Traumatic brain injury (TBI) has a whole host of manifestations, depending on what part of the brain was injured in the brain injury accident and how large the affected area is. If the injury area is relatively small and localized, that is known as a focal brain injury. If a large area of the brain has been affected, that is referred to as a diffuse brain injury.

Whether the affected area is large or small, the part of the brain that was injured will impact the effects from the brain injury accident. We all know that different parts of the brain affect different bodily and cognitive functions, but nowhere is this more dramatically illustrated than in a brain injury accident, where some functions can be completely unaffected while others can be dramatically and traumatically damaged – and often catastrophically so — resulting in permanent disability.

Depending on the injury, sometimes speech is affected, sometimes the ability to walk or the gait. Sometimes movement, memory, eyesight, or a wide variety of cognitive functions are impacted. If the frontal lobe has been damaged (a not uncommon injury in a for example, a car accident where the head hits the front windshield) social skills can be affected. If you see someone behaving inappropriately, it may be the result of a traumatic brain injury. With well over a million brain injuries a year in the U.S. alone, it’s a real possibility, so compassion is in order.

We are happy to say that there are many wonderful resources – both local and national – for traumatic brain injury patients and their loved ones and caregivers in our country and in Missouri and southeast Kansas.

Here are just a few you might want to consult:

• Brain Injury Association of America
• Traumatic Brain Injury Resource Center
• Brain Injuries Resource Center
• TBI Community
• BrainSource Website
• NIH (National Institutes of Health) National Institute of Neurolgoical Disorders and Stroke -Traumatic Brain Injury Information page and many others.

You may also want to make note of the upcoming Brain Injuries Conference in Las Vegas, Nevada from March 4-7, 2009. For much information, visit: Brain Injuries Conference

In addition to their national office, the Brain Injury Association has state offices in both Missouri and Kansas as follows:

Missouri Brain Injury Association of America office
Brain Injury Association of Kansas and Greater Kansas City

Although we refrain from endorsing specific facilities or approaches, we do hear from our Missouri clients that Rusk facility in Columbia, Missouri is excellent.

If you are seeking a legal brain injury consultation rather than medical, educational or support services, please feel free to call the traumatic brain injury attorneys at the law firm of Aaron Sachs & Associates. We are personal injury attorneys serving Missouri and southeast Kansas. There is no charge to you for an initial consultation to help you determine if you might have a legal claim, and we are happy to answer your questions.

Intro: You might have resolved to exercise more, eat healthier or spend less time in front of the TV in the New Year. But there are a few Legal Resolutions that should be on everyone’s list, especially if you’ve had a life change such as marriage, children or divorce. Brian and attorney Aaron Sachs will discuss what legal documents you should resolve to update every year in this week’s Legally Speaking.

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Question 1: Aaron, this week’s topic is Legal Resolutions for the New Year. Which legal documents should people be sure to review every year?

Aaron’s answer: These documents fall under the realm of what is commonly referred to as Estate Planning. In spite of the name, you don’t have to own an estate nor do you need to be wealthy. Everyone, regardless of their income, should make sure the following documents are updated to reflect their status of life and most current inclinations — or created if they don’t have them.

1. A will
2. A medical proxy, which is document that designates a person to make healthcare decisions on your behalf in the event that you’re not able to.
3. A power of attorney, which authorizes someone to act on your behalf in legal and business matters.

Question 2: What are some things you should consider when drafting or updating your will?

Answer: There are several things you should take into consideration. Here are a few of the most important ones:

• If you’ve recently had a child and do not have a will or have not updated your will to reflect this, it’s very important that you do so. You can name a guardian in the event of your death. You can also designate a trustee to manage the money your child inherits until your child is legally an adult.

• If you’ve recently gotten married (congratulations!), you’ll want to add your spouse as a benefactor in your will.

• On the flipside, if you were divorced in 2007, depending on how acrimonious the split was or how generous you’re feeling, you might want to delete your ex-spouse from your will. Similarly, if you’ve listed her as beneficiary in insurance policies and financial accounts you should review those and make the necessary changes. You should definitely get around to updating all your legal and financial documents in the event of a divorce.

• If your assets have changed substantially, you will want to address this in your will.

• If your life has remained pretty much status quo, or you’ve moved, you should consult your lawyer about any changes in federal and state inheritance tax laws that might affect you. Based on these changes you might want to make some modifications to your existing will.

• You can name a personal representative, also called an executor, of the will to make sure the provisions in your will are carried out. If you don’t name an executor, the probate court will appoint someone to follow up on your stipulations.

