Car accidents and especially crashes involving semi trucks or other commercial motor vehicles (CMVs) like dump trucks or box trucks commonly result in concussions or other traumatic brain injuries (TBIs).
Semi trucks and CMVs are bigger and heavier than the largest passenger vehicles. Semi trucks with loaded trailers can weigh up to 80,000 pounds. This is nearly 20 times the weight of a full-size SUV. The forces in these crashes, even at low speeds, are much greater than in a typical car crash. The sheer force alone is a contributing factor to concussions and TBIs. In fact, a recent study found that 69% of patients involved in a car crash met the criteria for diagnosis of a concussion or mild traumatic brain injury (mTBI).
When you choose a truck crash attorney, you not only need one who understands the complexities of the trucking industry, but also one who has experience in dealing with traumatic brain injuries and post-concussion syndrome.
If you have been involved in a car crash or truck crash, seek treatment even if you do not appear seriously injured. Concussions and TBIs/mTBIs are often invisible injuries; brain injuries happen even without a direct blow to the head (an outdated notion as medical doctors now know more about the mechanism of brain injury). Call 911 or accept help from first responders. This includes having emergency medical technicians (EMTs) check you out at the crash scene, going to an emergency room immediately afterward, or following up with your primary care doctor or urgent care as soon as you can.
A good truck crash lawyer knows that though these types of injuries are common in truck crashes, doctors will not necessarily diagnose your concussion or TBI immediately. The adrenaline kicks in and a trip to the ER may address acute injuries (broken bones, pain, etc.). In the days and weeks that follow, the brain injury becomes much more apparent (brain fog, memory issues, vision losses and a ream of other cognitive and emotional issues). These seemingly “invisible” injuries can be among the most impactful on your quality of life.
Over 50% of Concussions are Missed in the Emergency Room After a Crash
Upwards of 60% of concussions and other traumatic brain injuries are missed by emergency room doctors. Emergency rooms are focused – rightfully so – on critical injuries and getting you immediate medical care or emergency treatment. With head injuries, that usually means ruling out serious injuries like brain bleeding or skull fractures.
That is why doctors tell many car crash patients who receive emergency care that they are cleared of a head injury after a CT scan. These scans show only whether your skull is fractured or your brain is bruised, swollen, or bleeding. In fact, researchers later found that many patients with normal CT scans had suffered a TBI.
Insurance companies and defense attorneys will point to the lack of a concussion diagnosis in the emergency room as supposed evidence that the crash caused no TBI. But experienced truck crash attorneys know this is an outdated and unfair analysis.
Recent changes to the guidelines that many doctors follow in diagnosing concussions aim to improve diagnosis and get patients treatment sooner.
New Criteria for Concussion Diagnosis Hopes to Catch More TBIs
The American Congress of Rehabilitation Medicine (ACRM) first established a definition for mild traumatic brain injuries in 1993. Doctors and medical professionals have widely used this definition in practice since that time.
The ACRM’s 1993 mTBI definition required a trauma-induced physiological disruption of brain function shown through at least one of the following criteria:
- any period of loss of consciousness
- any loss of memory for events immediately before or after the accident;
- any alteration in mental state at the time of the accident (i.e., feeling dazed, disoriented, or confused); and
- focal neurological deficits that may or may not be transient.
While the medical community widely adopted this diagnosis criteria, its limits became obvious as research in the intervening decades deepened doctors’ understanding of the signs and symptoms of concussions and TBIs.
The ACRM published updated criteria for concussion diagnosis in 2023. The new framework contains six criteria for the diagnosis of a mTBI or concussion. Diagnosis is made once a plausible mechanism of injury is found and one or more of the following criteria are also present:
- One or more clinical signs that are attributable to brain injury;
- Two acute symptoms together with at least one clinical or laboratory finding attributable to brain injury;
- Clinical examination or laboratory evidence;
- Neuroimaging; and
- Confounding factors for the above criteria are excluded.
