Cognitive problems are the most common lingering symptoms of those who have made a good recovery from a traumatic brain injury.  Fortunately, cognitive rehabilitation can at least help reduce some of these problems.

Cognitive rehabilitation is training for the brain and for the victim of a brain injury.  Depending on the extent of your brain injury, cognitive rehab can help repair your brain’s neurological connections so that you can function at a higher level, or it can train you how to function with your limitations.

Some cognitive rehabilitation processes focus on retraining your entire brain.  In these, you might undergo repeated exercises doing the same thing over and over.  While these are necessarily repetitive, they are designed to reorganize your brain’s “wiring” so that the brain is more functional across a number of different areas.

Some cognitive rehab processes focus only on certain skills that are giving you problems.  For example, if your brain injury causes you problems with drinking out of  cup, you will undergo specific training to help you re-learn how to use a cup.  Alternatively, if it is too difficult to re-learn how to use a cup, you might be trained in alternatives, such as easily using a straw.

Because attention deficit and memory issues are the two most common symptoms of brain injuries, there are a number of different cognitive therapy procedures that can be used to help you improve in these areas.  In a typical situation, you would undergo exercises designed to re-train your brain, as described earlier.  You might also receive training in how to use memory strategies, such as mnemonic training (mnemonic’s are learning/memory aids — such as the old Roy G Biv we all learned to remember that Red, Orange, Yellow, Green, Blue, Indigo and Violet were the colors of the rainbow). You would receive training to teach you how to create and use these type of memory aids in a number of different areas of your life.   Memory training might also include learning how to use external cues — things that are designed to remind you of other tasks — or learning how to use a “memory notebook” — to journal things you are supposed to remember in the future.

Fortunately, studies have shown that a holistic approach that incorporates a number of different types of cognitive rehab processes can help you improve on your brain function, though most studies show that even with the best cognitive rehabilitation, victims of traumatic brain injuries still show problems.

Unfortunately, cognitive rehabilitation is very expensive.  In a 2009 letter to the United States Congressional Budget Office officials, the president of the Brain Injury Association of America estimated that the average cost of cognitive rehabilitation was $27,000.00.

If you want to learn more about cognitive rehab, additional resources are available:

• What Is Cognitive Rehabilitation Therapy?  (Society for Cognitive Rehabilitation)
• Cognitive Rehabilitation For Children & Youth (Brainline.org)
• Taking On The Military Establishment: Keith Cicerone Is Working To Ensure That Soldiers With Traumatic Brain Injuries Are Getting The Help They Need (American Psychological Association)

Brain injuries are devastating in children.

Today, traumatic brain injuries remain the leading cause of both death in children.

For those children lucky enough to survive, an early brain injury can have life-long consequences.  Brain injuries often affect a child’s ability to learn even years after the injury.   Young victims are particularly vulnerable because most brain development occurs between the ages of 1 and 5.  Even as children get older, studies still suggest that the younger they are at the time of injury, the more serious problems they will face.

And even when a child has a satisfactory or normal IQ levels, emotional problems caused by the head injury set them back.  One study found that 19 of 22 children with  brain injuries showed long-term emotional issues.

These problems have a real economic value.  One study found that only 27 percent of kids who sustained brain injuries were working full-time by the time they reached age 21.

Unfortunately, auto accidents are the leading cause of brain injury-related deaths in children.  Proper use of seat belts and car seats can really help minimize these risks.

Falls still account for most brain injuries in children, including falling down stairs, falling off of playground equipment, and falling out windows.  Parents can help reduce the risk for these types of injuries by child-proofing the house and making sure that playgrounds are protected by twelve inches of soft surface material (such as mulch, gravel,  etc.)

Bicycle accidents also account for thousands of brain injuries per year.  Parents can reduce the risk of bicycle-related brain injuries by teaching their children bicycle safety and making sure that children are properly using bicycle helmets.

A common argument that we hear from insurance companies is that our client’s brain injury couldn’t have been caused by the accident because the client’s head didn’t hit anything.  That is a fallacy.    It is true that most head injuries are caused by a trauma to the head.  For example, in a car wreck, the victim’s head may hit the window, the steering wheel or the dash board.  However, there are a number of other common situations that lead to brain injuries where there aren’t any direct blows to the head.  Some of those are listed below.

1.  Forces applied to the brain.   You don’t have to hit your head to apply forces to the brain.  When your head moves rapidly, your brain moves inside your skull and impacts the brain.  These forces, slamming your brain around in your skull, are often hard enough to cause brain injuries.  For example, one study found that in car wrecks of 35 miles per hour, 27% of drivers and 21% of passengers who were wearing seat belts were at high risk of head injury even when their head didn’t contact anything on the interior of the car.

