Among the most troubling matters I have handled as a personal injury lawyer in Atlanta are those involving brain injury to a child who has had a head injury. Just as young minds can be shaped, young brains are easily damaged. The effect of early brain damage can impact the trajectory of life over many decades As a brain injury lawyer for families and injured children, one of big challenges is in educating insurers, defense counsel and jurors about the lifetime effects of brain injuries to children.
A while back I handled a case in north Georgia in which a large truck took a turn too fast and rolled over on a family minivan. It cracked the skull of a toddler who was safely strapped in his child seat behind his mother in the driver’s seat. While the child looked a lot better within a few weeks, there were ongoing concerns about effects on his learning and behavior. After we laid the groundwork to use all the latest neuropsychological testing and imaging technology to show the injury, the insurance company agreed to pay all its coverage in a structured settlement in a trust to take care of the child over his lifetime. Because collection of more from the very small company was doubtful, the family chose to settle for that. Our research on the effects of even apparently “mild” childhood head trauma on later educational attainment, substance abuse, behavioral problems and incarceration apparently made an impression, even without flying mother and child to California for the latest and greatest brain scans such as high resolution functional MRI (fMRI), PET and PET-CT scans.
When Governor Deal appointed me to the Criminal Justice Reform Council, during my term as State Bar president, I realized that people incarcerated for crime have eight times the rate of prior traumatic brain injury as the general population. The CDC states that “Attention deficits may make it difficult for the prisoner with TBI to focus on a required task or respond to directions given by a correctional officer. Either situation may be misinterpreted, thus leading to an impression of deliberate defiance on the part of the prisoner.” And it isn’t just adults who have been said to be affected by this problem. The Child and Adolescent Psychiatric Clinics of North America state that, “children and teenagers who have been convicted of a crime are more likely to have had a pre-crime TBI.” Therefore, I prodded corrections officials to try to identify people incarcerated for crimes who had been survivors of childhood brain injury and look for ways to deal with those issues constructively.
As an Atlanta personal injury lawyer representing brain injury survivors, I often work with families whose child experienced a brain injury due to a car and truck wreck, defective products or premises, and sometimes swimming pool incidents. However, the research on sports and military brain injuries is highly relevant to the work we do. For example, research on military personnel injured in IED blasts in Iraq and Afghanistan has tremendous application in addressing problems arising from other causes of traumatic brain injury.
In the past twenty years extensive research has been done dedicated to concussions, and for good reason. It was reported in 2006 that about 1.6 to 3.2 million concussions occur annually in the United States. As youth sports and outdoor activities increase, it is important that people increase their awareness and knowledge about the signs of a concussion. It is also important to raise awareness about the different treatment paths someone should take after a concussion, especially if it is a young child.
The current definition of a concussion is “a biomechanical injury to the brain that is characterized by signs and symptoms of neuronal dysfunction” (McCroy 2009). “Mild” is really a misnomer with regard to any traumatic brain injury, though many organic brain injuries are more debilitating than a common concussion. Maybe a “mild” brain injury is simply one affecting somebody else’s family. However, any brain injury – even a concussion — can be dangerous, especially when it comes to young brains that are still developing.
Massive traumatic brain injuries are not subtle. When the skull is cracked, there is bleeding in the brain and the patient has little or no consciousness, that is immediately recognized in the ER. But there are many brain injuries such as concussions that have a significant effect of life that are subtle enough to be completely missed by emergency physicians who are focused on blood and broken bones.
There are multiple signs and symptoms that suggest that someone has suffered a concussion. Some symptoms include headache, dizziness, nausea, light or noise sensitivity, feeling “foggy” as well as an increase distress in emotion and sleep. The Brain Injury Association of America states that “persistent signs and symptoms to assess include excessive crying, persistent headaches, poor attention, and change in sleep patterns.” Awareness of these signs and symptoms is critical for patients, family members and co-workers.
Rules for monitoring concussions in athletes are also useful when a loved on has had a concussion in a car or truck collision. Here are four steps to take regarding sports concussions, which are equally applicable after a so-called “mild” concussion in a wreck:
– It is important to recognize common signs that are associated with concussions. However, it is also important to recognize that many people will try to ignore problems because they want to “tough it out” or are just unaware what they are feeling may be a concussion.
– Common signs of a concussion include headache, dizziness, and feeling “foggy”
– A proper medical evaluation should be used with graded symptom checklists, paper and pencil cognitive exams, and balance assessment tests.
– Once a concussion is suspected, the person must be removed from any additional “contact-risk activity”. There is overwhelming research done that shows the first 7-10 days after a concussion is when people with concussions are most at risk for succeeding concussions.
– There is a window of vulnerability where the brain is working off delayed reactions and slower cognitive processing which can be a bad combination if an athlete goes back into contact situations.
– Avoiding additional injury is vital because people with multiple concussions tend to have more severe and long lasting symptoms.
– Most symptoms of a concussion will last between 7 and 10 days, but children with head injuries should be monitored more closly. . A physician should be the only one who decides when a child can go back to normal activity and sports after a concussion.
– Make sure that everyone has the appropriate information about concussion management.
– Recovery time can be longer for kids than for adults, those who have had prior head injuries, those who suffered loss of consciousness and amnesia greater than 5 minutes after trauma, and those who have learning disabilities.
– Make sure you talk to your doctor about any concerns you have about the proper recovery time for your child.
– Activity should be gradually increased after there is clinical recovery.
– “Return to Play” guidelines require resolution of the acute symptoms both at rest and with exertion. A kid with a head injury shouldn’t be taking medications at this point because they could be masking symptoms.
– Return to normal activity should follow a systematic process, to work up to heavy exertion after head injury. A recommended five step process includes 48 hours at each of the following steps:
A,Moderate aerobic activity without moving, e.g., stationary bike;
B. Aerobic activity while moving, e.g., jogging or swimming
C, Sport-specific drills with no contact
D. Full contact in practice setting
E. Full contact in competitive setting
If a child or teenager in your family has a traumatic brain injury due to a car or truck wreck, defective product or dangerous premises, call to see if we can help.
Ken Shigley is past president of the State Bar of Georgia (2011-12), double board certified in Civil Trial Advocacy and Civil Pretrial Advocacy by the National Board of Legal Specialty Certification, and lead author of Georgia Law of Torts: Trial Preparation and Practice. His Atlanta-based civil trial practice is focused on representation of plaintiffs in cases of castastrophic personal injury and wrongful death.