Doctors designed the new criteria with post-acute diagnosis in mind as well. The first three criteria are particularly well suited to post-acute diagnosis. The importance of considering post-acute diagnosis cannot be overstated, given the high percentage of concussions and mTBIs that doctors fail to diagnose following car crashes.
Finding a Plausible Mechanism of Injury
Diagnosis begins by determining if there was a “plausible mechanism of injury.” Doctors can obtain this through the patient’s history, the description of the event, witness observations, or, importantly, by inference, such as being in a motor vehicle collision. Examples include striking your head on an object or surface, or the brain experiencing acceleration/deceleration forces without direct contact.
1 – Clinical Signs of mTBI
Clinical signs of a TBI or concussion are best understood as acute physiological disruptions of the brain function, such as loss of consciousness immediately after the injury, alteration of your mental status such as reduced or inappropriate responses, slowness to respond to questions or instructions, agitated behavior, or disorientation to time, place, or situation.
Other clinical signs are complete or partial amnesia of events immediately after or preceding the injury or other acute neurologic signs, such as observed motor incoordination upon standing, seizure, or tonic posturing.
2 – Acute Symptoms of mTBI
Experiencing two or more new or worsened acute physiological symptoms include a subjective acute alteration in mental status, such as feeling confused, disorientated, and/or dazed; physical symptoms such as headache, nausea, dizziness, balance or vision problems, or sensitivity to light or noise.
Acute cognitive symptoms include feeling slowed down, mental fog, difficulty concentrating or memory issues, or emotional symptoms such as uncharacteristic emotional lability and/or irritability.
Acute symptoms are subjective and self reported by the patient, differentiating them from doctor observed clinical signs.
3 – Clinical Examination & Laboratory Findings
Establishing cognitive impairment, balance impairment, oculomotor impairment, symptom provocation, or elevated blood markers of intracranial injury is, of course, sufficient to meet this criteria.
4 – Neuroimaging
The ACRM does not consider neuroimaging to be necessary for the diagnosis of a mTBI. The entire point of the revised criteria was to address gaps in diagnosis. However, MRI or CT scans, can in some cases, find evidence of trauma-related abnormalities that are sufficient to diagnose a mTBI. However, the ACRM noted that most people who suffer a mild TBI will have negative neuroimaging.
5 – Exclusion of Confounding Conditions
Doctors need to assess clinical signs of a concussion with an understanding that acute injuries, such as pain, psychological trauma, intoxication, pulmonary or circulatory issues, can affect diagnosis or may cause pre-fall or crash loss of consciousness. They will also need to consider other preexisting health conditions, physiological or psychological stress, and even exaggeration.
The following flowchart summarizes the 2023 ACRM Diagnostic Criteria:
Getting the Treatment You Need for a TBI
In the past, concussion treatment consisted primarily of prolonged rest. Many people still adhere to the idea that someone with a concussion cannot be allowed to fall asleep. However, that is largely a myth that persists.
Most concussion patients greatly benefit from sleep. In actuality, researchers have found that a few days of rest followed by a return to light activity as soon as possible helps recovery.
With concussion management and prevention being a hot topic in both high school, college, and professional sports, an abundance of new research in these areas has led to some advancements in treatments and general changes to the treatment protocols.
In the first 24-48 hours following a concussion, doctors recommend rest and avoidance of screens such as television, cell phones, or tablet use. However, research has found that returning to activity as soon as patients can tolerate it helps recovery.
Studies have shown that exercise helps with recovery and prevents the persistence of symptoms. Doctors now recommend returning to light physical activity, such as walking, after 48 hours following a concussion. Studies have also shown that aerobic exercise 2-10 days after a sport-related concussion helps recovery and minimizes persistent symptoms. Obviously, when the concussion results from a car or truck crash, returning to physical activity may present more challenges.
