Legal Update #19 Public Perception of Traumatic Brain Injury

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NLBC LEGAL UPDATE: April, 2004 - Issue #19

Sam Goldstein, Ph.D., Editor.
Complimentary Service of the Neurology, Learning and Behavior Center

Public Perception of Traumatic Brain Injury 

It is well recognized that jurors bring with them into the jury box and deliberation room the ideas and beliefs they have gathered through experience. It is well established that "pre-trial beliefs and values may influence and on occasion even overwhelm the evidence presented in court" (Wrightsman, et al., 2002). Pre-trial factors, including defendant attractiveness, race, gender and attitudes can and do influence juror understanding and interpretation of the facts presented at trial. Though jurors are advised to maintain objectivity, there is scant research to suggest that human beings are able to completely disregard past beliefs and experiences in considering new information. In fact, one of the basis processes of the brain is to integrate new information with what is already known. In this issue of Legal Update, I will briefly review the history of as well as a recent study examining the mis-conceptions of the lay public about Traumatic Brain Injury (TBI).

According to a recent National Institute of Health Consensus Developmental Panel on the Rehabilitation of Persons with Traumatic Brain Injury, it is estimated that in the United States there are approximately 1.5 to 2 million cases annually. TBI is considered the leading source of injury in neurologic disability among children and young adults. TBI can and often causes a constellation of observable cognitive, emotional, behavioral, interpersonal and vocational deficits. However, in many cases impairments can result from less conspicuous losses related to poor concentration, impaired processing speed or poor cognitive efficiency. Often, survivors of TBI, particularly those with mild to low moderate injuries returning to work and school do not exhibit gross deficits yet are expected to perform at pre-injury levels. They may struggle because of these "hidden disabilities."

Misconceptions concerning TBI are wide spread and as Swift and Wilson (2001) demonstrated, prevalent within the medical and related fields as well. In some situations these misconceptions can and do influence treating and forensic examiners' opinions concerning etiology and prognosis for TBI patients. In 1997, Farmer and colleagues demonstrated equal misperceptions about pediatric TBI held by educators as well.

In 1988, Gouvier and colleagues administered a twenty-five item survey to 221 individuals in a southern Louisiana shopping mall. Up to 50% of the sample answered questions regarding unconsciousness, amnesia and recovery incorrectly. In 1993, Willer found similar results screening Canadian adults.

Just recently, Guilmette and Paglia (2004) assessed the public's perceptions of head trauma in an urban setting in a northeast region of the country. One hundred seventy-nine individuals were screened in a department store. They were asked to voluntarily complete a nineteen item survey. These results surprisingly find that there has been no significant change in the level of knowledge about moderate to severe brain injury within the last ten to fifteen years. Consistently, a significant number of people hold inaccurate beliefs about TBI and its sequelae, including in this study 42% of the sample believing that a second blow to the head can improve memory functioning. These misconceptions appeared unrelated to age, gender or education. As others have noted, it appears that knowledge about TBI likely comes, at least in part, from popular media. Further, family members, employers and even TBI survivors likely hold these misconceptions. These incorrect ideas may play a potentially significant role in personal injury trials. For example, 35% believed that a whiplash injury could not cause brain damage. Thirty-five percent believed that after a traumatic brain injury it was not more difficult for someone to learn than previously. In regards to forensic issues, 28% believed that a concussion was "harmless and never results in long-term problems or brain damage." Twenty-five percent believed that if a person wanted to "it would be easy to fake brain damage from a head injury" and 66% believed that the only way to prove brain damage from a head injury was by an x-ray of the brain. Surprisingly, 59% believed that most people with severe TBI are eventually able to return to their previous work. Finally, 44% believed that a head injury affected the brains of men and women differently. These beliefs, as Guilmette and Paglia note, "may give rise to pre-existing assumptions held by jurors about visibly healthy plaintiffs."

These data, though limited in scope and total sample size, may well reflect generally held misconceptions in the broader public. Attorneys are advised to consider addressing these issues during voir dire as well as allowing time for forensic neuropsychologists and related medical specialists to educate jurors about the facts of TBI prior to offering testimony.

References

Farmer, J.E., et al. (1997). Misconceptions about traumatic brain injury among educators and rehabilitation staff: A comparative study. Rehabilitation Psychology, 42, 273-285.

Gouvier, W., et al. (1988). A survey of common misconceptions about brain injury and recovery. Archives of Clinical Neuropsychology, 3, 331-343.

Guilmette, G. et al. (2004). The public's misconceptions about traumatic brain survey: A follow-up survey. Archives of Clinical Neuropsychology, 19, 183-189.

Swift, B., et al. (2001). Misconceptions about brain injury among the general public in non-expert professionals. Ane exploratory study. Brain Injury, 15, 149-165.

Willer, N., et al. (1993). A note concerning misconceptions of the general public about brain injury. Archives of Clinical Neuropsychology, 8, 461-465.

Wrightsman, A., et al. (2002). Psychology in the Legal System (5th Edition). Belmont, CA: Wadsworth Publishing Group.

Did you miss a previous Legal Update? All of Dr. Goldstein's legal updates are now available on his website, www.samgoldstein.com/legalupdates. The following is a directory of past updates:

  • Accuracy of Self-Reported Educational Attainment Among Diverse Populations
  • The Neurological Effects of Commonly Used Prescription Medications
  • Depression After Mild Traumatic Brain Injury
  • Post Traumatic Stress Disorder Among Children Involved in Automobile Accidents
  • The Two Faces of Mild Head Injury
  • Update on Post Traumatic Stress Disorder
  • Post Concussion Syndrome
  • The Altering of Reported Experiences
  • Three Official Statements of the National Academy of Neuropsychology
  • The Role of Chronic Pain in Every Day Functioning
  • How Much Do We Really Know About Traumatic Brain Injury?
  • Are Post-Concussional Symptoms Unique to Neurologic Impairment? Likely Not.
  • Medications to Improve Cognitive Functioning in Individuals With Traumatic Brain Injury
  • The Neuropsychological Effects of Whiplash Injury: Fact or Fiction?
  • Depression, Neuropsychological Testing and Everyday Functioning
  • Update on Psychiatric Disorders after Traumatic Brain Injury
  • Pain and Emotional Distress

The Neurology, Learning and Behavior Center provides multi-disciplinary, clinical and forensic assessment, case management, trial consultation and treatment services for children and adults with brain injury and dysfunction, Attention-Deficit Hyperactivity Disorder, language disorders, learning disability, developmental delay, emotional disorders, Autism and adjustment problems. The Center is dedicated to the provision of treatment services.