more sensitive than the current Diffuse Ten- sor Imaging (DTI) technology.26 Other footprints are being discovered, including footprints in the blood. For ex- ample, patients with TBI have been shown to have significantly higher levels of glial fi- brilary acidic protein (GFAP) than patients without such injuries, a finding that has led to work on diagnostic blood tests. Not sur- prisingly, some of this work has been fund- ed by the Department of Defense and, to some extent, the National Institutes of Health.27
We still know, however, that many injuries exist without obvious footprints and cannot be fully confirmed until autopsy. The proof of brain injury can be one of the most complex and challenging tasks of a trial lawyer, a task requiring up-to-the-mo- ment knowledge of the rapidly evolving re- search. Fortunately, the future holds great promise for making this task less daunting. ____________________ Robert Luce, Esq., is chair of the litigation
group at Downs Rachlin Martin PLLC. For the last twenty years he has represented plaintiffs in serious personal injury cases, fo- cusing on brain and spinal cord injuries. Bob serves on the board of the Brain Injury As- sociation of Vermont.
See Molly A. Burgess, New Developments Lead to Early TBI Detection (Apr. 2, 2010), http://www.defense.gov/news/newsarticle
The University of North Carolina’s “Center
for the Study of Retired Athletes” has focused on this issue. Several research papers can be ac-
cessed on its website at www.csra.unc.edu
The research of the “Center for the Study of
Traumatic Encephalopathy” at Boston Univer- sity, as well as good background information on sports concussions, can be found at www.
Ann C. McKee et al., Chronic Traumatic En- cephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury, 68 J. NEUROPATHOL-
Centers for Disease Control, Injury Prevention & Control: Traumatic Brain Injury, http://www. cdc.gov/TraumaticBrainInjury
(last visited Mar.
OGY & EXPERIMENTAL NEUROLOGY 709, 709 (2009). 5
19, 2012). 6
Centers for Disease Control, Report to Con-
gress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem, http://www.cdc.gov/traumaticbrainin-
Centers for Disease Control, Heads Up: Con- cussion in Youth Sports, A Fact Sheet for Coach- es, http://www.cd
Centers for Disease Control, Injury Prevention
& Control: Traumatic Brain Injury—Concussion, http://www.cdc.gov/concussion/signs_symp-
cians, at p. 2, http://www.cdc.gov/concussion/
Centers for Disease Control, Facts for Physi- /Facts_for_Physicians_booklet-a.
Id. at p. 3.
11 Id. at p. 4. 12 Id. at p. 6. 13 Id. at p. 7.
ry, supra note 8. 15
14 CDC, Facts About Concussion and Brain Inju- Id.
16 CDC, Report to Congress, supra note 6.
Ronald M. Ruff et al., Recommendations for Diagnosing a Mild Traumatic Brain Injury: A Na- tional Academy of Neuropsychology Education Paper, 24 ARCHIVES OF CLINICAL NEUROPSYCHOLOGY 3,
5 (2009). 18
19 This is not a complete list of focal signs of in- Ruff et al., supra note 17, at p. 7.
jury, only the most common ones. 20
See, e.g., Nils R. Varney et al., Quantitative PET Finding in Patients with Posttraumatic An- osmia, 16 J. HEAD & TRAUMA REHABILITATION 259
This is addressed in Thomas W. McAllister,
Mild Brain Injury and the Postconcussion Syn- drome, in TEXTBOOK OF TRAUMATIC BRAIN INJURY 279, 300-01 (Jonathan M. Silver et al. eds., 2005). Dr. McAllister is a neuropsychiatrist practicing at
Dartmouth Medical Center. 23
MURIEL D. LEZAK, NEUROPSYCHOLOGICAL ASSESSMENT 771-72 (4th
24 DAVID I. GRAHAM & PETER L. LANTOS, GREENFIELD’S NEUROPATHOLOGY 197 (6th
ed. 1997). 25 Stefanie Rosema et al., Social Function in Chil-
dren and Adolescents After Traumatic Brain In- jury: A Systematic Review 1989-2011, 29 J. NEUROTRAUMA (forthcoming 2012), available at http://online.liebertpub.com/doi/abs/10.1089/
Samuel S. Shin et al., High-Definition Fiber
Tracking for Assessment of Neurological Def- icit in a Case of Traumatic Brain Injury: Find- ing, Visualizing and Interpreting Small Sites of Change, 116 J. NEUROSURGERY (forthcom- ing 2012), available at http://thejns.org/doi/
Drissa Zongo et. al., S100-B Protein as a
Screening Tool for the Early Assessment of Minor Head Injury, 59 ANNALS EMER. MED. 209 (2012).
THE VERMONT BAR JOURNAL • SPRING 2012
Proving a “Mild” Traumatic Brain Injury
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