Traumatic Brain Injury Epidemic and the Role of the Neuropsychologist
Over the past few years, traumatic brain injury (TBI) have become a hot topic. It seems like no matter where you turn, the issue is being discussed. The medical issues it creates, the legal problems that are rising for those who have been negligent and even research from the medical field is all converging into a conversation that seems inescapable. Part of the reason stems from the attention that billion-dollar-companies like the NFL are getting, but another reason the topic is so controversial is because of the sheer statistics that have recently come to light. The widespread epidemic of traumatic brain injuries needs more awareness so that those who are suffering are not doing so without the support of the medical and legal community.
The Statistics on TBI
At least 10 million TBIs serious enough to result in death or hospitalization occur annually.
An estimated 57 million people worldwide have been hospitalized with one or more TBIs.
The amount of those 57 million that are living with a TBI-related disability is not even known.
In the US, 1.4 million TBIs occur each year. Of those:
- 1.1 million go to the ER
- 235,000 are hospitalized
- and 50,000 die
These numbers actually underestimate the true burden of TBIs on our country and around the world, as they do not consider:
- The estimated 200,000 Americans treated for TBI each year in outpatient facilities (i.e. doctor’s office)
- TBIs treated in US military facilities worldwide, which is thought to be a large number
- Undiagnosed and misdiagnosed TBIs, which could be the largest number of them all. 
Causes of TBI
The leading causes of TBIs are falls, events in which someone is struck with something accidently, assaults, and motor vehicle crashes. In fact, vehicle collisions are the second most common cause.
Sports is also a very common cause of TBIs, as the nature of physical contact and rough play lends itself towards the head coming in contact with something forcefully.
According to the CDC, there are 300,000 sports-related TBIs each year, but this only counts those with a loss of consciousness, which in turn, is thought to only be between 8% and 12% of TBIs. This means a more accurate estimate would be 1.6 million to 3.8 million sports-related TBIs each year. Still, unrecognized and unreported cases may inflate this figure dramatically .
Underreporting of TBIs
TBIs were once believed to affect only those with a long history of repeated head injuries or only those who lost consciousness as a result of the impact. However, we have since learned that TBIs are much more common and pose much more serious risks, even if the situation is relatively mild.
After a 21-year-old football player from the University of Pennsylvania unexpectedly committed suicide, an autopsy revealed that he had early-stage symptoms of Chronic Traumatic Encephalopathy. CTE is a condition that was formerly believed to exist primarily among boxers, however, it is known today that it can affect any victim of TBI. It is a progressive degenerative disease which afflicts the brain of people who have suffered repeated concussions and traumatic brain injuries, such as athletes who take part in contact sports.
The young football player was never even diagnosed with a concussion after his injury, speaking to the most problematic issues concerning treatment for TBI—willingness to report.
Not only is there an issue of failure to recognize the signs and symptoms of TBI, both in young athletes and adults alike, there is also an unwillingness to report for fear of losing game time or reputation.
A study found that over half of high school football players admitted to experiencing concussion symptoms and did not report it to a coach or parent.
A similar study found that concussions among youth ice hockey players in Canada occur 30 times more often than what is officially reported. If that number even begins to represent the problems we may have in America with sports and underreporting of TBIs, we have a major issue on our hands (as is suspected) .
Both athletics and the military have a culture of toughness and perseverance. For these organizations to reward a “shake it off” –like behavior, is to discourage the reporting of an injury. Compounding the issue is the lack of outward symptoms from a TBI. It is much easier to recognize that someone with a broken arm should sit out the game than it is to see that someone’s brain is damaged after a “routine” impact.
The number of missed TBIs is a concern that is being aggressively addressed by doctors and researchers worldwide. Although it is clear that most TBI patients suffer at least some acute cognitive difficulties, the nature and course of TBI cognitive recovery remain an area of intense controversy. Some cases involving mild TBI recovered completely within the first three months, while others continue to report distressing symptoms for months or years post-injury. Frequently the complaints involve a constellation of physical, emotional, and cognitive symptoms collectively known as post-concussion syndrome (PCS). Experts continue to argue over whether PCS is over–diagnosed or underdiagnosed, but it is clear that proper diagnosis requires more than just objective diagnostic testing.
Neuropsychology and TBI Diagnosis
A neuropsychologist is a psychologist who specializes in understanding the relationship between the physical brain and behavior. The brain is complex. Disorders of the brain and nervous system can alter behavior and cognitive function .
Diagnosis is where a neuropsychologist’s work in a TBI case begins. Objective evidence of cognitive impairment is part of the Diagnostic and Statistical Manual-4th Edition (DSM-IV) criteria for diagnosing post-concussion syndrome. Therefore, documenting neuropsychological deficits is an important tool used to help establish the validity of symptom complaints, particularly in the medical-legal arena.
Neuropsychologists are trained to observe, assess, and recognize the relationship between the anatomy and physiology of the human brain and a person’s behavior. These experts can help clarify and organize the clinical observations made by a physician and objective testing, like MRI and CT scans. Such clarification is critical in determining whether an injured person has TBI and the severity of said injury.
It is important to note that not all Traumatic Brain Injuries are created equally. Most physicians consider a concussion to be a mild traumatic brain injury or mTBI. However, the severity of symptoms varies considerably, even in mild cases of TBI such as concussions. Many believe that loss of consciousness is required in order to diagnose a concussion. In reality, a concussion may cause a loss of or change in consciousness, posttraumatic amnesia, or all of the above. Some victims recover within a number of weeks showing minimal effects; others experience debilitating symptoms that persist for years. It should also be noted that as the number of TBIs experienced over a lifetime increases, both the short-term symptoms and the increase. Neuropsychologists know how to recognize each of the signs of TBI and use said symptoms, along with objective testing, to diagnose and create treatment plans for victims.
Ultimately, any person who suffers a head injury should consult with several doctors to ensure that all of the symptoms are documented. The role of the neuropsychologist in such cases is to assist in diagnosis through the recognition and documentation of behavioral and psychological changes. Injuries that are not obvious to the naked eye are substantially more difficult for juries to comprehend. This makes the neuropsychologist’s role absolutely critical when a TBI victim is attempting to recover damages for his or her injuries through a lawsuit.
If you, or someone you love, has suffered a brain injury as a result of someone else’s negligence, don’t go at it alone. Contact an experienced personal injury attorney to help protect your legal rights. We will be sure to use our extensive resources of neuropsychologists to help substantiate your injury and symptoms. Dolman Law Group is always here for you in the event of a catastrophic injury. If you have questions about your rights, please contact us at 727-451-6900.
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