history.  However, research shows that one concussion -- even if it caused the victim no lasting symptoms -- leaves the victim at risk of permanent symptoms should he receive another concussion.   That is why professional football players retire after receiving multiple concussions despite "feeling fine", and why boxers who don't retire eventually become "punch drunk."

To prove that the victim had fully recovered from the prior injury, and that it was the most recent concussion that caused the symptoms, it can be helpful for family, friends, and employers to testify.  These witnesses can frequently establish that the victim exhibited no changes in his behavior, mood, or cognitive abilities until after the most recent injury.
 

Coup Contrecoup Brain Injuries

An impact on one side of the head can cause the pudding-like substance of the brain to hit the inside of the skull and then bounce back and hit the inside of the skull on the opposite side of the head.  When the brain suffers two injuries from one impact, it is called a “coup contrecoup,” or “coup contra coup” injury. Sometimes, the secondary (contrecoup) injury is more damaging than the primary (coup) injury. To complicate things, internal bleeding and swelling from the primary injury can mask the brain damage caused by the secondary injury.  One of my clients went weeks before sophisticated imaging of his brain and neuroevaluations showed that his cognitive problems were almost all due to a “contrecoup injury,” rather than the more obvious “coup” injury.