Safety and Health Reporter
Brien Roche Law > Blog > Personal Injury > Cross Examining Brain Injury Experts

Cross Examining Brain Injury Experts

Fairfax Injury Lawyer Brien Roche Addresses Brain Injury Experts

Brien Roche

Brain injury experts may be either neurologists, neurosurgeons or neuropsychologists.  The proposed cross examination below is designed for the first two. Cross of a neuropsychologist must be further refined to avoid the chance of the witness giving opinions on cause of TBI. In addition neuropsychological exams are addressed on this site. This cross-examination should be reviewed with other pages on this site: cross-examination,cross-examining experts, cross-examining defense medical experts, standard of care..

In cross examining neurologists and neurosurgeons you must define some basic terms and proceed from there. The cross may proceed as follows:

Defining Terms With Brain Injury Experts

  • First of all a traumatic brain injury is defined in the Clinical Practice Guidelines of the Veterans Administration and the Department of Defense as having several facets.  One of those facets is any alteration in mental state at the time of the injury.
  • The guidelines use the terms “concussion” and “mild to moderate traumatic brain injury” interchangeably.
  • A widely accepted definition of a mild traumatic brain injury from the American Congress of Rehabilitation Medicine is that patients with mild traumatic brain injuries can exhibit persistent emotional, cognitive, behavioral and physical symptoms alone or in combination, which may produce a functional disability.
  • The Concussion Quick Check by the American Academy of Neurology states that loss of consciousness occurs in less than 10% of people with concussion.
  • Also the Virginia state regulations define a traumatic brain injury as to a child at 8 VAC 20-81-10:“Traumatic brain injury” means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s educational performance. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma. (34 CFR 300.8(c)(12). The federal regulation is the same.

Loss of Consciousness

Loss of consciousness is an important marker to you:

  • If you lost consciousness right now how would you know
  • Isn’t it true that all you would really know is that there is a gap in your memory
  • Also if there are no witnesses observing the person isn’t it tough to know if there was a loss of consciousness
  • Symptoms

    The symptoms that may be associated with a concussion or mild to moderate traumatic brain injury are

    • Physical:  headache, nausea, vomiting, dizziness, fatigue, blurred vision, sleep disturbance, sensitivity to light or noise, balance problems, transient neurological abnormalities.
    • Cognitive:  attention, concentration, memory, speed of processing, judgment, executive function.
    • Behavioral/emotional:  depression, anxiety, agitation, irritability, impulsivity, aggression.

    Setting the Baseline With Brain Injury Experts

    • Did you review the plaintiff’s prior medical records and other records that establish the baseline?
    • Establish what the baseline of the plaintiff is.  Ask the witness exactly what he knows about the client’s prior condition.
    • Did the expert conduct the global assessment of functioning?
    • If he did not then have him do that on the witness stand.
    • Does he have any knowledge of problems that the client was having at home or work prior to the injury?
    • Any evidence of problems that the client’s family, friends or fellow employees reported prior to the injury?
    • Did you take statements of any of these family members?
    • Would you agree that the level of functioning of the plaintiff prior to the injury would put him in the 90 – 100 range which is the range of superior functioning?
    • Finally using another copy of the same visual aid referred to above have the witness cross off all the symptoms for he has no proof existed before the injury.

    Symptoms of the Plaintiff

    Using a visual aid that contains all of the symptoms above circle all of the symptoms the plaintiff has complained of.

    • The symptoms that the plaintiff has complained of meet the criteria for a mild traumatic brain injury.
    • The neuropsychological testing demonstrated many of these same symptoms. On your visual aid mark the symptoms borne out by the neuropsychological testing.
    • The neuropsychological testing is objective.
    • Have the witness acknowledge that the plaintiff has complained of attention and concentration disorders.
    • Also attention and concentration issues are cognitive deficits that are consistent with mild traumatic brain injury.

