An Open-Minded Approach to Closed-Head* Injury Cases:
A Plaintiff’s Perspective
(*Head= Brain)

June 26, 2008

These materials are intended to provide a good resource for lawyers representing brain injured clients and their families who want to become more knowledgeable about the brain and brain injuries.  Much of this information is available on the Web. Anyone interested in the attachments should contact my office or Consumer Attorneys of San Diego (CASD) to obtain sources and materials.  The information presented by attorney Michael Goldstein at the seminar on the role of neuroimaging is also available through CASD.

In order to effectively represent those suffering brain injuries, particularly “mild” traumatic brain injuries, the lawyer must be knowledgeable about the brain. The brain injury survivor can not be understood without this knowledge. 

These materials are intended largely to provide the lawyer with sources to consider in learning about the brain, how it is injured, and legal proof of that injury. We will only be able to review a fraction of the information in this outline during the seminar, but the material should be of assistance in focusing research about “the silent epidemic of brain injury.”

Topics to be discussed are:

A. Empathy; standing in the shoes of your brain-injured client and family.
B. Do you have a mild traumatic brain injury (mtbi) case?
C. Do you want this mtbi case?
D. How do you prove your mtbi case?


Outline of Presentation

A. Empathy  

B. Do you have a mtbi case?

    1. Overview of the brain-what we’re talking about
    2. Definitions of mtbi
        2.1 Meaning of “mild”
        2.2 Various definitions
        2.3 Sensitivity and specificity
    3. Statistics- lots of cases out there
        3.1 Comparison of annual incidence 
        3.2 CDC and BIAA fact sheets
    4. Types of brain injuries
        4.1 Focal
        4.2 Diffuse axonal injury
        4.3 Other 
    5. Types of Forces
        5.1 Penetrating
        5.2 Contrecoup, whiplash, acceleration-deceleration
        5.3 Blast injuries
        5.4 Other
    6. Consequences of brain injury; symptoms
        6.1 Right or left brain
        6.2 Diffuse brain
        6.3 Cognitive, physical, and emotional
        6.4 BIAA website
    7. Onset
        7.1 Chemical cascade
        7.2 NINDS--process of cell death can be prolonged
    8. Interest in the Brain
        8.1 Magazine articles--Time and National Geographic cover stories
        8.2 Interesting facts
        8.3 Veterans returning from Iraq and Afghanistan
    9. Basic Anatomy
        9.1 Neuroscience tutorial
        9.2 Where to find
        9.3 Coronal and horizontal sections 
        9.4 Limbic system 
        9.5 Univ. of Iowa
        9.6 Interactive brain atlas
        9.7 Other websites

C. Do you want this brain injury case?

    1. Credibility
    2. Liability; Insurance/assets
    3. PCS
        3.1 Persistence of symptoms
    4. Costs; Introduction to multi-disciplinary approach
        4.1 Types of experts

D. How do you prove your mtbi case?

    1. What is “evidence”
    2. Permanence of PCS
        2.1 Miserable minority
    3. Psychological/ malingering defenses
    4. Vulnerable client/ pre-existing conditions
    5. PTSD
    6. Experts and treaters- multi-discipline consistency
    7. Literature and reliable authority
    8. Quality of life
        8.1 CACI 3905A and PCS symptoms
    9. Focus groups
  10. Neuroimaging—Presented at seminar by attorney Mike Goldstein and neuroradiologist Roland Lee, M.D. (Separate materials available through Consumer Attorneys of San Diego.)