The Schmidt Law Firm, Minneapolis Injury Lawyers, has over 40 years experience in bringing justice to the victims of personal injury and wrongful death, with special expertise in handling cases of brain injury resulting from car accidents, workplace accidents, construction site accidents, industrial accidents, farm accidents and sports injuries.
Douglas E. Schmidt, the senior attorney at the Schmidt Law Firm, has special experience in handling cases involving both mild and moderate to severe traumatic brain injuries. Schmidt has lectured to health care providers and lawyers on the subject of head injuries, traumatic brain injuries and post-concussion syndrome.
Mild Brain Injuries Are Not a “Mild” Problem!
Doug Schmidt says this-
“There is no such thing as a mild traumatic brain injury. The medical literature says that mild traumatic brain injuries are a significant problem and one that is often overlooked.”
It is important that the lawyer who represents the victim of a traumatic brain injury understand the long-term consequences of even a mild traumatic brain injury.
Traumatic Brain Injuries from Sports Activities.
Minnesota people have recently become acutely aware of the serious and long-term consequences of a closed-head injury, ie. Mild traumatic brain injury. Minnesota Twins baseball player Justin Morneau recently was out of commission for nearly 8 months due to a minor impact sliding into second base due to post concussion syndrome.. Another Minnesota Twins player Denard Span has been out of commission for a closed head injury. Several Minnesota Gophers football players will be required to sit out an entire year of elgibility due to a closed head injury with post-concussion syndrome.
Recently, the problems associated with closed head injuries to youth hockey players has been the subject of much attention, with Dr. Mark Stuart of the Mayo Clinic bringing the subject to public attention.
Douglas Schmidt has been actively involved in youth hockey and certainly understands the problems of concussion injuries resulting from the trauma of youth sports.
Traumatic Brain Injuries Are Often Overlooked by Medical Providers.
Douglas Schmidt says this:
I have been handling car accident cases for 40 years. I have personally witnessed the fact that many people, perhaps close to half of the victims of car accidents, have a closed head injury, a concussion, that has been completely overlooked by the medical community. I consider it an important part of my job as a personal injury lawyer to watch for closed head injuries that have been overlooked by the doctors and get my clients to doctors that know and understand the serious consequences of mild traumatic brain injuries.
Good Information is Available About Mild Traumatic Brain Injuries.
Schmidt recommends that anyone who is seeking information regarding mild traumatic brain injuries start by going online to “Heads Up-Facts for Physicians About Mild Traumatic Brain Injury (MTBI)”, published by US Dept of Health and Human Services, Centers for Disease Control and Evaluation.
Click for a summary of that article:
1. The term “mild traumatic brain injury” (mTBI) is used interchangeably with the term concussion.
2. A concussion (mTBI) is defined as a complex pathalogical – physiologic process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head.
3. an mTBI results in the constellation of physical, cognitive, emotional and/or sleep-related symptoms, and may or may not involve a loss of consciousness (LOC).
4. Individuals with a history of concussion are at increased risk of sustaining a subsequent concussion.
5. Symptoms of deficits that continue beyond three months may be assigned a post- concussion syndrome. Clinical signs and symptoms of mTBI include
-reduced speed of mental processing,
6. The onset and/or recognition of symptoms may occur days or weeks after the initial injury.
7. ACE (acute concussion evaluation) should be considered by physicians for possible concussion among patients with various types of injuries, including motor vehicle crashes.
8. Research indicates that up to 90% of concussions do not involve loss of consciousness. (LOC).
9. Significant symptoms associated with relatively light force might indicate an increased vulnerability to mTBI, especially among patients with history of multiple mTBI’s or pre-existing history of migraine headaches.
Important Facts to Know About Traumatic Brain Injuires.
The Schmidt Law Firm calls the following interesting facts to your attention about traumatic brain injuries:
1. The terms “Concussion” and Mild Traumatic Brain Injury” are synonymous and used interchangeably in the medical literature.
The joint report of the Veterans Administration and Us Department of Defense in its Clinical Practice Guideline, Management of Concussion/Mild Traumatic Brain Injury, April 2009, p.17 states:
The terms concussion and mTBI can be used interchangeably. The use of the term concussion. Her history of mild TBI may be preferred when communicating with the patient, indicating a transient condition, avoiding the use of the terms “brain damage. Close quote or “brain injury”…
2. Total loss of consciousness is not required for there to be a TBI. Partial loss of consciousness is sufficient, i.e. mental confusion or disorientation.
-Mayo Clinic’s website states that mental confusion/disorientation is a sufficient indicator of a concussion, even in the absence of total loss on consciousness:
If a blow to your head has knocked you out or left you dazed, you’ve had a concussion.
-McCrea, J.Athl.Train 2001, Jul-Sept 36(30: 274-279:
…more than 90% of sport-related head injuries result in no observable loss of consciousness (LOC) or amnesia and only slight disorientation.
-Practice Parameter: the management of concussion in sports-Report of the Quality Standards Committee. Neurology. 1997;48:581-585 defines concussion as:
“trauma-induced alteration in mental status with or without LOC.”
-VA-DoD Clinical Practice Guideline, Management of Concussion/Muld Traumatic Brain Injury, April 2009, p. 16 states:
Definition of Traumatic Brain Injury:
A traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs, immediately following the event:
-Any period of loss of or decreased level of consciousness (LOC).
-Any loss of memory for events immediately before or after the injury (post traumatic amnesia – PTA).
