What are Coup/Contrecoup Injuries?

Welcome to Legal Squeaks, I’m your host, Dennis VanDerGinst. Before getting in today’s topic, I’d like to remind you all please subscribe to or follow Legal Squeaks on your favorite podcast forum. It’s free. Make sure you tell your friends and family members to check us out as well.

Now, today’s topic is traumatic brain injuries or otherwise known as TBIs. TBIs can occur in any situation where there’s an injury case that arises either on the job, you know, in the course of a worker’s compensation claim or a negligence case where somebody has been injured. And it’s important to identify these situations because TBI’s can be so serious that the amount of compensation is largely increased when it exists.

But often they’re not highlighted, highlighted by the medical provider, and some attorneys will overlook the existence of TBI’s and therefore, somebody who has suffered in this fashion might not be properly compensated. So it is important that they they be properly identified, properly treated and properly, properly monitored.

So what is a TBI, what’s a traumatic brain injury? It’s the disruption of a normal function of the brain. It can be caused by a bump, blow, a jolt, a penetrating head injury. Some, sometimes it can also be caused by what might seem to be a whiplash injury. Now, there is some difference of opinion as to whether that’s the case. But I’ve certainly heard a lot of medical experts indicate that because of the nature of a whiplash injury and the brain kind of being rattled within the skull, just like the inside of an egg inside of its shell, that a TBI can occur in that fashion as well.

The Glasgow coma scale is used to classify the traumatic brain injury severe, severity into either mild, moderate or severe categories. It grades a person’s level of consciousness on a scale of 3 to 15, based on verbal motor and eye opening reactions to stimuli. A concussion, for instance, is a form of brain injury on the lower end of the severity scale. It’s often, in fact, referred synonymously as a mild TBI.

Some providers say that moderate or severe TBI’s have to accompany a loss of consciousness, but we’re finding that that’s not so anymore. There are more providers who are willing to state that loss of consciousness is not a prerequisite to being diagnosed with a moderate or severe TBI.

Some, sometimes the symptoms to a traumatic brain injury appear right away, but other times it might not be noticed for days or months after the injury or until person resumes their everyday life.

And that’s because sometimes they are focused on a more acute injury, for instance, a fracture or something like that that needs the immediate attention of the of a provider and is causing more, more pain, more attention to be paid to that portion of the body. So sometimes it takes a while.

In fact, other times they may not recognize or admit that they’re having problems. They may not understand that their problems, what the problems are and that the symptoms they’re experiencing are actually related to a traumatic brain injury. That’s kind of part of the problem. It’s a brain injury. So sometimes you can’t process information correctly.

The signs and symptoms of a concussion can be difficult to sort out. Early on, problems might be overlooked by the person, by the family members and even by the doctors. People might look fine, even though they may be acting or feeling differently. In the presence, as I mentioned, of a TBI, vastly enhances the value of the injury claims so the client’s physical and medical well-being as well as the financial well-being is often hinging upon properly identifying and treating TBI’s.

So you have to be aware that treatment providers might not follow up an initial diagnosis for concussion because they may feel there’s nothing else to be said or done other than what is in the discharge papers. So you, as either a patient or the family member of a patient, need to be sure that there’s some reasonable follow up to make sure that you’re documenting, as well as properly treating a TBI.

So some of the things that, that you need to be aware of. If you see that in your discharge papers or any of your medical records, there’s the mention of a concussion or the words traumatic brain injury, that’s a trigger for you. That, that’s something you have to be watching. If you see or you’re aware from any other source that there is a history of trauma to the head, again, that should alert you that you need to be watching and monitoring that patient, whether it’s yourself or someone else.

If you see or notice that the patient. Is having certain difficulties that I’m going to outline here, if you either see it in the records or you’re noticing it yourself or of a family or friend, a family member or friend, these are other things that should trigger you to to make sure that you are properly following up.

So if there are difficulties, for instance, in thinking clearly. If the person is feeling slow down. They’re having problems concentrating, difficulty remembering new information. If they’re experiencing headaches. If they have vision problems. If they especially early on, if they have nausea or vomiting. Sensitivity to noise or light. If they have balance problems. If they’re feeling tired, like they have no energy. If they’re moody and irritable, sad, emotional, nervous, anxious.

If they’re having difficulty sleeping, either having, you know, wanting to sleep more or not sleeping enough or having trouble sleeping. Those are all triggers for you to know that there’s the possibility that there is a traumatic brain injury that needs to be followed up on. So if you’re the patient or if you are a family or friend of a patient, there are some things you need to do under those circumstances.

One, and this, by the way, is, there are a number of reasons why you’re doing it, you know, certainly to get the proper medical attention. But also if you do have an underlying injury claim, you want to make sure that you are properly documenting everything.

So one of the things you want done is to journal what’s going on with the patient, the difficulties that the patient is experiencing. This can be, you know, simply on a pad of paper. It can be typed. It doesn’t have to be. It can be done by the patient or it can be done by a family or friend who’s monitoring the patient.

Certainly you want to follow up with your primary care provider to make sure that he or she is getting you the proper medical attention and that proper medical attention is often going to start with a referral to a specialist. Normally, the first specialist you would see with a traumatic brain injury is going to be either a neurologist or a neurosurgeon. You know, for instance, if there’s a hematoma or something along those lines, that needs to be addressed surgically.

Sometimes along the treatment profile, you’re going to see there’s a need for physical therapy, occupational therapy, sometimes if it’s pronounced problem, you may need speech and language pathologist to get involved, recreational therapist, vocational therapist to help reintroduce a patient to the the ability to work and make a living.

Often when someone is going through a traumatic brain injury, they suffer from depression. They’re, they’re frustrated. They are confused. They don’t understand what’s going on or why. So they might need to see a psychiatrist or psych, psychologist or another therapist or counselor along those lines.

If they have those vision problems that we mentioned, obviously, they might need to see an ophthalmologist. Sometimes someone like a nutritionist might be worth speaking to. Certainly a physiatrist might be helpful in order to to to monitor all of the treatments and make sure there’s one source, that can be the family doctor or can be as someone separate, who is monitoring all of the treatment providers.

And then certainly once the treatment is secured, the proper treatment to address the underlying problems, in order to indicate what kind of cognitive or behavioral problems that the patient has gone through, you might need to see a neuropsychologist who can document any losses along those lines. For that reason it’s also helpful that perhaps school transcripts, prior psychological testing, IQ tests, things like that, those are great to have so that a baseline can be established from what the patient was like before the accident and now what they’re facing as as far as cognitive and behavioral losses as a result of the injuries from the accident.

So that’s all, those are all things that should be secured and monitored, you know, as the patient is treating. In addition, there are some danger signs that you have to be mindful of because in rare cases, dangerous blood clots can arise that crowd the brain against the skull and develop issues that might need emergency attention. So if you, if you as the patient, you begin to get a headache that gets worse and doesn’t go away right away, that’s something that you might want to be wary of.

Weakness, numbness or decreased coordination, repeated vomiting and nausea, especially if it’s after the first few days. Slurred speech, looking drowsy, not being able to wake up, having one pupil in the middle of the eye larger than the other. Certainly if you’re having convulsions or seizures, if you can’t recognize people or places, you get more confused, you get more agitated. Any unusual behavior. Certainly if you lose consciousness, any of those situations would require getting medical attention right away.

In addition to medical attention and legal attention, there are a lot of support groups available to those who have suffered a TBI. For instance, The Brain Injury Association of America. So simply look online for one of those near you because there are a lot of them available and they are extremely useful for those people who are suffering those frustrations.

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