1. Winning a Traumatic Brain Injury Case Presented by: Richard H. Adler Attorney at Law Adler Giersch PS Using Lay Witness Illustrations New Laws Practice Pointers Imaging Neuropsychologist

2. I. Magnitude of the Problem

3. II. Using Before and After Witnesses

4. 1. Top Reasons to use Before/After Lay Witnesses

5. 2. When to Obtain Before and After Lay Witness Statements

6. 3. Who are Good, Qualified Before and After Witnesses?

7. 4. Effectively Communicating with Before and After Witnesses

8. 5. Some Examples of Open-Ended Questions for Lay Witnesses

9. III. New Law

10. 1. HB 2055 Effective 07/22/07

11. 2. Lystedt Law

12. IV. Illustrations and TBI Cases

13. V. Ethnical Concerns in Handling Traumatic Brain Injury Cases: Knowledge Skill, Thoroughness and Preparation

14. “Rule 1.1 COMPETENCE A lawyer’s shall provide competent representation to a client. Competent representation requires the legal knowledge, skill, thoroughness, and preparation reasonably necessary for the representation.” Rules of Professional Conduct (RPC) page 223

15. VI. Effectively Challenge the “No LOC” (loss of consciousness) Dilemma

16. VII. Initial Considerations on Handling A TBI Case 1. Liability 2. Training and Dispatching an Investigator 3. Assess Your Client 4. Develop Theme of Pre TBI vs. Post TBI

17. 5. Change Your Thinking Mild does not mean minor Mild does not mean minor Mild-moderate-severe-continuum Mild-moderate-severe-continuum Is it possible to have mild neurological injury and: Is it possible to have mild neurological injury and: Mild functional impairment? Yes Mild functional impairment? Yes Moderate functional impairment? Yes Moderate functional impairment? Yes Severe functional impairment? Yes Severe functional impairment? Yes

18. VIII. Acceleration-Deceleration Forces and Impact on Grey/White Matter

19. A. Head and brain in neutral position prior to impact B. Initial impact from behind causing front of brain to impact anterior aspect of skull.

20. A. The contre-coup injury to the brain occurs when the brain strikes the skull on the opposite side of impact. Once the skull has stopped moving the brain continues striking the front of the skull. B. The coup injury to the brain occurs when the brain strikes the skull on the opposing side of impact.

21. Other Considerations to think about in understanding the role of acceleration-deceleration injuries with TBI

22. 1. Hard tissue (bone) breaks and does not tear; soft tissue (cell, tissue, ligament, disc) tears, but does not break. 2. The white matter of the brain is closest to the center. 3. Grey and white matter in the brain have different “inertia” variables.

23. Cont’d 4. The frontal and temporal lobes of the brain, the major speech and language areas, often receive the most damage because they sit in pockets of the skull that allow more room for the brain to shift and sustain injury. 5. During rapid acceleration and deceleration, the effect of centrifugal force may result in tissue tear hemorrhages (small tears of the white matter).

24. Cont’d 6. Tearing or shearing injuries may take place at the time of the initial injury or it may take as long as 24 to 48 hours for the process to be completed. 7. Nerves and tissues, when pulled or stretched in a slow manner, can oftentimes result in no injury. 8. Injuries are diffuse throughout the brain and not focal or centralized

25. Cont’d 9. The structure of a brain cell contains synapses. At the end of the connectors are neurotransmitters. 10. Cranial nerves travel through the holes in the skull bone.

26. IX. Excitotoxicity Injuries

27. X. Responding to the Negative MRI/CTs: Normal Brain Structure Does Not Mean Normal Brain Fracture

28. XI. Rebutting the “Normal” Neurological Exam by the IME/DME Neurologist

29. XII. Effectively Communicating with your Neuropsychologist 1. Questions to ask your neuropsychologist 2. Neuropsychologists find it useful to have all school records

30. XIII. Neuropsychological Assessments for Traumatic Brain Injury 1. Executive Function 2. Language Skills 3. Verbal Memory 4. Attention 5. Organizational Efficiency, Visual-Motor Memory and Retention of Motion Information 6. Sensory-Motor 7. Emotional Status

31. XIV. Responding to the “Malingering” Label

32. Richard H. Adler Attorney at Law Adler Giersch PS 333 Taylor Ave N. Seattle, WA 206.682.0300 radler@adlergiersch.com www.adlergiersch.com