Excerpts

Sample excerpt. Preview only – please do not copy.

TRAUMATIC BRAIN INJURY

Traumatic brain injury (TBI) occurs when there is an acute, external force to the head, which may result in transient alteration of consciousness and/or compromise of brain matter. It is one of the most common acquired neurological conditions, but the vast majority (> 80%) of all cases of TBI can be classified as mild in the sense that they are associated with no or minimal (< 30 minutes) loss of consciousness, limited (< 1 day) posttraumatic amnesia, and no acute intracranial findings on computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Recent literature reviews suggest that mild, uncomplicated TBI is rarely associated with persistent neuropsychological sequelae (Iverson, 2005; Schretlen & Shapiro, 2003). Yet, cases of mild TBI are encountered increasingly in the medical– legal arena pertaining to personal injury claims in civil court.

In this chapter, I review a case from my own practice that involved a claim of neurobehavioral impairment, more than 1 year after mild TBI. I had done the original neuropsychological evaluation of the plaintiff, which was subsequently critiqued by a different psychologist who was involved with his treatment, and I was then asked to comment on that other psychologist’s review. There was additional follow-up after the plaintiff psychologist was deposed by the attorney who had retained me. Eventually, the case was settled out of court before my scheduled deposition was taken. Some of the specific identifying information in this case description has been altered to protect privacy, but the psychometric test results and quotations are identical to the original texts.

PROFESSIONAL APPROACH

Neuropsychological independent medical–legal evaluations (IMEs) make up about 15% of my practice at a private, not-for-profit rehabilitation hospital, and the majority (> 70%) of these involve cases of TBI. I never advertised to seek these kinds of referrals, nor did I make any attempts to cultivate them. It is probably most accurate to say that the referrals found me because I had been practicing in the local community for several years and was doing quite a few clinical neuropsychological evaluations in the context of rehabilitation. Some of those cases eventually involved claims of long-term impairment or disability, leading to legal procedures where I was typically called to testify in depositions as a treating doctor or fact witness. Gradually, I started getting referrals directly from attorneys who had cross examined me during such processes. Currently, the vast majority (> 90%) of these IME referrals come from representatives of the defense—typically either an attorney defending a person who is being sued as being at fault in a motor vehicle accident and therefore potentially responsible for the plaintiff’s subjective symptoms or an insurance company that is questioning the causal relationship between an accident and the plaintiff’s ongoing subjective complaints.