Traumatic Brain Injury & Severe Chronic Pain

Traumatic Brain Injury Information


Surprising as it may be, despite the fact that Traumatic Brain Injury (TBI) (including concussions) can have a catastrophic impact on one’s life, the options for treating this injury are shockingly meager. Brain injury may require intensive neurocognitive rehabilitation. Yet, such rehabilitation can be both hard to find, and difficult to fund. Costs can be prohibitive. Financial recoveries from litigation can be a crucial funding source.

Neurocognitive rehabilitation includes the patient working with a neuropsychologist and/or coordinating with a cognitive therapist to target brain functions impacted by trauma. This work will typically involve progressively challenging mental tasks and exercises. Its positive results come from leveraging the brain’s capacity for regrowth, principally supporting the generation of new brain communication pathways. Since brain function is largely governed by networks that enable communication among the brain’s approximately 86 billion brain cells, these new pathways may help restore the brain functions compromised by traumatically injured pathways.

Neurorehabilitation also has an adaptive goal. This will typically include training in the use of various memory and organizational aids, since short-term memory and organization are frequent causalities of TBI. This work can also involve developing new approaches for the patient to perform activities of daily living, and if the patient is capable of resuming work, new approaches for performing their job.

Rehabilitation can also involve computer based neurofeedback. This modality utilizes patient specific protocols to enhance the brain’s electrical function in damaged regions. Preliminary diagnostic workup includes brain mapping of the brain’s electrical activity to identify which brain areas should be targeted for this rehabilitative challenge.


What is traumatic brain injury (TBI)?

TBI refers to harms to the brain of varying severities. TBI is divided into three main classifications: mild, moderate or severe. A mild TBI can have minimal or no loss of consciousness. A moderate TBI can involve a loss of consciousness for a longer time. A severe TBI involves a more extended disruption of consciousness.

However, one can have severe, disabling and lifelong impairments in brain function without any loss of consciousness. Therefore, even if a brain injury is classified as “mild,” it doesn’t mean that its consequences are mild. These classifications only refer to how the person seems right after the trauma; not how they end up.

Because the brain controls so many functions, among these three TBI classifications, there are unlimited variations of TBI. Just like every person is unique, although TBIs can have many common features, each TBI is distinct in terms of the brain and personality changes it causes.

What causes TBI?

As the brain is approximately 2 1/2 pounds with a consistency similar to jello, it is fragile and thus quite vulnerable to injury. Because of its fragility, brain injury does not even require damage to the head. For instance, many TBIs occur just from whiplash. As a consequence of the neck being thrust back and forth at an accelerated speed such as from a rear or front end collision, the brain can be shaken inside the skull and injured in many ways. If there is enough force to sprain or strain the neck, there is more than enough force to cause a brain injury.

What is a concussion? And how does it relate to TBI? Are the words interchangeable?

Concussion refers to an insult to the brain which is associated with a variety of early signs or symptoms. They can include: headaches, dizziness, double vision, nausea, vomiting, ringing in the ears. All do not have to be present for a concussion to be diagnosed. Some of these symptoms may emerge days after the trauma. In the weeks and sometimes months following a concussion, a person can notice additional issues such as memory difficulties, irritability, insomnia,fatigue and increased sleepiness, struggles with attention and concentration, slower thinking, word finding problems, and many other things.

Every concussion is a TBI. But not every TBI is a concussion. Concussion is interchangeable with the classification “mild TBI.” However, as stated above, the classification refers to how a person is right after the trauma, not to its consequences. While for many people concussion symptoms resolve, the older you are or the more concussions or other brain injuries that you have previously, the greater the potential for enduring brain problems.

What should one do if they have TBI? How should it be treated?

Treatment can depend on the severity of the brain injury. Moderate and severe TBIs typically require intensive medical attention and long-term cognitive and psychotherapies. For concussion/mild TBI, if it does not resolve on its own over time, cognitive therapy or neurofeedback therapies can be quite beneficial in supporting recovery of function. Cognitive therapy involves exercises and tasks for improving mental performance and or developing strategies for adapting to impairments in mental function. Neurofeedback involves computer based challenges for enhancing the brain’s electrical functioning that often produce corresponding improvements in mental performance.

If TBI is not diagnosed early, what are the repercussions?

It depends on the nature of the brain injury. For mild TBI, diagnosis is frequently delayed as trauma victims and their physicians are usually more focused on accompanying physical injuries and pain. But a delay in diagnosing TBI can result in confusion. The injured person and family members may wonder why the injured person’s personality has changed or mental abilities have suddenly declined.

Does TBI get worse over time?

Depending on the severity and nature of the injury, many TBIs resolve with limited loss of function. However, others can have delayed adverse consequences that take years or decades to emerge.

What are the longer term consequences of TBI?

Consequences of TBI can include a decline in the quality of a person’s thinking and changes in their ability to function in ways they were before. For many TBI victims, although they may look and sound the same, their inner self has significantly changed. It can make life very challenging and even overwhelming. To no longer have the capabilities that you have always known and have been part of you can make life very difficult to cope with. It can also cause great confusion and frustration for loved ones, when you seem the same from the outside, yet act so differently from the ways they once knew you to be before.

How can a lawyer knowledgeable about TBI help a TBI victim?

If the TBI is caused by the negligence of another party, a lawyer can represent the victim in a lawsuit. In the process, a lawyer can help the client understand the full nature of their condition and obtain monetary compensation for the various life losses causes by the injury. Losses can include earnings, medical bills, costs of future help and care, as well as compensation for past and future pain and suffering and loss of enjoyment of life. Because many physicians are not that well trained in TBI, lawyers can help refer their clients to testing and evaluations that their physicians might not ordinarily refer them to.

What is important in managing the case as a TBI lawyer?

A TBI lawyer should ensure that their clients have had evaluations by proper professionals that investigate the brain insult in depth. Such evaluations will typically exceed what physicians may order for diagnosis of TBI.

Lawyers must understand that they are representing four different people. Who the client was before; who the client is now; who that client would have been; and who that client is going to become and the challenges that they face in the future. It is particularly important for lawyers to understand how their clients will cope with the brain injury in their future because if there are not adequate financial resources to cope with the hardships that TBI can bring as a person ages, the future life challenges inflicted by the TBI can be horrible.

Why is neuroscience important in evaluating TBI cases?

From a medical standpoint, physicians are trained to diagnose and offer treatment. For example, a physician can diagnose a concussion. But a concussion can have many different consequences. Neuroscience has various ways of investigating those consequences in ways that do not alter the doctor’s diagnosis but can potentially give a lot more insight into how the brain has been affected by that diagnosis. Thus, a law firm that has neuroscience experience and expertise can represent a TBI victim in a much stronger way: first, by ensuring that the dimensions of the injury are investigated in much greater depth than is typically done at the doctor’s office; and importantly second, obtaining more reliable evidence of the TBI injury.