CORONAVIRUS UPDATE: What We Are Doing to Protect Our Clients

Rehabilitation and Healing of Traumatic Brain Injuries

As a Sacramento Brain Injury Attorney since 1982, I have handled hundreds of cases for people who suffered from concussions, fractured skulls and other injuries impacting the brain resulting from auto, trucking, bicycle, motorcycle or pedestrian accidents .

Often, the nature of the brain injury is not immediately apparent. Other serious injuries can take the limelight immediately after the accident. Only later, do the serious cognitive, emotional and behavioral deficits and problems of a brain injury become apparent.

Every year, over 550,000 people are hospitalized with a traumatic brain injury  and 15% of those, more or less, suffer a long term disability.

Anytime someone suffers a concussion or tbi ( Traumatic brain injury), if the injury arises from an accident, it’s important to document the client’s baseline condition. I’ll talk more about that a few paragraphs down.  All too often, however, people are treated in the Emergency Room, given minimal examination to rule out broken bones or deficits( those  which can be seen on MRI or CTI scan) , and then sent home without any recommendation for followup.

At best, they may be seen by a neurologist,  who can, if competent, diagnose injuries apparent on Ct scan or MRI. But many brain injuries DO NOT show up on MRI or Ct-Scan and a Neurologist is generally not the best qualified person to diagnose or document most brain injuries.

The person who is most highly trained in the deficits caused by brain injuries is a neuropsychologist.  A neropsychologist is typically a PhD, who has long postgraduate training in neuroanatomy and in psychology.  The neuropsychologist will review the clients school records, (even high school and elementary school records) look at past academic testing that was done, interview friends and family, and then do an extensive battery of tests known as a Neuropsych Exam.

Only after that exam is finished, and the nature of the brain deficit established, can a good rehabilitation plan be formulated.
A neuropsychologist can really be helped analyzing the injury if he understands the course and progression of the symptoms.
A personal injury lawyer can help the client document the nature and extent of his or her symptoms by having a checklist filled out by the client soon after his or her initial appointment with the lawyer, in which the client is asked about the presence or absence of those symptoms typically associated with a head injury. The client’s spouse or significant other should also fill out a checklist at that time, since the spouse or other close family member, often will see signs or  symptoms  that  the brain injured person may not be aware of.

For example, one question may ask whether the injured party feels emotionally labile (all over the map) since the accident. He or she may check “no”, but if you ask the spouse or other family member, they may check a resounding “Yes”.
It’s very common for a person with a traumatic brain injury to be unaware or not fully aware of cognitive or behavioral issues which appear clear to close family members.

If these checklists are filled out at the initial interview or shortly thereafter, they can be helpful to a neuropsychologist who sees the client perhaps many months or even years later. The checklists help document the baseline condition shortly after the accident so that its easier to diagnose improvement or deterioration.  Generally speaking, the impairments normally present after a brain injury can be classifed as cognitive, physical or behavioral.  Cognitive impairments include memory, attention and concentration and also include communication difficulties. There is often difficulty in taking in new information.

Physical problems can include difficulty with speech and muscular issues with arms,legs or the trunk area. There may also be intense headaches and loss of taste or smell or difficulties in swallowing. Behavior issues may include impulsiveness, distractibility, aggression, agitation and inability to relax.  There is no magic pill that will immediately cure a brain injury. Every injury is different and affects a person in a unique way. Some injuries get better with time and a lot of help but some can linger, especially if no plan of action or rehabilitation is undertaken.  Rehabilitation of brain injuries is typically costly, and this medical cost often frustrates people who want their pre-accident condition quickly  restored.  Rehabilitation often requires a multidisiplinary approach. Some of the experts involved can include psychiatrists,  physical medicine and rehabilitation specialists, nurses, psychiatrists, physical therapists, speech therapists, social workers and case managers.

Sometimes the rehabilitation can be on an outpatient basis, but often a stay in full-time rehabilitation facility is necessary.
The rehab team is focused on healing and prognosis and reviews the neuropsychological testing, the medical records and MRI and CT scans and behavioral observations to chart the best path to recovery.  The rehab team works very closely with the family of the injured person as well, as its critical that family members know what to expect and how they can most help the brain injured person in his recovery. One thing that helps most everyone with a brain injury is diminished stress. Active participation in activities that are known to lower stress, such as Yoga, Meditation, Guided Imagery or  Hikes in Nature,  have helped many of my clients in the past. A new modality called HeartMath , a type of biofeedback is also useful.
Feel free to contact me at anytime for referral to a good Yoga therapist or for Information on Guided Imagery or Heartmath.

The journey back from a traumatic brain injury is difficult, but like any other journey can be completed if a good guide and trusted advisers are there for you.  I’m Ed Smith, a Sacramento Brain Injury Lawyer since 1982. Feel free to call me anytime for free, friendly advice. In Sacramento my number is 916-921-6400. Elsewhere it is 800-404-5400.  You can also reach me at my website at

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