Evaluation of Traumatic Brain Injury Cases: The Plaintiff’s Perspective By Charles G. Monnett III

Vocabularies  plaintiff /'plentɪf/ a person who makes a formal complaint against somebody in a court of law 原告； 起訴人  traumatic /trau'mætɪk/ connected with or caused by trauma 創傷的；外傷的；損傷的  litigation /ˈlɪtə'geʃən/ the process of making or defending a claim in a court of law 訴訟；打官司  prognosis /prɑg'nosɪs/ an opinion, based on medical experience, of the likely development of a disease or an illness （對病情的）預斷，預後

 concussive [kənˈkʌsɪv] 給與衝擊的 震盪性的  Post-concussive syndrome: 腦震盪後綜合症  sequela [sɪˈkwilə] 【醫】後遺症, 後發症 ；結果  nausea /'nɔsɪə/ the feeling that you have when you want to vomit, for example because you are ill/sick or are disgusted by something 惡心；作 嘔；反胃  tinnitus /'tɪnətəs/ an unpleasant condition in which somebody hears ringing in their ears 耳鳴

 seizure /'siʒɚ/ a sudden attack of an illness, especially one that affects the brain （疾病，尤指 腦病的）侵襲，發作  spasticity 痙攣  insomnia /ɪn'sɑmnɪə/ the condition of being unable to sleep 失眠（症）  agitation /ˈædʒə'teʃən/ worry and anxiety that you show by behaving in a nervous way 焦慮不安； 憂慮；煩亂

Some Technical Terms…  MRI: Magnetic Resonance Imaging 磁共振造 影  CT: Computed tomography 電腦斷層掃描  EEG: Electroencephalography 腦電圖  PET: Positron emission tomography 正電子 發射計算機斷層掃描  SPECT: Single photon emission computed tomography 單光子放射電腦斷層造影

Main Idea  Because the effects of TBI are unique to the injured individual, it is difficult to compare cases or make generalized assessments about the value of types of TBI claims, making the evaluation of a claim involving mild traumatic brain injury a challenging task for attorneys. Each case will require careful consideration of factors that may affect the ultimate outcome.

Supporting Information  Post-concussive syndrome for patients with mild TBI includes physical, cognitive and emotional symptoms which vary greatly for each patient.  Physical?  Cognitive?  Emotional? → No typical pattern showing how the patient is influenced by TBI

 Many factors affect the value of each TBI case. Careful consideration of factors is required.  One of the factors: Documented injury  In most mild TBI cases, diagnostic tests will be completely normal.  No consistency between the diagnostic tests and the neuropsychological evaluation → Hard to convince the insurer or jury that the Plaintiff has impaired mental functions

Conclusion  No typical pattern  Unique cases  Difficult to compare  Difficult to value TBI claims  Each case needs consideration on different factors

Glasgow Coma Scale  level of consciousness after head injury Glasgow Coma Scale Eyes Does not open eyes Opens eyes in response to painful stimuli Opens eyes in response to voice Opens eyes spontaneously N/A Verbal Makes no sounds Incomprehe nsible sounds Utters inappropriate words Confused, disoriented Oriented, converses normally N/A Motor Makes no movements Extension to painful stimuli (decerebrate response)decerebrate response Abnormal flexion to painful stimuli (decorticate response)decorticate response Flexion / Withdrawal to painful stimuli Localizes painful stimuli Obeys commands

Glasgow Coma Scale  the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35“  The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person)  Generally, brain injury is classified as:  Severe, with GCS ≤ 8  Moderate, GCS  Minor/Mild, GCS ≥ 13.

Discussion  Do you think it is proper to compensate plaintiff with acquired brain injury that haven’t diagnosed?  If you are the judge, will you adopt these general classifications of brain injury which provide indication of patient’s ultimate prognosis? Why?

 In the article, it mentioned one of the factors that affect the value of a TBI case— documented injury. Can you think of some other influential factors?  Do you think it is possible to classify TBI not only into 3 categories(severe, moderate, mild) but into more subcategories so as to provide easier ways to value TBI claims? Why or why not?