Part VII: Injuries and Damages

Traumatic Brain Injuries

A person who suffers a severe blow or jolt to the head or a penetrating head injury may frequently develop a condition that disrupts the function of the brain. This is known as a traumatic brain injury (TBI). Auto accidents are a leading cause of TBIs, as are falls, such as a slip and fall accident in a grocery store or a trip and fall due to a defective walkway. TBI is a leading cause of death and disability in the United States. Each year, 1.4 million people sustain a traumatic brain injury. Fifty thousand of those die from the TBI, 235,000 people are hospitalized, and 1.1 million people are treated and released from an emergency room. The injury may be relatively minor, such as a minor concussion or brief period of unconsciousness, or it may be severe, such as a lengthy period of unconsciousness (a coma) or amnesia after the injury. Each year, 80,000 to 90,000 people will sustain a long-term disability as the result of a TBI. The Centers for Disease Control and Prevention estimate that at least 5.3 million Americans currently have a long-term or lifelong need for help to perform activities of daily living (ADLs) as a result of TBIs.

The leading causes of traumatic brain injury are falls and motor vehicle accidents, being struck by or against an object, and assaults by another person involving traumatic injury to the head. But TBIs need not be caused by a blow to the head. A violent jolt of the head such as one might experience in a rearend collision (“whiplash”) may result in serious brain injury. In a violent collision, the head snaps forward and the brain hits the front of the skull, then the head snaps backward and the brain hits the back of the skull. These impacts can cause a serious TBI. “Shaken-baby syndrome” is an example of a serious brain injury being inflicted without a direct blow to the head.

Even in this age of advanced medicine and neurobiology, there is no cure for a TBI. Improvement from a brain injury depends on the brain’s “plasticity,” that is, the brain’s ability to “rewire” itself and have other areas of the brain take over the functions of the damaged areas.

Brains do not heal like broken limbs, and each person’s brain is different. Although they may superficially appear alike, no two brain injuries are the same and the consequence of two similar traumatic brain injuries may be vastly different.

Health care professionals who deal with TBIs do not talk in terms of “recovery,” but rather “improvement.” The word “recovery” implies that that the effects of a TBI will disappear, whereas the reality is that improvement is usually all that can be expected. With a TBI, some of the effects may disappear after a couple of years or more, but more frequently these longterm changes linger on, changing only slowly—if at all—over the person’s lifetime.


TBIs are classified into three categories: mild, moderate, and severe.

  1. Mild Traumatic Brain Injury A person with a mild TBI is one who has suffered trauma to the brain and: (a) had any period of loss of consciousness and/or confusion, (b) was disoriented or confused for less than 30 minutes, and/or (c) suffered from Posttraumatic Amnesia (PTA) (loss of memory for events immediately before or after the accident). Mild TBI is the most common type of TBI, and it is often missed at the time of the initial injury. Fifteen percent of people with mild TBIs have symptoms that last one year or more.
  2. Moderate Traumatic Brain Injury Moderate TBI exists when a person has suffered trauma to the brain and: (a) lost consciousness for at least 20 minutes to six hours and/or (b) suffered from Posttraumatic Amnesia for more than 30 minutes but less than 24 hours. It also applies where the person has suffered a skull fracture. Moderate TBI may result in long-term physical or cognitive deficits, depending on the type and location of the brain injury. Rehabilitation will help to overcome some deficits and provide skills to cope with any remaining deficits.
  3. Severe Traumatic Brain Injury A severe brain injury is a life-threatening condition in which: (a) the person loses consciousness for more than six hours or (b) has Post Traumatic Amnesia lasting longer than 24 hours. If the person lives, she will typically be faced with long-term physical and cognitive impairments, ranging from a persistent vegetative state to less severe impairments that may allow the person, with extensive rehabilitation, to continue to function independently.


Symptoms common to mild TBIs include fatigue, headaches, visual disturbances, memory loss, poor attention and/or concentration, sleep disturbances, dizziness and/or loss of balance, irritability, feelings of depression, and, rarely, seizures. Other symptoms associated with mild TBIs include nausea, loss of smell, sensitivity to sound and lights, getting lost or confused, and slowness in thinking. Sometimes the cognitive symptoms are not readily identified at the time of the injury, but instead may show up as the person returns to work, school, or housekeeping. Friends and colleagues may notice changes in the person’s behavior before the injured person realizes anything is wrong.

