Table of Contents
Chapter 1: Pre-Trial by Paul
R. Wiesenfeld, J.D.................................................................1
Chapter 2: Trial by Paul R.
Wiesenfeld, J.D...............................................................
17
Chapter 3: The Biomechanics
of a Traumatic Brain Injury by Doctors John Rosa,
D.C., and Rick Rosa, D.C................................37
Chapter 4: The Neurological
Aspects of a Brain Injury by Peter G. Bemad, M.D..................................................................51
Chapter 5: The Neuropsychological
Effects of a Brain Injury by Marvin H. Podd, Ph.D.................................................................59
Chapter 6: Mild Traumatic Brain
Injury by Mark Sementilli, Ph.D.................................................................
83 ,
Chapter 7: An Overview of the
Neuropsychological Aspects of Traumatic Brain
Injury
by Vincent P. Culotta, Ph.D ...........................................................
103
Chapter 8: Psychiatric Sequelae
of Traumatic Brain Injury by Allan Z. Schwartzberg,
M.D.....................................................
125
ACKNOWLEDGEMENTS
This book would not have been possible without
the help, guidance and friendship of Dr. Lewis
Eigen.
The Medical and Legal Aspects of a Brain
Injury I
PREFACE
The last frontier of science" and "the
most complex • structure in the known universe"
are just a few of the JL. statements dedicated
professionals have made about the human brain.
While both are true and both dignify nature's
most wondrous creation, the statements still underestimate
the beauty, majesty and mystery of our brain.
The physical entity of our brain can be held
in one hand, but who can hold an "idea"
or measure a "thought"? Where does the
mind begin and the brain end? Can we make ourselves
sick? Can we make ourselves better? However interesting
and constructive these questions may be,
they do not begin to tell us what the brain is,
what initially turns it on and what it can
do.
For the lawyer, even one with extensive trial
experience, a traumatic brain injury (TBI) case
is a test of will and purpose, of resolution and
character. In no other kind of case is a trial
lawyer's skill as tested or knowledge probed as
in this type of case. If one were ever to get
organized, this is the time to do it. If one were
ever to become eloquent, this is the time, and
finally, if one were to discover the necessity
for patience, this is most definitely the time.
When we talk about the expenses of a trial, none
compare to the financial costs a lawyer must
pay in a case of TBI. Props, exhibits and videos
are just a few of the necessary items the lawyer
must bring to the courtroom. One must know the
difference between a diagram and a diagnosis,
a brain stem and a stem cell.
When the brain is damaged, there is no tool available
for the surgeon to come and fix it. The prosthesis
for a damaged brain is another brain. Just as
no two people are alike, no two brains are alike.
We depend on nature and nurture to fix an injured
brain. Drugs can help, as can therapy. Trial and
error, effort and hope must also be thrown into
the mix.
When a medical doctor testifies in a TBI case,
he or she may say, with all due humility, "Look,
Mr. Wiesenfeld, we just don't know exactly how
it works or why it works the way it does and if
it will ever work the same as before." Techniques
of brain repair are primitive. There is no
machine so finely tuned that it can look into
the 'brain and tell us exactly what's going on.
Even if there were, we still would not know what
to do with the information.
At a trial in which the injury is a broken arm
or leg, the doctor can put an X-ray up on a light
screen and say, "See! This is what happened."
In a TBI case, no one can see the injury. Because
we can't see it, we have to infer it, estimate
its manifestations and make a guess, albeit an
educated one, on its effect. Inference, vagueness,
a lack of clarity and uncertainty are the plaintiff
lawyer's greatest nightmares.
The plaintiff can look good, and this appearance
can be terribly deceptive. He or she can
even speak well, and this is an even greater problem
to overcome. But the brain, like an atom if broken
or split, causes an explosion of misery and pain
that is horrendous. '
Family, relatives and friends of the person who
suffered from a brain injury will feel the devastation
almost as much as the injured party. If a divorce
should come—and one is likely—it is
the injured party who will seek it. Society may
not recognize the problem for what it is. When
the community has been made aware that one of
its own was hurt, it's usually too late.
The Medical and Legal Aspects of a Brain
Injury III
A magnificent challenge is afforded to the lawyers
who handle i». cases. Tell us, cries the
audience, what exactly is the injury? Show us,
they demand. Prove it is the brain that was injured
and not that the person is malingering or just
not trying hard enough.
We know the effect well enough; it's the cause
that creates "the drama.
With knowledge comes power. Today, we have the
power to cross the last frontier. When it's finally
crossed, that power has to change into compassion
and understanding so that the victim of a TBI
is not left alone and misunderstood.
Paul R. Wiesenfeld
Why is a thought, a secretion
of the brain, more wonderful than gravity, a secretion
of matter? It is our arrogance, our admiration
of ourselves."
Charles Darwin
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