This risk is often made worse because multiple impacts occur.  Studies have repeatedly shown that repeated brain injuries have a cumulative effect on people, and in high impact accidents, there are often multiple injuries.  For example, in a simple rear-end case, upon impact, the head is immediately thrown forward, causing the brain to hit the front of the skull.  And then the head whips back, causing a second impact with the back of the skull.  With more complications, such as impacts with other cars or quick stops, there are additional opportunities for more impacts and more injuries, all occurring without the head ever hitting anything on the interior of the car.

Even hearing the above description, some may discount the non-impact cause of head injuries.  But remind them of shaken-baby syndrome.  Countless children are harmed or even killed from head injuries suffered by shaking — and they all occur without any impact.

2. Blast Injuries.  One legacy of the Iraq war is that we are learning more and more that people around explosions can suffer severe brain injuries without any type of impact on the head.  These same type of injuries are often found in construction-site accidents or in various types of manufacturing plant accidents.

3.  Lack of Oxygen.  Brain injuries are also often caused by anoxia, or lack of oxygen to the brain.  These types of injuries often occur in near-drowning cases, but they also arise in other situations.

4.  Loss of Blood.  An injured person who loses a lot of blood may also develop a brain injury even though the head never impacted anything during the actual accident.

5.  Electrical Injuries.   Many doctors miss this, but any type of electrical injury can potentially cause a brain injury in a person.

Just because you or a loved one doesn’t have an impact on your head, don’t dismiss the possibility of a brain injury.  Recognizing the brain injury and getting prompt treatment can make a difference in your outcome.

If you think you or a loved one has sustained a head injury, it’s critical to know potential symptoms of brain injuries.

Knowing the symptoms can help you understand when a brain injury is possible so that you know to speak to your doctor about it.  A 2003 Centers For Disease Control report to Congress noted that in many instances, persons with mild traumatic brain injuries fail to timely seek medical care because they don’t recognize their symptoms. Even worse, the report notes that once care is sought, many medical providers still fail to diagnose the head injury or recognize the severity of the brain injury.  Knowing the symptoms of brain injury and looking for them in yourself or your spouse can help make sure a diagnoses is made as soon as possible.

Knowing the symptoms can also help you understand what you or your loved one is going through.  Often, a spouse or loved one will become frustrated with the way injured person’s conduct.  In those situations, it’s important to understand the symptoms of brain injuries and to know that the injured isn’t choosing to act that way.  Instead, the injured has a serious condition with serious consequences and needs to get medical care.

There are literally thousands of potential symptoms of head injuries.  If you come to our office with a potential head injury, you will be given a form that asks you about the following symptoms, which we commonly see in brain injury cases:

• Headaches
• Feelings of dizziness
• Nausea and/or vomiting
• Noise sensitivity (easily upset by loud noise)
• Sleep disturbance
• Fatigue/tiring more easily
• Irritability
• Feeling depressed or tearful
• Feeling frustrated or impatient
• Forgetfulness/poor memory
• Poor concentration
• Processing issues/taking longer to think
• Blurred vision
• Light sensitivity
• Double vision
• Restlessness
• Reading problems
• Writing problems (writing letters out of order, etc.)
• Word recall/inability to remember words, names or numbers

If you have a head injury, you’re not likely to have all of these symptoms.  Most people only have 2-3, and many only have one.  What is important is to know the symptoms and look out for them following a wreck or other event.

Doctors had long thought that in cases of mild injuries these symptoms would slowly disappear as the brain heals.  But new research is beginning to reveal that even mild brain injuries can have permanent damage and be related to long-lasting symptoms.  For example, in the summer of 2012, a new study of brain injured veterans (and sadly, our veterans are now suffering too many brain injuries) found that symptoms of post-concussion syndrome can last for years.   This and other studies are confirming what we see in our practice — even the most “minor” brain injuries can last a life-time.

Over the years, we’ve been fortunate to help a number of clients who have suffered brain injuries in various types of accidents.  After speaking to some recent clients, one of their biggest frustrations is that it’s difficult to find easy to understand information about brain injuries, brain injury treatment, and brain injury prognosis.  As a result, we’ve spent a good amount of time trying to help them find accurate, easy-to-understand information.

Over the next few weeks, I’ll be writing a series of blog posts that try to give some basic information.

Keep in mind, this isn’t medical advice, and patients with brain injuries, more than anyone else, should get the help they need as quick as they can.  But I maintain that people who know more about their condition and their case, make better decisions and get better results.