A person who has suffered a moderate or severe TBI may suffer from such cognitive deficits as difficulties with attention, concentration, distractibility, memory, speed of processing information, confusion, impulsiveness, language processing, and what are often referred to as “executive functions.” Executive functions refer to the complex processing of large amounts of intricate information that we need to function creatively, competently, and independently as beings in a complex world. After a severe TBI, the person may be unable to function well in her social roles because of difficulty in planning ahead, keeping track of time, coordinating complex events, making decisions based on broad input, adapting to changes in life, and otherwise “being the executive” in her own life.

Some of the difficulties resulting from a moderate to severe TBI include speech and language problems, such as not understanding the spoken word, difficulty speaking and being understood, slurred speech, speaking very fast or very slowly, and issues with reading and writing. Sensory problems include difficulties with the interpretation of touch, being aware of changes in the temperature, and limb position. Partial or total loss of vision, weakness of eye muscles and double vision, blurred vision, difficulties judging distance, involuntary eye movements, and intolerance of light are other problems frequently found with moderate to severe TBIs.

Physical changes include paralysis, chronic pain, loss of bowel and bladder control, sleep disorders, loss of stamina, changes in appetite, difficulty regulating body temperature, and menstrual problems. Moderate to severe TBIs can cause a wide range of functional changes affecting thinking, language, learning, emotions, behavior, and sensation. TBIs can also cause seizures and increase the risk for such conditions as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more likely as the person grows older.

A common complaint among persons who sustain a TBI is fatigue. Studies of people with TBIs found that between 37 and 98 percent of them said they had some type of fatigue. There are three types of fatigue: (1) physical fatigue: feeling tired and a need to rest and having muscle weakness, (2) psychological fatigue, in which the person can’t get motivated to do anything, is often accompanied with depression (50-60 percent of people who suffer a TBI develop major depression, which affects only about 5 percent of the general population at any one time), anxiety (about twice the rate of the general population), Posttraumatic Stress Disorder (PTSD) and other psychological conditions, which may take months or years of psychotherapy to treat and may require psychoactive medication, and (3) mental or cognitive fatigue, in which the person has difficulty concentrating and finds it hard to stay focused, becomes irritable, or has headaches.


The long-term effects of a TBI depend on a number of factors, including: (1) the severity of the initial injury, (2) the rate and completeness of physiological healing, (3) the types of functions affected, (4) the resources available to aid in the recovery of function, and other factors. Most spontaneous improvement from a TBI occurs within the first month after a brain injury. Some additional gains may occur over the next three to six months. The long-term effects of a TBI are different for every person. Some may experience only subtle difficulties, others will have moderate dysfunction, while to still others the TBI may be life-threatening. With TBIs, the systems in the brain that control our social-emotional lives are often damaged. The consequences for the individual and his significant others may be very difficult, as these changes may imply to them that “the person who once was” is no longer there. Personality can be substantially or subtly modified following injury. The person who was once an optimist may now be depressed. The previously tactful and socially skilled negotiator may now be blurting comments that embarrass those around them. The person may also be characterized by a variety of other behaviors: dependent behaviors, emotional swings, lack of motivation, irritability, aggression, lethargy, lack of inhibition, and being unable to modify behavior to fit varying situations.

The severity of the injury and the resulting direct effects on the individual’s body systems and cognitive abilities may not predict the amount of impact the TBI has on a person’s life. For example, a severe injury to the frontal brain area may have less impact on an agricultural worker’s job performance than a relatively mild frontal injury would have on a physicist’s work. Hence, the extent of injury and damages in a specific person’s life will depend on his pre-injury lifestyle, personality, goals, values, and resources, as well as his ability to adapt to changes and to learn techniques for minimizing the effects of brain injury.


If you or a loved one has suffered a traumatic brain injury due to another person’s carelessness—such as an automobile accident caused by another person’s inattentiveness or a slip and fall on a store’s slippery floor—it is important that you promptly seek representation by a personal injury law firm experienced in this type of injury. Monetary damages you are entitled to receive when you have sustained a traumatic brain injury include all of your medical and rehabilitation costs, lost wages because you were unable to return to work, loss of enjoyment of life due to your impaired condition, pain and suffering, and psychological damage.