    Rule Out the Negatives With Brain Injury Experts

    • A brain injury can occur even though there has been no blow to the head;
    • There does not have to be a loss of consciousness to sustain a brain injury.
    • You can’t reject the diagnosis of traumatic brain injury because there has been no loss of consciousness.
    • Also a normal neurological examination does not rule out a traumatic brain injury.
    • MRI and CT scans are often normal on a patient who has suffered a mild traumatic brain injury.
    • MRI and CT scans are often not sensitive enough to detect brain damage.
    • The reason that a doctor orders an MRI or CT is to look for a brain bleed.
    • Finally doctors often fail to diagnose TBI, even when the patient has sustained such.

    The Future

    • These symptoms can affect the client’s activities of daily living.
    • A person with a TBI may experience the symptoms for a long time.
    • Some people with traumatic brain injuries never recover.
    • Also people with these problems can experience difficulties at work.

    Higher Risk Patient

    • Does the plaintiff have a history of psychiatric issues?
    • Would you agree that people with a history of depression or anxiety have worse outcomes following an injury?
    • Is a history of depression a risk factor for a poorer outcome following a traumatic brain injury?
    • If the client has any prior history of psychiatric conditions then that is a preexisting condition which puts the client at a higher risk for a poor outcome.
    • Could the plaintiff’s history explain why she has not fully recovered?
    • In addition would a person such as this plaintiff be expected to have a worse outcome than someone with no history?

    Personal Experience

    • Ask the doctor how many TBI patients he has treated over the last 3 years.
    • Move on to another topic and then 30 minutes later come back and ask the doctor how many of those patients he reported to the Virginia DMV as being unable to drive.
    • Also if time permits and this question was asked during deposition then subpoena the DMV to confirm whether or not he is telling the truth.
    • The witness testified that the client fully recovered from any injury within 6 months of the injury.  Is that based upon the population statistics that 85% – 90% of people with mild traumatic brain injury fully recover within the first 6 months.
    • Finally this would mean that 10-15% do not recover

    Call, or contact us for a free consult. Also for more info on this issue see the Wikipedia pages.

    Comments are closed.

    Contact Us For A Free Consultation

    Cross Examining Brain Injury Experts

    Fairfax Injury Lawyer Brien Roche Addresses Brain Injury Experts

    Brien Roche

    Brain injury experts may be either neurologists, neurosurgeons or neuropsychologists.  The proposed cross examination below is designed for the first two. Cross of a neuropsychologist must be further refined to avoid the chance of the witness giving opinions on cause of TBI. In addition neuropsychological exams are addressed on this site. This cross-examination should be reviewed with other pages on this site: cross-examination,cross-examining experts, cross-examining defense medical experts, standard of care..

    In cross examining neurologists and neurosurgeons you must define some basic terms and proceed from there. The cross may proceed as follows:

    Defining Terms With Brain Injury Experts

    • First of all a traumatic brain injury is defined in the Clinical Practice Guidelines of the Veterans Administration and the Department of Defense as having several facets.  One of those facets is any alteration in mental state at the time of the injury.
    • The guidelines use the terms “concussion” and “mild to moderate traumatic brain injury” interchangeably.
    • A widely accepted definition of a mild traumatic brain injury from the American Congress of Rehabilitation Medicine is that patients with mild traumatic brain injuries can exhibit persistent emotional, cognitive, behavioral and physical symptoms alone or in combination, which may produce a functional disability.
    • The Concussion Quick Check by the American Academy of Neurology states that loss of consciousness occurs in less than 10% of people with concussion.
    • Also the Virginia state regulations define a traumatic brain injury as to a child at 8 VAC 20-81-10:“Traumatic brain injury” means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s educational performance. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma. (34 CFR 300.8(c)(12). The federal regulation is the same.

