ABSTRACT
Awareness Following Brain Injury ............................................................... 15 1.6 Special Assessment Considerations in Mild TBI Cases ............................... 17 References ................................................................................................................ 19
The incidence of brain injury in the U.S. has been estimated to be in excess of 10 million new cases each year (Hartlage, 1990). Approximately 1.5 million Americans sustain head injuries requiring medical attention each year, with roughly half of these requiring hospitalization as a result (Davis, 1990). The incidence of traumatic brain injury (TBI) in the U.S. continues to grow despite many state and national prevention initiatives. Both the medical professional community and the lay population have become increasingly aware of the prevalence of traumatic brain injury and, to some degree, its clinical sequelae. Even more relevant to the readers of this text is the fact that a number of lawsuits and forensic cases related to traumatic brain injury have increased exponentially over the past decade. Certainly the TBI caseload percentage of neuropsychologists and select neurologists has also increased dramatically. The purpose of this chapter is thus to provide a general overview of the forensic assessment issues in cases of traumatic brain injury. The etiologies of TBI are quite varied, but include motor vehicle accidents, falls, on-the-job injuries, and assault. In the forensic evaluation, it is critical for clinical and legal professionals to
have a clear set of criteria for and definition of TBI. In the medical, neuropsychological, and legal literature, there are a variety of definitions and criteria set forth on the matter of TBI; however, existence and severity of a TBI are usually established by the following (Evans, 1992; Esselman and Uomoto, 1995):
1. The occurrence and period of loss of consciousness 2. The degree of loss of memory for events immediately before or after the
accident 3. The degree and duration of alteration in mental state at the time of the
accident 4. The degree of focal neurological deficits (which may or may not be transient)
It needs to be emphasized that in both the research and clinical settings, various definitions and criteria continue to be used for specific diagnosis and classification of traumatic brain injury. Both standardized and less formalized methods are used as part of the classification and identification of such. Some of the more commonly used assessment tools and clinical terminology in the diagnosis and classification of traumatic brain injury are discussed in later sections of this chapter. It should also be remembered that, depending on the setting and clinician making the diagnosis, other terms may be used in lieu of traumatic brain injury. Other terms or diagnoses equivalent to traumatic brain injury may include closed head injury (CHI), concussion, head trauma, or brain trauma.