Vestibular rehabilitation can help alleviate disruptive symptoms such as dizziness, balance problems, and visual symptoms. The earlier these interventions are available to the patient, the better the results. The approach includes gaze stabilization exercises, balance training, habituation exercises, and canalith repositioning maneuvers for benign paroxysmal positional vertigo. Studies have shown that utilizing visual interventions such as the vestibulo-ocular reflex and cervical manual therapy early in the rehabilitation process lessens symptoms and allows earlier return to activities.
Medications, such as topiramate and amitriptyline, are helpful for the treatment of persistent post-traumatic headaches. Studies have shown that these medications can be used to reduce the frequency of post-traumatic headaches and migraines associated with post-concussion syndrome.
Creatine Shows Promise for TBI and Concussion Prevention and Treatment
Creatine is one of the most widely used sports and fitness performance supplements in the United States. Creatine is a naturally occurring substance that your muscles and brain utilize as a source of energy. It is most widely associated with “gym bros” to improve muscle size and performance.
Creatine is one of the more widely available and affordable supplements. Decades of research and use have shown that it is a safe and well-tolerated supplement for most people. New research shows promise for mTBI treatment and recovery.
While its use in sports and training is well known, there is a growing body of research building evidence of its neuroprotective properties and usefulness in the treatment of post-concussion symptoms. Recent research has shown that creatine supplementation has both a protective effect for concussions and mTBI and has the potential for use in TBI recovery.
A recent pilot study in young children and adolescents diagnosed with a TBI showed significant improvement in post-concussion symptoms such as headache, dizziness, and fatigue.
Animal studies have also shown creatine to have neuroprotective properties. In fact, the study showed that long-term creatine use reduced the extent of brain damage from head trauma by 36%-50%. Creatine supplementation has the potential to reduce the risk that a concussion or TBI will cause long-term issues.
Studies have also shown that creatine supplementation improves cognitive function after sleep deprivation and even boosts cognition in older adult Alzheimer’s patients. A recent study found that a 0.35 gram per kilogram of body weight dose of creatine (approximately 30 grams for a 180 lb person) was effective in reducing the cognitive deficits from a night of partial sleep deprivation.
Why does creatine supplementation help your brain? Supplementation of creatine is thought to boost the body’s ability and help with energy production. Your brain accounts for over 20% of your body’s energy expenditure.
Supplementation of creatine helps boost energy metabolism in the body, including within the brain tissue. One of the functions of creatine is to help maintain the levels of adenosine triphosphate, or ATP, in the tissues of your body that have a high demand for energy. This includes not only your muscles, but also your brain.
In a concussion or traumatic brain injury, doctors think that diffuse stretching of axons caused by internal shearing and stretching is the primary mechanism of damage to the brain. This can induce further damage by causing a metabolic cascade that ultimately results in what is best described as an energy crisis for your brain that can last weeks or months after a concussion.
Creatine, by providing ATP to your brain, is thought to help support cognitive function and performance and stabilize the brain’s function following head trauma. Researchers also suspect that creatine supplementation prior to sustaining head trauma has neuroprotective effects even in people. Creatine supplementation can preserve mitochondrial function and keep the brain’s cells functioning.
Researchers in Denmark are currently assembling a pilot control study to conduct a randomized controlled trial on the effects of creatine monohydrate on persistent post-concussive symptoms. This study hopes to enroll young adults with post-concussion syndrome persisting for six months to a year. Researchers will give the study participants 5 grams of creatine monohydrate a day for seven weeks. The researchers hope that the regular supplementation with creatine will reduce the number and severity of the post-concussion syndrome symptoms experienced.
If you have suffered a TBI in a truck crash, you need a law firm with experience and education in dealing with traumatic brain injuries. Attorneys at the Law Offices of Peter M. Anderson have nearly 30 years of experience in brain injury cases stemming from car accidents and truck crashes. Call today if you need help with your case: 303-444-1505