Mild Traumatic Brain Injury (MTBI)

What is MTBI?

Brain Injury

Mild traumatic brain injury (MTBI) is in the news especially with the discussion of concussions in sports like football, soccer, hockey and rugby. The Centers for Disease Control and Prevention (CDC) defines a concussion as "a type of traumatic brain injury or TBI caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a "ding," "getting your bell rung," or what seems to be mild bump or blow to the head can be serious." We have learned lately that repetitive "minor" trauma can cause serious future cognitive problems known as cognitive traumatic encephalopathy (CTE).

A good source of information on CTE is Christopher Nowinski's Head Games which focuses on the long term problems of NFL players.

Two places to learn more about MTBI are the CDC at and The American Academy of Neurology at

The message is that a concussion is a brain injury and all brain injuries are serious despite how they are categorized. Concussions are a type of acquired brain injury (ABI) and doctors have applied a rating system called the Glasgow Coma Scale (GCS) to categorize concussions or TBI's into three areas of severity: Mild (GCS 13-15), Moderate (GCS 9-12) and Severe (GCS <9). Despite the initial rating of the concussion or TBI, the true test of the severity of injury is how long its effects alter a person's ability to operate in the real world.

Some common disabilities from TBI include cognition problems (memory, thinking and reasoning), sensory processing (sight, hearing, taste, smell and touch), communication (ability to comprehend and speak), behavior (depression, anxiety, aggression, personality changes) and physical problems like headaches. Neuropsychologists and neuropsychiatrists are appropriate doctors for these types of residual problems.

These injuries may also appear on PET scans or DTI (diffusion tensor imaging) scans.

It is established that one can sustain a MTBI without losing consciousness, with a normal CT and MRI studies and with a normal neurological examination. Nevertheless, insurance companies, defense lawyers and their experts, attempt to minimize the effects of a MTBI by emphasizing the lack of loss of consciousness, normal radiological studies and exams despite the medical literature. The CDC has made it clear that "MTBI symptoms may appear mild, but they can lead to significant, life-long impairment in an individual's ability to function physically, cognitively and psychologically."

Each case of MTBI is unique so it is difficult to draw conclusions about its long term effects. However the CDC states that as many as 75% of all brain injured people sustain MTBIs. Lifelong problems include persistent headache, confusion, pain, cognitive and/or memory problems, fatigue, changes in sleep patterns, mood changes and/or sensory problems as outlined above. The CDC correctly points out that the majority of people diagnosed with MTBI recover fully and depending on the seriousness of the blow, can recover within weeks or six to twelve months. However, there is a group of victims who make up about 15% of those diagnosed with MTBI who experience "persistent disabling problems". This group is referred to as the "miserable minority."

Of course, one can have a skull fracture or a bleed on the brain (e.g. subdural hematoma, epidural hematoma) and get a diagnosis of MTBI. Complicating factors such as this often lead to a more serious prognosis.

What should you do if you have been diagnosed with an MTBI?

If this diagnosis is related to an activity, an incident which you believe might involve the fault of another person or entity or a faulty product (e.g. helmet), you need to contact Abramson Smith Waldsmith immediately. The reason for the early contact is to preserve the evidence and also to insure that you get the appropriate medical treatment. This includes getting the best radiological scans to preserve evidence of your injury. It also includes getting the appropriate therapy and neuropsychological consultation that you need to get better. It might also include educational consultation if the injured person is a student.

With respect to school aged children, accommodations (limitations on homework, increased time to take tests and grade modification) may be necessary to enable your child to stay in school. The first thing you must request is consideration of a "504 Plan". This is a written plan pursuant to the federal Rehabilitation Act, Section 504, which offers all children with disabilities equal access to education. The 504 committee in your school creates a plan for your child which includes all accommodations.

The second tier of help in school is seeing if your child qualifies for an Individualized Education Plan (IEP). An IEP is a customized educational plan for a student who qualifies for special education. The Individuals with Disabilities Education Act (IDEA) was made the law of the land in 2000. It requires schools to provide IEPs for qualifying students. IDEA has thirteen categories of qualifying disabilities and "traumatic brain injury" is one of them. Once your child qualifies for special education, you will move beyond the 504 Plan.

You may find that your school is not as knowledgeable about your child's rights as it should be. Consultation with Abramson Smith Waldsmith will insure that your child gets everything that he/she is entitled to while dealing with the effects of a traumatic brain injury. We retain consultants who are experts in this field to assist you in maximizing your child's benefits.

Contact Us

For more information about mild traumatic brain injuries or to schedule a free initial consultation with an experienced personal injury lawyer, contact Abramson Smith Waldsmith, LLP. Or call us at 415-421-7995 or toll free at 888-745-2988.