• In Missouri, if you die without a will, your assets will be divided amongst your immediate family. If no relatives are found your property goes to the state.

Question 3: What about a health care proxy? What do people need to know about drafting this document?

• A health care proxy, also called a medical proxy, a health care surrogate, or a durable medical power of attorney, is a document that designates an agent to carry out your wishes, or make decisions for you, regarding future health care choices should you become unable to do so. Your agent should be over 18 and someone close to you that you trust.

• In some cases, a person will designate his or her physician. This practice has provoked some controversy because sometimes the patient’s wishes and the physician’s recommended course of treatment are in conflict. In many states, Missouri being one of them, appointing your physician, an employee of your physician or the owner/operator of a healthcare facility in which you are a resident is prohibited, unless you are related.

• Aside from designating the person, and an alternate if you choose, to make these decisions on your behalf, you should think about medical directives for this person to follow. Some things you should consider include:

a. The use and circumstances of using a feeding tube to prolong or sustain life
b. Organ or tissue donation
c. The use of certain treatments and surgeries such as blood transfusion or dialysis

• Once you put these directives in writing, and have the document notarized, your agent must carry out your wishes, even if he or she disagrees. We all remember the Terry Schiavo case that made national headlines in 2005 where her parents and husband battled in court over the decision of whether or not to remove her life support system. This case speaks to the importance of having a health care proxy.

• Missouri’s version of this document, the Durable Medical Power of Attorney, only becomes effective when you are unable to make decisions for yourself. Unless stated otherwise, two medical doctors must make the incapacity decision.

Question 4: What about a power of attorney? And how is it different than a will or a health care proxy and why is it important?

• A power of attorney (POA) is created when one person, commonly called the “principal” gives someone else, an agent or “attorney in fact”, written authority to act in the principal’s name.

• Some people use it if they have multiple transactions going and don’t want to have to be present at every one. It’s also used to help your family or relatives handle your affairs in the event of a disability, incapacity or death.

• One of the most significant ways that a power of attorney differs from the other two documents mentioned is that you can appoint a POA to act on your behalf while you’re not only alive, but perfectly able.

• Additionally, each of the documents mentioned addresses a different aspect of your life, but two or more of the documents can be combined to address the relevant issues.

• An ordinary POA is revoked when the principal becomes incapacitated. But a “durable power of attorney” is continuous and only invalid when the principal is deceased. Also, it can be created to only go into effect when the principal is incapacitated or when some other future event is stipulated.

• You can appoint one or more people to make decisions. Once this agent is appointed, his or her decisions are as legally binding as if you made them yourself. You can appoint one person to make all decisions, or one person for each specific decision. But no agent can make changes to your will. It’s recommended that you be as specific as possible in this document to avoid any confusion.

• Again, your agent needs to be over 18 and should be someone close to you, perhaps your spouse, child or a trusted business partner or attorney. The agent does not have to live in the same state but, similarly as with a health care proxy, your agent can’t be an employee of the Missouri Department of Mental Health or Missouri Department of Social Services in which the principal resides, nor can the agent be a full time judge or a clerk of the court, unless such person is closely related to the principal.

Bottom line: No matter how old you are or what health condition you are in, these documents might not be pleasant to think about, but they can really help your family and loved ones out in the event of unforeseen circumstances.

Traumatic brain injury is a catastrophic injury that has far reaching effects for the injured party and his or her family.

One of the most confusing and challenging parts of a traumatic brain injury — particularly if it’s caused by a closed head injury — is that often the injured person looks the same, and there may be no outward sign of injury.

For example, if a person is in a car accident and he or she breaks a bone or is cut or bruised, it is quite clear to friends, family members, employers, doctors, etc. But sometimes with a brain injury, there is neurological damage that affects cognitive functions (ability to think, talk, reason, work, understand, carry out tasks in a logical order, etc.) but because the injury is internal rather than external, it is hard for those around the brain damaged person to remember that he or she is not the same and may not have the same capabilities from prior to the accident. Sometimes it’s hard to remember to be patient and understanding.

This is one reason why we recommend that the loved ones of the brain injured person seek out a support group and/or counseling in addition to any services the accident victim is receiving. If your loved one has been in a Missouri brain injury accident, please seek out support from an organization that specialize in brain injuries. You can find them easily by “Googling” Missouri brain injury organizations.

A head injury resulting in a traumatic brain injury doesn’t always reveal itself right away. The injured person may think he or she is fine and may convince those around that there is nothing wrong. However, that doesn’t mean everything is okay.