-Any alteration of mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.) (alteration of consciousness/mental state – AOC).
-Neurological deficits (weakness, loss of balance, change in vision, fractious, paresis/plegia, sensory loss, aphasia, etc.)that may or may not be transient.
The VA-DoD Guidelines also state, a p. 18:
A diagnosis of M TBI should be made when there is an injury to the head. As a result of blunt trauma, acceleration or deceleration forces or exposure to blast that results in one or more of the following conditions: a. Any period of observed or self-reported: transient confusion, disorientation, or impaired consciousness…
The Kay Report, p.2, states:
It is also possible that significant, long-term deficits can occur in the absence of any documentable loss of consciousness.
3. A forceful blow to the head is not necessary for there to be a Traumatic Brain Injury.
The U.S. Dept of Health and Human Services, Centers for Disease Control and Evaluation publication entitled “Heads Up-Facts for Physicians About Mild Traumatic Brain Injury (MTBI)” states that “research indicates that up to 90% of concussions do not involve LOC.”
The VA/DoD Clinical Practice Guideline clearly states that a blow to the head, or the head striking an object is not necessary, that an acceleration/deceleration (whiplash) trauma is sufficient:
“External forces may include any of the following events: that had been struck by an object, they had striking an object, the brain undergoing an acceleration/deceleration movement without direct external trauma to the head, a foreign body penetrating the brain, forces generated from event such as a blast or an explosion, or other forces yet to be defined.
Kay, Minor Head Injury: An Introduction for Professionals, National Head Injury Foundation, Dec. 1986 (study funded by the US Department of Education, National Institute of Disability and Rehabiliation Research Grant) states:
Minor head injury can also occur after a severe whiplash injury, even if the head is not struck.
4. The presence or absence of a recording of LOC (loss of consciousness) by EMT or Emergency Department personnel is totally irrelevant.
The presence or absence of recording by the EMT personnel or the Emeergency Department personnel is totally irrelevant for at least three different reasons:
A. Simply asking the patient if they were unconscious is the worst possible way to determine whether someone has been “knocked out”. How can a person know that he or she has been unconscious when they were unconscious? By definition, a person that has been unconscious cannot be conscious of the fact that they were unconscious!
B. Further, most lay people do not understand the concept of “partial loss of consciousness” which involves “confusion, disorientation or slowed thinking”. Accordingly, asking someone if they have been unconscious cannot be expected to produce adequate data.
C. The determination of whether a person has suffered dramatic brain injury requires a careful clinical examination of the type that is rarely done in Emergency Departments.
D. Because delayed onset of symptoms of a traumatic brain injury occurs frequently, reliance on the initial assessment is grossly misplaced. (See point 4 below.)
Studies show that less than half (45%) of the Level I Trauma Centers evaluate every patient for mild TBI and 32% of accident victims report symptoms of post-concussion syndrome one month after the injury.
McCrea, id. states:
The effects of concussion on mental status are often difficult to assess on routine clinical examination. * * * …the effects of concussion on mental status are usually more subtle than obvious, often making them difficult to identify and fully characterize on routine clinical examination.
5. The symptoms of TBI frequently has a delayed onset (delayed progressive onset). As a result, many TBIs are simply missed in the initial diagnosis.
The U.S. Dept of Health and Human Services, Centers for Disease Control and Evaluation publication entitled “Heads Up-Facts for Physicians About Mild Traumatic Brain Injury (MTBI)” states :
Significant symptoms associated with relatively light force might indicate an increased vulnerability to M TBI especially among patients with history of multiple M TBI’s or pre-existing history of migraine.
The onset and/or recognition of symptoms may occur days or weeks after the initial injury.
The VA/DoD Clinical Guidelines recognized the following category of mTBI:
1.5 Post Deployment Delayed Awareness and Delayed Reporting of Symptoms.
1.5.2 Delayed Initial Presentation of Symptoms.
The report recognizes a category of “patients with symptoms a develop more than 30 days after a concussion (who and print should have a focus diagnostic workup specific to those symptoms only.”
6. Special attention is required for the medical doctor to take a proper history to determine the existence of a traumatic brain injury.
Simply asking the injury victim if he or she has experienced LOC is totally ineffective in diagnosing the existence of a head injury. (The proper method requires specific questioning regarding the last recollection before the injury and the first recollection after the injury AND specific questioning as to whether the victim has experienced the symptoms of a head injury, i.e. mental confusion, disorientation, headache, blurred/double vision, dizziness, nausea, etc.)
7. The long-term consequences of a traumatic brain injury was significant.
The medical literature confirms the the following long-term consequences of traumatic brain injury;
-Brain injuries in children increase the incidence of ADHD.
-Brain injuries increase the incidence of dementia and Alzheimers.
-The incidence of major depression following traumatic brain injury has been determined to be as high as 25%.
8. The incidence of traumatic brain injury in patients with pre-existing depression is higher and the recovery more difficult.
The U.S. Dept of Health and Human Services, Centers for Disease Control and Evaluation publication entitled “Heads Up-Facts for Physicians About Mild Traumatic Brain Injury (mTBI)” states :
Significant symptoms associated with relatively light force might indicate an increased vulnerability to mTBI especially among patients with history of multiple mTBI’s or pre-existing history of migraine.
9. The onset and/or recognition of symptoms may occur days or weeks after the initial injury.
10. The incidence and severity of successive TBI after one or more prior TBIs is significantly greater.