I also think the information is particularly important in head injury cases.  Sometimes doctors are slow to diagnose head injuries because the doctors don’t know you well enough to compare your condition after the wreck to your condition before the wreck.  Therefore, it’s important for you, your friends and family members to know the symptoms of head injuries and potential causes of head injuries to help with the diagnosis process.

Yesterday’s Austin American Statesman had a story about the government’s efforts to condemn (purchase) land on the US-Mexico border for construction of the border wall.  It follows the story of Teofilo Flores, who accepted the government’s $1,650 offer for a slice of his backyard.  That didn’t seem like a bad deal until Mr. Flores learned that a neighbor had received 40 times that amount for a similar piece of property and that another nearby farmer had received almost $1 million in exchange for his cooperation.

I won’t bore you with the details of the story, but the general theme was that those who retained attorneys to represent them in the negotiations received significantly more in the process than those without attorneys.  Of interest to me – a trial lawyer – those who asked for a jury to decide their cases received settlement checks that were on average 1,200 percent more than the original offers.

It immediately struck me that this is virtually identical to what happens in injury cases.  People think they’re saving themselves money by not hiring a lawyer to pursue their claims.  But that’s a mistake.  Even insurance company studies prove that injured persons who retain lawyers recover more than those who are not represented.

And there are good reasons for that.  People don’t know the ins and outs of making a claim, what the fair value of a claim might be, and how to best present the claim.  Even if lay people study up on those issues, they still don’t have the hammer necessary to force insurance companies to take them seriously.  In our cases, if the insurance company isn’t playing fair, we’ll file a lawsuit and take it to trial, if necessary.  That’s the biggest bargaining chip we have.

But insurance companies know that unrepresented people don’t know the process, don’t know the fair value of the claim, and know that if they don’t treat an unrepresented person fairly, there’s not a lot that person can do if the person isn’t willing to hire a lawyer.  And because insurance companies know this, you can rest assured that they’ll take advantage of this.

If you or a loved one is injured, don’t try to resolve the claim yourself.  At least talk to a lawyer first.  You don’t want to find yourself in poor Mr. Flores’s shoes, settling your case and only learning later that you’ve been taken advantage of.

A constant issue I hear from personal injury clients is that doctors often do a poor job communicating with patients about the patients’ injuries and their course of care.

But with the internet, there are a number of ways for clients to learn about their injuries and treatment themselves.  It is the internet, so some of the information is horrible, but much of it is quite good.

One source that I have found helpful is Up To Date (www.uptodate.com). 

Up To Date is an online medical encyclopedia.  It is written and edited by doctors, updated frequently, and footnoted very well so you can follow up on studies.  It is designed to be used by medical professionals — hospitals, clinics, doctors, etc.  It is set up so that it provides basic information about conditions and then answers many of the most popular clinical questions about conditions.  When you look at the website, you’ll see that it receives good reviews from doctors and medical facilities from all over the world. 

But it also markets to patients.  Up To Date currently has a subscription option where you can have unlimited access to the website for 7 days for $19.95 or 30 days of unlimited access for $44.95.

If you have a condition that you want to learn more about, you might consider paying these fees so that you really understand your condition and your future.

Like many of you, I’ve never been to a hockey game.  But despite that, we have much we can learn from the National Hockey League.

You see.  The NHL has a concussion problem.

The NHL’s most recognizable player is young star Sidney Crosby.  But last January, Sid the Kid took a high hit and sustained a concussion.  His concussion caused him to miss half the 2010-2011 season, the 2011 Stanley Cup playoffs, and the first quarter of the 2011-12 season.  He finally came back, but after eight games back, Crosby sustained another hit and symptoms of concussions and is again out indefinitely.

Crosby isn’t alone. In about a quarter of the season, 23 different NHL players have been limited by concussions.

What I take from this is that the NHL, unlike the NFL or some other sports, take concussions and head injuries seriously.  And I think it’s important for all of us to learn that.

I frequently tell people that the thing that scares me the most about our car wreck or other personal injury cases are the potential head injuries.  They are difficult to diagnose, and the consequences can be life-altering. 

So if you or a loved one is hurt in an accident, make sure you’re on the lookout for potential signs of head injuries.  Don’t dismiss those headaches, changes in temperament, feelings of confusion, nausea or vomiting, or fatigue.  Take them seriously, and seek the care you need.

The lasting legacy of the Iraq and Afghanistan wars will be the amazing number of head injuries suffered by our troops.

