Abstract
D.Litt. et. Phil.
Head injury is the major cause of death for individuals under 35 years old in the United
States of America, and a similar picture exists in South Africa.
A major cause of traumatic brain injury is motor vehicle accidents. In addition, the
advances in modem medical technology increase the chances for survival, for example,
sophisticated medical diagnostic techniques such as computerised tomography (CT),
and magnetic resonance imaging (MRI). Advances in emergency trauma and
neurosurgical procedures have also increased the number of survivors following a head
injury.
The symptoms resulting from head injury include disturbed physical, cognitive,
psychological and behavioural functioning. Long-term management of these symptoms
is usually required. A body of evidence exists that demonstrates the value of
rehabilitation during the first year of recovery from traumatic brain injury. Head injury cases often result in litigation in that the injured person may be entitled to
compensation for the injuries sustained. Considerable forensic debate exists around
the issue of whether the victim's symptoms are attributable to organic brain damage,
or whether they reflect a pre-existing functional psychological state of psychiatric illness,
or personality disorder. Further still, the individual may be 'malingering' or faking
postconcussion symptoms of headache, dizziness, fatigue, memory deficit, impaired
concentration, irritability, anxiety, insomnia, concern about bodily functions, and
hypersensitivity to light and noise. Alternatively, a common diagnosis is traumatic
neurosis with a psychogenic basis, and in the context of litigation is referred to as
"compensation neurosis". Specifically, the issue of contention revolves around
concussion, and mild or minor head injuries. This study proposed that both neuropathophysiological and psychosocial symptoms
occur in the event of a traumatic brain injury. This view supports the traditional model
that pain or the sequelae of head injury are not affected by compensation. Therefore,
the objective of the study was that follow-up assessment after compensation pay-outs
should produce similar results to the assessment results obtained during the litigation
process.
The hypotheses of the study were essentially confirmed. The neuropsychological error
scores produced in the assessments during litigation, and two-to-four years after the
completion of litigation were similar. However, similar to other studies, variations were
evident. Four exceptions were demonstrated in that significant improvement was
evident with regard to shotterm verbal memory delayed recall for paragraphs, and for
immediate recall (without and after interference) in verbal memory for a word list.
These improvements therefore pertain to verbal memory. The fourth improvement
occurred with respect to manual dexterity and visual-motor work speed, although the
improvement may be peripheral or primary (neurological). Further findings included that no gender differences were evident in the
neuropsychological posttest scores. It was confirmed that individuals with a good
Glasgow Outcome Scale rating showed less posttraumatic amnesia, a shorter time
since injury, less additional injuries, and a lower compensation sum. It was also
supported that individuals with a good Glasgow Outcome Scale rating showed less
impairment on neuropsychological indices. However, an exception was that individuals
with a moderate Glasgow Outcome Scale rating showed improvement on the
neuropsychological index measuring immediate concentration, visual scanning, and
visual-motor work speed.
The qualitative data or psychosocial measures of severity and outcome produced a
similar picture that the majority of subjects maintained their pretest status although
some exceptions were evident. Within the medico-legal domain it was shown that, in general, concordance of severity
was high amongst the medical experts for the plaintiffs and the defendents. However,
their prognoses were indicated to be less accurate, and whilst their consistency in
documenting diagnoses in the reports of the subjects was adequate, they were found
to be inconsistent in documenting severity ratings and prognoses.
It was suggested that improvements may be attributed to neurophysiological
differences, non-participation in a rehabilitation programme, the interference and delay
of rehabilitation, increased psychological reactions associated with litigation, and
mechanisms of secondary gain which may by attributed to the other players, such as
the family, the attorneys, the medical experts, among others, and not only to the
individual or victim.