    Loss of Consciousness

    Loss of consciousness is an important marker to you:

  • If you lost consciousness right now how would you know
  • Isn’t it true that all you would really know is that there is a gap in your memory
  • Also if there are no witnesses observing the person isn’t it tough to know if there was a loss of consciousness
  • Symptoms

    The symptoms that may be associated with a concussion or mild to moderate traumatic brain injury are

    • Physical:  headache, nausea, vomiting, dizziness, fatigue, blurred vision, sleep disturbance, sensitivity to light or noise, balance problems, transient neurological abnormalities.
    • Cognitive:  attention, concentration, memory, speed of processing, judgment, executive function.
    • Behavioral/emotional:  depression, anxiety, agitation, irritability, impulsivity, aggression.

    Setting the Baseline With Brain Injury Experts

    • Did you review the plaintiff’s prior medical records and other records that establish the baseline?
    • Establish what the baseline of the plaintiff is.  Ask the witness exactly what he knows about the client’s prior condition.
    • Did the expert conduct the global assessment of functioning?
    • If he did not then have him do that on the witness stand.
    • Does he have any knowledge of problems that the client was having at home or work prior to the injury?
    • Any evidence of problems that the client’s family, friends or fellow employees reported prior to the injury?
    • Did you take statements of any of these family members?
    • Would you agree that the level of functioning of the plaintiff prior to the injury would put him in the 90 – 100 range which is the range of superior functioning?
    • Finally using another copy of the same visual aid referred to above have the witness cross off all the symptoms for he has no proof existed before the injury.

    Symptoms of the Plaintiff

    Using a visual aid that contains all of the symptoms above circle all of the symptoms the plaintiff has complained of.

    • The symptoms that the plaintiff has complained of meet the criteria for a mild traumatic brain injury.
    • The neuropsychological testing demonstrated many of these same symptoms. On your visual aid mark the symptoms borne out by the neuropsychological testing.
    • The neuropsychological testing is objective.
    • Have the witness acknowledge that the plaintiff has complained of attention and concentration disorders.
    • Also attention and concentration issues are cognitive deficits that are consistent with mild traumatic brain injury.

    Rule Out the Negatives With Brain Injury Experts

    • A brain injury can occur even though there has been no blow to the head;
    • There does not have to be a loss of consciousness to sustain a brain injury.
    • You can’t reject the diagnosis of traumatic brain injury because there has been no loss of consciousness.
    • Also a normal neurological examination does not rule out a traumatic brain injury.
    • MRI and CT scans are often normal on a patient who has suffered a mild traumatic brain injury.
    • MRI and CT scans are often not sensitive enough to detect brain damage.
    • The reason that a doctor orders an MRI or CT is to look for a brain bleed.
    • Finally doctors often fail to diagnose TBI, even when the patient has sustained such.

    The Future

    • These symptoms can affect the client’s activities of daily living.
    • A person with a TBI may experience the symptoms for a long time.
    • Some people with traumatic brain injuries never recover.
    • Also people with these problems can experience difficulties at work.

    Higher Risk Patient

    • Does the plaintiff have a history of psychiatric issues?
    • Would you agree that people with a history of depression or anxiety have worse outcomes following an injury?
    • Is a history of depression a risk factor for a poorer outcome following a traumatic brain injury?
    • If the client has any prior history of psychiatric conditions then that is a preexisting condition which puts the client at a higher risk for a poor outcome.
    • Could the plaintiff’s history explain why she has not fully recovered?
    • In addition would a person such as this plaintiff be expected to have a worse outcome than someone with no history?

    Personal Experience

    • Ask the doctor how many TBI patients he has treated over the last 3 years.
    • Move on to another topic and then 30 minutes later come back and ask the doctor how many of those patients he reported to the Virginia DMV as being unable to drive.
    • Also if time permits and this question was asked during deposition then subpoena the DMV to confirm whether or not he is telling the truth.
    • The witness testified that the client fully recovered from any injury within 6 months of the injury.  Is that based upon the population statistics that 85% – 90% of people with mild traumatic brain injury fully recover within the first 6 months.
    • Finally this would mean that 10-15% do not recover

    Call, or contact us for a free consult. Also for more info on this issue see the Wikipedia pages.

    Contact Us For A Free Consultation

    Contact Us For A Free Consultation