Explaining Traumatic Brain Injury in Court
Michael V. Kaplen: One of the most important aspects of a brain injury case is explaining to a jury how the brain is injured in an accident.
In order to do this, I need to show a model of the brain to the jury and first explain something about the physical make up of the brain itself.
The brain is a very soft and delicate structure sort of like the mushy consistency of Jell-o or oatmeal. So, it is easily subject to being bruised or injured instead of be bruised or injured. Further, each layer of the brain has a different consistency or density so that when the brain moves, each layer moves at a different rate of speed.
Sought of like when throwing a whiffle ball and a hard ball. They both are the same size and shape, but each moves at a different speed.
Like the yoke of an egg, the brain is damaged by shaking and while frequently, the inside yoke is damaged and the inside brain is damaged, the outside, the shell or the skull remain intact without any damage.
The brain sits in the skull. While people think that the skull provides a lot of protection to the brain, which in some respects it does, It also provides a source of damage to the brain itself because the inside of the skull has many sharp ridges and protrusions which can easily be seen and felt.
So the brain sits in the skull surrounded by fluid, known as cerebral spinal fluid which acts as a shock absorber to normal day to day movements.
When there is an accident– The individual’s head rapidly moves forward or backwards or is twisted to the side within the skull and the brain also moves within the skull and this is when the damage to the brain tissue takes place.
The movement of the brain within the skull causes injury to tiny microscopic nerve fibers. As a result of the movement of the brain within the skull, the brain brushes up against these sharp ridges and protrusions that we discussed causing the brain to become bruised and causing the nerve fibers to become disrupted, to become torn and even to die.
Not all brain injury takes place at the point of impact and we have to learn something about two French terms known as coup and contra coup.
These terms help to explain that sometimes the injury to the brain occurs at the site of impact–this is known as a coup and at other times injury takes place on the opposing side of the brain, which is known as a contra coup injury.
It all depends on what is moving, the brain or the object that strikes the brain.
For instance, if you fall backwards and strike your head on the ground, the point of impact is the coup injury and the other side of the brain after it bounces forward and backward in the skull is known as the contra coup injury.
When it’s the brain that is moving and hitting a fixed solid object such as the ground or the dashboard of the car, you get a small coup injury and a bigger contra coup injury.
But, if it is a moving object that strikes the skull which is stationary, like if a baseball bat hits a player standing still, you get a bigger coup injury at the point of impact and a smaller contra coup injury on the other side of the brain.
The most vulnerable portions of the brain to injury within the skull are here where the frontal lobes and the temporal lobes sit.
The frontal lobes and the temporal lobes, are responsible for all of our emotions, our executive functioning–our ability to shift focus between different tasks, our memory and concentration and our personality.
These are the lobes that are most often affected by the movement of the brain within the skull.
Other damage to the brain takes place as a result of chemical changes within the brain. As the nerve fibers of brain cells stretch and break, they set off chemical reactions that slowly take place over time. These chemical changes often damage and kill nerve cells causing more brain damage to take place.
There are also other structures deep within the brain that are also very vulnerable to injury as a result of the brain’s movement within the skull.
One of these structures is the hippocampus region of the brain which is the switching station between the right side of the brain and the left side.
While some of the injuries may show up on CT scans or MRI studies, frequently the injuries are so microscopic that they do not show up. This does not mean that the injury did not take place, but only that the testing equipment that we have is not sensitive enough to pick up the microscopic structural damage that has taken place.
In experiments in monkeys and in looking at autopsies of the brain, we are able to document this damage to the brain tissue and determine how it took place.
A brain injury attorney needs to know how to explain the mechanism of brain injury and brain damage to a jury to properly represent his or her client.