Need for Brain Injury Experts for a Full Recovery

The Quality of the Brain Injury Experts Dictate the Result

By Gordon S. Johnson, Jr.

Only with experienced brain injury experts can an attorney assure the proper diagnosis and treatment, keys to full compensation and recovery. But diagnosing the full extent of deficits and disability after a brain injury cannot be done by one doctor. Brain damage impacts four principal domains, cognitive, behavioral, mood and physical problems. Let’s start with the last, the physical problems.

The brain injury expert who begins the analysis of the physical problems is the neurologist through a detailed neurological exam, where reflexes, cranial nerves, balance and movement should be analyzed. Yet, the neurological exam is only a brief snapshot of subtle yet quite significant abnormalities that will likely take a different brain injury expert to identify.

The Need for a Brain Injury Optometrist

Visual deficits are among the most likely symptoms to spot after a brain injury, particularly a mild brain injury. The problems are not so much in the way in which the eye itself works, but in the way in which the cranial nerves which control eye movements function. A simple eye test won’t answer the questions, as it is often in looking down, and near vision convergence that the deficits are spotted. These deficits while possibly evident on a classical neurological exam, are rarely spotted by the run of the mill neurologists. An optometrist who specializes in evaluating head injury patients is key.

The Need for a Full Vestibular and Balance Analysis

Balance deficits are at the head of the list of of problems after brain injury, yet rarely is more done than a few measures by the neurologist in the neurological exam. While the Romberg test does show some balance related problems, as it is only a gross measure of ataxia, it flags fewer brain injury survivors with balance problems than there are. In the Romberg, the patients is asked to stand with feet together and eyes closed.  A positive sign occurs when a swaying, or taking a step occurs. The point is whether the survivor becomes more unsteady when the eyes are closed.

But vestibular problems, those that involve the inner ear are far more complex than the ataxia shown by a Romberg. Primary vestibular problems come from inner ear deficits or as a result of the eyes inability to focus properly when the head is in motion. Thus, after any significant brain injury, the patient should be referred to a neurootologist, a specialized ear, nose and throat doctor who is an expert in spotting balance problems and a condition called nystagmus. To spot nystagmus, video goggles which record the movement of the eyes when the head is maneuvered work best. Other tests that may be performed by a neurootologist are the ENG test, the rotary chair test and the posture platform test.

Neuropsychologists are Cognitive Specialists

As said elsewhere on the pages, the role of the neuropsychologists has a higher hierarchy amongst the brain injury experts than it should. Neuropsychologists are experts in measuring the cognitive changes after brain injury, but rarely evaluate the full behavioral and mood changes that should also fall into their domain. As psychologists, one would think that human behavior and mood would be part of the specialty of neuropsychology, but far too many neuropsychologists believe that their test that measures cognitive function give them the full picture. Only if the neuropsychologist uses the formal test data as a reference point to a full subjective analysis of the full spectrum of the disability, do their opinions reach an opinion that encompasses the disability.

The cognitive analysis of the neuropsychological exam can illuminate those issues, but it works much better after a severe brain injury than a mild brain injury. In a mild brain injury, there are only a few measures that would be expected to be changed, with the overall picture likely to look very average. Average does not mean normal, as the brain injury person before injury may not have been average.

Speech and Language Pathologists are the Experts at Brain Injury Treatment

Speech pathologists have the longest history and most experience of treating brain injury survivors, which means they should be an indispensable member of the team of  brain injury experts. The development of speech pathologists at the center of the brain injury treatment team probably relates to the focus on historic allocation of virtually all treatment dollars to severe brain injury recovery. In a severe brain injury, there is a great need for speech and language rehabilitation.  As speech pathologists have the most history treating brain injury survivors, they also have listened to the survivors more than any other specialty. Thus, speech pathologists actually get it. They understand that there is more to recovery than language skills and often are at the center of therapy for all types of brain injury symptomatology, especially those things that rarely show on neuropsychological testing.

A simple test to see if the lawyer you are considering hiring or have hired is truly a brain injury expert: Ask him to explain why the speech pathologist is important. If the answer is something vague about speech, the lawyer is probably clueless.

Other brain injury experts which may be needed in a particular case are the neuropsychiatrist and the neuroradiologist. On the economic side of the personal injury case, a vocational expert, an economist and life care planner are critical.


Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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