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Traumatic Brain Injury in Criminal Cases

After Traumatic Brain Injury (TBI), people can experience personality changes, social anxiety, irritability, anger, depression, general anxiety, mood swings, emotional lability, and feelings of being overwhelmed. The bottom line is that the brain no longer functions exactly the way it did prior to the head injury. The location of the injury within the brain also determines these factors as each part of the brain is responsible for a different function.

If a person has experienced any head injuries during their lifetime, it may play a part in how they react, respond, and behave in stressful situations. Having a forensic nurse expert analyze the medical records and assess the long-term effects any historical head trauma may have caused could be crucial to proving your case theory.

Sport-related injuries

As children grow and become more and more active, especially in sports related activities, the chances that they will sustain a head injury increases. In recent years, there has been an increase in research dedicated to the long-term outcomes/consequences for these people in relation to their cognitive and neuropathological development. These studies have looked at outcomes that are related to “subconcussive” head injuries (no concussion symptoms) as well as multiple diagnosed concussions.

Children and adults play sports with helmets (ex: football and ice hockey) and without helmets (ex: soccer and boxing) and receive repetitive impacts to their head from both the ball and from contact with other players and the ground. New rules have emerged to attempt to protect players from these impacts but cannot protect them entirely. There have been multiple studies done on boxers, soccer players, football players, and ice hockey players with mixed results to due varying methods of research. Some studies showed there were noted impairments in memory, attention, concentration, judgement, planning, and visuo-perceptual tasks, most likely indicating permanent organic brain damage. Computed tomography scans (CT) also have identified central brain atrophy in some of the study participants.

Repetitive trauma

In both animal and human studies, there is evidence that the brain can be more easily injured while recovering from a previous concussion. In one study of 223 high school athletes, 20% of them reported experiencing at least one concussion while they were playing their sport. Athletes that had experienced two or more concussions reported more problems with cognition, physical symptoms, and sleep. Those with three or more concussions were more likely to suffer a loss of consciousness, amnesia, and mental status changes.

In a survey of 2,500 retired professional football players, 269 (11.1%) of them reported having either a history of or a current diagnosis of depression. This finding shows an increasing linear relationship between a history of concussion and lifetime depression after adjusting for comorbidities. There has been increasing interest in studying the relationship between previous concussions and suicide due to highly publicized suicides in professional athletes who showed evidence of chronic traumatic encephalopathy (CTE). The theory is “the deficits associated with concussion may lower the threshold for a person with suicidal thoughts to act on them.” The literature is growing regarding a relationship between more severe traumatic brain injury (TBI) and suicidal behavior. However, these patients also frequently have higher rates of substance abuse, personality disorders, and higher self-reported aggression and hostility. Further studies will be needed in order to compare behavior pre- and post-concussion.

Despite efforts in recent years to do more research, little is known about how TBI affects the developing brain. Most of the older research was done with professional boxers, with the impacts and consequences being much more severe than that of other sports. However, data from this research can provide insight into worse-case scenarios. Dementia pugilistica or “punch-drunk syndrome” is a chronic progressive traumatic encephalopathy found in boxers that shares features with Alzheimer’s disease and results in a high risk for cognitive impairment. Multiple studies have shown that head injury is a risk factor for developing dementia, Alzheimer’s disease, depression, ALS, and Parkinson’s disease.

Comorbidities and history of trauma

Ultimately, whether repetitive head impacts and multiple concussions sustained during someone’s lifetime leads to long-term cognitive impairment or disease remains unclear. Additional research is needed to further delineate whether or not the long-term consequences are a result of comorbidities, genetics, or the brain injuries alone.

Of course, these studies do not consider other sources of traumatic brain injury that can occur to a person during their lifetime, such as inflicted injury, motor vehicle accidents, falls, bicycle accidents, child abuse, etc. Children who sustain head trauma with no brain injury will usually recover completely without any long-term complications. However, depending on severity, a traumatic brain injury can lead to permanent disabilities. Single or repetitive brain injury can result in issues such as seizures, sleep disorders, neurodegenerative diseases, problems with endocrine regulation, and mental health disorders lasting weeks, months, or years. Multiple studies indicate there is evidence for progressive atrophy in these patients.

Affect on the cells in the brain

There are many mechanisms at play when there is a traumatic brain injury. There is damage or death to nerve cells when levels of neurotransmitters become too high, an imbalance of free radicals and antioxidants leading to cell death, delayed “normal” cell death, inflammation, post-traumatic epilepsy in which neurons stay abnormally excited for prolonged periods, diffuse axonal injury that damages the cells when the brain shifts inside the skull, damage or death of the protective covering of the nerve cells (demyelination) causing a decrease in the speed of nerve impulses, and alterations in blood flow or lack of blood flow within the brain. With a mechanism of injury so diverse and multi-factorial, there is no wonder that a traumatic brain injury can be so complex and difficult to manage both in the acute and chronic stages.

(Committee on Sports-Related Concussions in Youth; Board on Children, Youth, and Families, 2014)

(Bramlett & Dietrich, 2015)


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