The majority of TBI cases, from a medical standpoint as well as from a legal standpoint, involve “mild” TBI. Unfortunately, this term suggests, at least to those unfamiliar with brain injuries, that the injury is minor or trivial.
Addressing the confusion created by the nomenclature used within the field of neurology, Nathan Zasler, M.D., director of brain injury rehabilitation programs at Sheltering Arms Hospital in Richmond, Virginia, aptly cautions professionals:
“From both clinical and research perspectives, one of the major problems faced by rehabilitation professionals is inconsistent nomenclature…Modifiers such as subtle, minimal, and minor are to be discouraged. Practitioners must understand that the term “mild” describes only the initial insult relative to the degree of neurological severity; there may be no correlation with the degree of short-term or long-term impairment or functional disability.”
The aim of the trial attorney must be to scour the literature for the evolution of any terms or protocols that have gained broad acceptance.
Generally, brain injuries are classified as “severe,” “moderate,” “or mild.” One can think of brain injuries as being on a continuum, with “mild” at one end of the spectrum and “severe” at the other. The confusion lies in the inability of medical professionals to arrive at accepted definitions of commonly used terms. The aim of the trial attorney must be to scour the literature for the evolution of any terms or protocols that have gained broad acceptance.
Most recently, the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine, a nationally respected body of rehabilitation physicians and professionals representing both sides of the litigation spectrum, adopted the following definition of mild traumatic brain injury:
Traumatically induced physiologic disruption of brain function, as manifested by at least one of the following:
1. Any period of loss of consciousness;
2. Any loss of memory for events immediately before or after the accident;
3. Any alteration in mental state at the time of the accident;
4. Focal neurologic deficits may or may not be transient but do not exceed (1) Loss of consciousness of approximately 30 minutes or less; (2) An initial Glascow Coma Scale Score of 13 – 15 after 30 minutes; (3) Post traumatic amnesia of no more than 24 hours’ duration.3
While some physicians and professionals still question even this comprehensive definition of a mild TBI, it is gaining acceptance within the field, steadily silencing the din of conflicting definitions formerly used by practitioners. This is but one example of the need for the trial attorney to sift through large volumes of literature to discover criteria to disarm the opponent who attempts to use conflicting definitions and disagreements in the field to suggest that the alleged injury is but a figment of the plaintiff’s attorney’s imagination.