February 2025
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Traumatic brain injuries (TBIs) are among the most complex and impactful injuries encountered in injury cases. These injuries often lack visible symptoms, yet profoundly affect a person’s quality of life. Incorporating advanced medical insights from biomechanics, vestibular science, neurovisual medicine, and subconcussive injury research into legal strategies can provide attorneys with compelling evidence to prove causation, highlight injury severity, and secure appropriate compensation for their clients.
The Science of Biomechanics: Linking Accidents to Brain Injuries
Biomechanics provides critical insights into how physical forces from an accident lead to brain injuries. In TBI cases, understanding these mechanisms is essential for connecting the injury to the event: Rotational Forces and Axonal Damage: Research shows that rotational accelerations—often more damaging than linear forces—are the primary cause of diffuse axonal injuries (DAIs). These injuries occur when nerve fibers stretch or tear due to the brain’s movement within the skull, a common scenario in motor vehicle accidents and falls.
Subconcussive Impacts: Even impacts that do not cause fullblown TBIs can result in subtle but lasting brain injuries. Known as subconcussive events, these injuries often go unrecognized but contribute to cumulative neurological deficits over time.1
Quantifying Trauma: Using biomechanical principles such as Newton’s Second Law (Force = Mass × Acceleration) and delta velocity (ΔV), attorneys can demonstrate how the forces involved in an accident were sufficient to cause brain injury.2
By leveraging biomechanical evidence, attorneys can effectively address defense arguments that downplay the severity of the impact.
Vestibular Science: The Role of Balance and Dizziness
Dizziness and balance issues are among the most common yet underdiagnosed consequences of TBIs. These symptoms, often rooted in vestibular dysfunction, significantly affect daily life and recovery.
Peripheral Vestibular Disorders: Injuries to the inner ear structures, such as labyrinthine concussion or benign paroxysmal positional vertigo (BPPV), can cause persistent dizziness and imbalance.
Central Vestibular Dysfunction: Damage to brainstem or cerebellar pathways due to diffuse axonal injury disrupts balance and coordination.3
Proving Impairment in Court:
Objective tests like caloric testing, video head impulse testing (vHIT), and vestibular-evoked myogenic potentials (VEMPs) provide quantifiable evidence of vestibular damage.
Therapeutic Interventions:
Vestibular rehabilitation therapy has shown significant success in treating post-concussive dizziness, underscoring the need for ongoing care and justifying claims for long-term treatment costs4 By presenting vestibular science in court, attorneys can illustrate the debilitating effects of TBIs and the necessity of comprehensive medical care.
NeuroVisual Medicine: Treating Visual-Vestibular Disruptions
Visual symptoms are another frequent yet underappreciated consequence of TBIs. Neurovisual medicine addresses issues like binocular vision dysfunction (BVD), where the eyes fail to work together properly, causing headaches, nausea, and difficulty focusing.
Key Symptoms of BVD:
Headaches, dizziness, and difficulty with depth perception.
Challenges with reading and visual clarity, particularly during close or far tasks.5
Microprism Lenses for Relief:
Advanced treatments such as microprism lenses help realign vision and reduce symptoms. These lenses have been shown to provide up to 80 percent symptom reduction in patients with TBIs.
Legal Implications:
Presenting neurovisual assessments and successful treatment outcomes can strengthen arguments for the long-term impact of the injury and the necessity of ongoing care.6
Subconcussive Events: Expanding the Understanding of Injury
Subconcussive events, defined as impacts that do not cause a full-blown concussion, are gaining recognition for their cumulative effect on neurological health. These events, though subtle, can
Cumulative Effects: Research highlights that even minor, repetitive impacts can result in long-term deficits, making these events particularly relevant in cases involving athletes or multiple accidents 7
Diagnostic Challenges: Advanced imaging and biomarkers are critical for identifying these injuries, which may not be immediately apparent but still cause significant functional impairments. By incorporating evidence of subconcussive impacts, attorneys can broaden the scope of their claims to include less obvious but equally damaging injuries.
Building a Strong Legal Case with Medical Insights
Injury attorneys can enhance their TBI cases by applying advanced medical knowledge:
Strengthening Causation: Use biomechanical evidence to demonstrate how forces from an accident caused brain injuries, addressing common defense claims of insufficient trauma.
Highlighting Invisible Injuries: Incorporate vestibular and neurovisual science to substantiate claims of ongoing impairment and quality-of-life reductions.
Refuting Malingering Claims: Present objective evidence from advanced testing to counter accusations of malingering or exaggeration.
Proving Long-Term Impact: Emphasize the cumulative effects of subconcussive events and the necessity of ongoing therapies to improve recovery prospects.
Conclusion
The integration of biomechanics, vestibular science, neurovisual medicine, and subconcussive injury research equips attorneys with powerful tools to advocate for clients with TBIs.
By leveraging these disciplines, attorneys can present compelling evidence that underscores the full extent of their client’s injuries, ensuring justice and appropriate compensation for their losses.
Our firm has created a guide for TBI related injuries. It can be accessed for free at: https://www. loarpllc.com/.
ENDNOTES
1 Tapia RN, Eapen BC. Rehabilitation of Persistent Symptoms After Concussion. Phys Med Rehabil Clin N Am. 2017 May; 28(2):287-299. doi: 10.1016/j.pmr.2016.12.006. PMID: 28390514.
2 Moghaddam, H. S., Rezaei, A., Ziejewski, M., & Karami, G. (2020). Computational mechanics of traumatic brain injury under impact loads. International Journal of Mechanical Engineering and Robotics Research, 9(7), 917-924. https://doi. org/10.18178/ijmerr.9.7.917-924
3 Gianoli, G. J. (2022). Post-concussive dizziness: A review and clinical approach to the patient. Frontiers in Neurology, 12, 718318. https://doi. org/10.3389/fneur.2021.718318; Doble, J. E., Feinberg, D. L., Rosner, M. S., & Rosner, A. J. (2010).
Identification of binocular vision dysfunction (vertical heterophoria) in traumatic brain injury patients and effects of individualized prismatic spectacle lenses in the treatment of postconcussive symptoms: A retrospective analysis. PM&R, 2(4), 244-253. https://doi.org/10.1016/j. pmrj.2010.01.011
4 (Gianoli, 2022); (Doble et al., 2010).
5 Doble, J. E., Feinberg, D. L., Rosner, M. S., & Rosner, A. J. (2010). Identification of binocular vision dysfunction (vertical heterophoria) in traumatic brain injury patients and effects of individualized prismatic spectacle lenses in the treatment of postconcussive symptoms: A retrospective analysis. PM&R, 2(4), 244-253. https://doi.org/10.1016/j. pmrj.2010.01.011
6 (Doble et al., 2010).
7 Tapia RN, Eapen BC. Rehabilitation of Persistent Symptoms After Concussion. Phys Med Rehabil Clin N Am. 2017 May; 28(2):287-299. doi: 10.1016/j.pmr.2016.12.006. PMID: 28390514.