Yesterday, NPR released a report detailing ways that we are failing those injured.  One key component of the report was failed testing and diagnoses for the injuries. 

The United States has spent $42 million trying to adminster test to members of the military to diagnose whether they have suffered any kind of traumatic brain injury.  In theory, the program should work great.  Every member is tested before deployment and then upon return from depoloyment,  That way, the original tests can serve as a baseline to determine where the military member was before entering the conflict.

But it hasn’t worked out well.  From the report:

We have failed. We have failed soldiers,” says retired Col. Mary Lopez, who used to run the Army’s testing program. She still works with soldiers in Germany. “It is incredibly frustrating because I can see firsthand the soldiers that we’ve missed, the soldiers that have not been treated, not been identified, misdiagnosed. And then they struggle.

The story about how the military got where it is, why they chose the test they did, etc are all interesting, but not what I want to write about today.

Instead, I think personal injury victims can learn from Col. Lopez’s summation — brain injuries are difficult to diagnose and when undiagnosed, the injured don’t get the help they need and then have problems.

That is a lesson that is important for those injured in almost every type of injury claim.  Brain injuries from car wrecks or other accidents are hard to diagnose.  Most of the time, doctors aren’t looking for brain injuries, and doctors usually don’t know their patients well enough to tell if there is a difference in the patient after an incident.

And if the doctors don’t make that diagnose, then the injured don’t get help.

That’s why I always tell my clients to be on the lookout for head injuries.  Often, you or a loved one will be the only ones who notice that you have memory issues or a changed personality.  So it’s important for you to look out for the symptoms.

It’s also important to get the help you need.  When the head injury is severe, there are a number of different forms of cognitive therapies that you can undergo, but the problem has to be diagnosed first.

I’m spending a little time today preparing for a jury trial in a couple of weeks, and due to some circumstances, it got me thinking about the things about a case that a jury doesn’t get to know. 

These issues sometimes come up when talking to new clients. One of the common comments I hear is, “If the jury just gets to hear about X then that will really help our case.” 

But  many times, the jury may not get to hear about X.

There are a number of rules that limit what information we get to tell a jury.  Sometimes the rules exist to prevent the jury from hearing information that courts believe is irrelevant, and sometimes it is to prevent the jury from hearing information that is deemed to be too prejudicial to one side or the other.  Regardless of the reason for the rule, there are a number of limits.  Some of the more popular limits are listed below.

1.  Insurance.  In most personal injury cases, the defendant (the party that did something wrong and is being sued)  has insurance to pay for the lawyer and that will pay for any judgment rendered against the defendant.  However, one of the most long-standing rules is that the parties can’t tell the jury that the defendant has insurance, that insurance might cover the jury’s award, or anything similar.

2.  Attorneys’ fees.  In most personal injury cases, the plaintiff (the party that is injured and filed the lawsuit) has to pay his or her attorney out of the jury’s award.  And yet, we’re never allowed to tell the jury this fact.

3.  The defendant’s history.  In many cases, the defendant may have a history that our clients think is relevant.  For example, if it is a car wreck case, the driver may have a bad driving record with prior wrecks or tickets.  Or, the other side may have a criminal history or a history of alcohol or drug abuse.    In most cases, the jury never gets to hear about these “prior bad acts” (as we call them).

4.  Settlement offers or negotiations.  Sometimes clients think that we can tell a jury about settlement offers from defendants and that the jury will use those as a “floor” for an award.  But in most instances, we can’t tell a jury about settlement negotiations, mediation, or other settlement discussions.

5.  Effect of jury answers.  The way our system works, the jury doesn’t decide who wins or who loses.  Instead, the jury is asked a series of questions.  But the jury doesn’t get to know what their answers mean, and we’re not allowed to tell them how their answers might affect the ultimate award.  This was really demonstrated in a case of ours a few years ago.  In a business case, we obtaned a jury verdict that included an $8,000,000.00 punitive damage award.  But due to tort reform legislation, that recovery was limited to $250,000.00.  When we told the jury about it afterwards, they were floored.  They had been trying to punish the defendant for their egregious conduct, but the result ended up being a drop in the bucket for this large company.

My list could go on and on. There are any number of additional things a jury doesn’t get to hear about, but these are a biggies.

And as I said, these are only the general rules, and in some cases, there might be ways for attorneys to legitimately get the right to tell the jury about some of thse items.  In fact, I often tell people that one of the advantages of hiring an experienced personal injury attorney is that they might know tricks that increase the likelihood that you get to tell the jury these things.   That is especially true for trucking accident cases.