After a head injury, there are a number signs and symptoms to watch for that may indicate a serious or traumatic brain injury has occurred. Depending on what part of the brain was injured, according to neurologychannel.com, here is a list of some brain injury symptoms:

• Anxiety, nervousness
• Behavioral changes:
o difficulty controlling urges (disinhibition)
o impulsiveness
o inappropriate laughter
o irritability
• Blurry or double vision (diplopia)
• Depression
• Difficulty concentrating or thinking
• Difficulty finding words or understanding the speech of others (aphasia)
• Difficulty swallowing (dysphagia)
• Dizziness/ Vertigo (sense of spinning)
• Headache
• Uncoordinated movements
• Lightheadedness
• Loss of balance; difficulty walking or sitting
• Loss of memory
• Muscle stiffness and/or spasms
• Seizures
• Change in sleep pattern
• Slurred and/or slowed speech
• Tingling, numbness, pain, or other sensations
• Weakness in one or more limbs, facial muscles, or on an entire side of the body
Depending on the cause of the brain injury, you may want legal assistance or support from a Missouri brain injury lawyer. Please feel free to call us. There is no charge for an initial call to ask any questions you may have.

Brain injuries often have dramatic and traumatic consequences that can include:

• Loss of memory, including inability to remember simple things like how to eat, talk, read, write, etc.
• Impeded speech
• Impeded ability to walk or move
• Significant change in personality
• Loss of job
• Loss of relationships
• Inability to live on one’s own and manage ADLs (activities of daily living)
• Anxiety or depression

A traumatic brain injury can also result in a coma or a persistent vegetative state, depending on the severity of the head injury.

Serious head injuries that result in traumatic brain injuries often mean that life as the person knew it before the brain injury is forever altered.

Any serious brain injury has life altering consequences for the brain-injured persons and their families, which is why support groups and/or counseling are highly recommended for dealing with the emotional trauma that accompanies the physical trauma of brain injuries.

Many brain injury organizations offer counseling and support group services and resources. The Brain Injury Association of Missouri has an entire page devoted to support groups throughout Missouri and in parts of Illinois.

Sometimes legal help, advice or support is also needed, depending on the cause of the brain injury. If you are seeking assistance from a Missouri brain injury lawyer, please feel free to call us. There is no charge for an initial call to ask any questions you may have.

Traumatic Brain Injury, sometimes abbreviated as TBI, is a devastating head injury that can be caused by a motor vehicle accident, a bicycle accident, a work accident or a bad fall. Statistics indicate that there are more than 14,000 Missouri brain injuries every year.

As a Missouri personal injury attorney, a brain injury attorney, and as a member of the Brain Injury Association of Missouri (baimo.org) and a former member of their Board of Directors, I have seen more than my share of traumatic brain injuries and the devastating effects head injuries have on the patient and his or her family. Although a certain percentage of brain injuries would not be considered “preventable,” a number of them certainly are. Wearing seat belts is one of the most important means of preventing traumatic head injuries, and wearing bicycle helmets is another.

The most astonishing fact about brain injuries is that – although brain injuries do not get nearly the press or public attention as these other conditions, — annually “more people will sustain a traumatic brain injury than will develop Multiple Sclerosis, Spinal Cord Injury, HIV/AIDS, and Breast Cancer combined.” It is my hope as an attorney dealing with brain injury cases, and the hope of our firm, that traumatic brain injury will begin soon to get the kind of public attention and support it deserves.

The terms head injury, closed head injury, brain injury and traumatic brain injury (TBI) are often used interchangeably by people. But to doctors or brain injury lawyers, each of these terms has a specific meaning. Head injury is a broad term that can refer to any injury to the head, whether major or minor. Thanks to the protection and hardness of the skull, not all head injuries result in brain injuries.

Serious head injuries often result in brain injuries and fall into two major categories: a closed head injury or an open head injury. An open head injury means that the skull has been penetrated or breached in some way. A closed head injury means that the skull is intact, but the brain inside has been injured.

Open head injuries are fairly easy to diagnose. If the skull has been penetrated, broken or cracked, simple observation, x-ray, CT scan and/or MRI reveal the injury. Closed head injuries are more difficult to diagnose, and sometimes go untreated even if a traumatic brain injury has occurred. The brain injury may not be visible because bruising is hard to see, and both bleeding of the brain and brain injury symptoms can be delayed.

Medline Plus (by the National Library of Medicine and NIH) advises seeking immediate medical help after a brain injury if the person . . .
• Becomes unusually drowsy
• Develops a severe headache or stiff neck
• Vomits more than once
• Loses consciousness (even briefly)
• Behaves abnormally

If in doubt seek immediate medical attention.