Traumatic brain injuries (TBIs) are always something to be concerned about, because they can permanently and dramatically change someone’s life. Sometimes these effects are instantaneous, sometimes they can slowly worsen over time, with effects including cognitive, neurological, and emotional impairments. Dr. Steve Tutty, an experienced clinical, forensic, and neuro psychologist, utilizes thorough, multifaceted, and evidence-based steps in these evaluations in order to identify the extent of the damage and consider the most effective treatment options.
Dr Tutty is a licensed psychologist with over 25 years of direct clinical and forensic practice, as well as two decades in teaching, researching, and publishing in the field across multiple US states. He’s built his career on evidence-based principles, specifically in regards to psychological and neuropsychological evaluations (whether they be for traumatic brain injuries or neurodivergence like ADHD) in order to tailor interventions to the client and improve their standard of living. He’s worked with over 2,300 children and adolescents with neurodiverse conditions, as well as over 530 adults suffering from personal injuries, most often TBIs.
One-third of his practice is specifically dedicated to personal injury evaluations for traumatic brain injuries, and in that professional capacity he has long emphasised their importance. These personal injury evaluations examine how the brain is functioning in the aftermath of an injury like a concussion, a direct blow to the head, or other injury, and the information uncovered in this process determines treatment and recovery needs. It’s a necessary and complex process that should never be neglected.
The cost of a traumatic brain injury
Traumatic brain injuries can come from a variety of sources, and can happen to anybody at nearly any time of any day. The National Institute of Neurology documents simple falls as the leading cause of TBIs, followed closely by motor vehicle accidents. Given how many Americans have no choice but to drive or ride in a motor vehicle every day, and how easy it is to simply slip and fall, it’s easy to see how common these injuries can truly be. What’s even more concerning is that, paired with how easily a TBI can occur, their consequences can be long-lasting and debilitating.
“While most persons experiencing TBI’s recover within 90 days, approximately 10% continue to experience long-term symptoms, such as migraine headaches, short term memory impairment, word finding delays during conversations, difficulty with problem solving, balance and coordination problems, sleep impairment, changes in personality (e.g. flat affect, depression, irritability, anger), etc.,” says Dr Steve Tutty. “This TBI group has often been labelled as the ‘walking wounded’ as their neurological symptoms persist well beyond the 90-day recovery period and are quite resistant in benefitting from traditional neurological treatments, such as neurological rehabilitation, speech and language therapy, occupational therapy, pharmacotherapy, counselling, and so on.”
Traumatic brain injuries are the leading cause of disabilities for people under the age of 24 in the US, and they contribute to nearly 30% of injury-related deaths in the country. Adults that survive the initial injury can continue to manifest neurological symptoms over time that can impact every part of their lives. Personality changes and mood disorders can combine with deficits in memory, problem solving, and balance (which itself can lead to further TBIs) can hurt people’s ability to work, socialise, study, exercise, and generally live out their lives.
The evaluation process: What happens, and what matters
One of the best approaches to assess the extent of a traumatic brain injury (TBI), determine the best path to recovery, and prepare for future complications is to perform a neuropsychological evaluation, also known as a TBI assessment. Dr Steve Tutty and his team currently provide these kinds of personal injury evaluations in Manhattan, and have been for years in other US States.
The first step (after the patient arrives at the emergency department) is often either a CT or MRI scan to determine if there has been structural damage to the brain in the form of fractures, and to check for any bleeding in the brain. Scans can’t catch everything, however; CT scans can’t detect functional deficits in cognition, for example, because those deficits are often a result of diffuse axonal injuries like micro-tears that come as a result of direct head trauma or sudden rotational acceleration. Because of this, injured adults with even mild TBI’s and intact Glasgow Coma Scale (GCS) ratings can fail to regain their full pre-injury functional baseline due to damage to subcortical white and grey matter junctions.
Once the scans are complete, the longer evaluation process begins, and it requires the evaluator to perform in a number of roles across the weeks-long endeavour. The patient’s pre-TBI functional baseline needs to be identified via a comprehensive review of their medical, work, and school history, as well as through interviews of their close friends and family.
Once that step is complete, the neuropsychological evaluation focuses on how the patient is functioning currently across key areas: memory, language, motor functions, problem solving, personality functioning, and so on, with an eye for how those skill sets and traits have changed post-injury. In addition to tracking deficits, areas of resiliency and strength are also analysed, because these areas will be used in the rehabilitation process and can aid in compensatory strategies the injured adult can use later.
“Following these evaluation steps, an extensive review takes place regarding the injury (e.g., emergency response reports, traffic incident reports, post TBI treatment records, etc.) and the likelihood (greater than 50%) that the observed neuropsychological deficits are directly due to the proximate cause (the injury) or other events prior to the injury,” explains Dr Tutty. “Finally, an evidence-based recovery plan is designed for the injured adult, taking into account the treatments completed to date, to help maximize their recovery over time.”
Comprehensive neuropsychological evaluations in the aftermath of a traumatic brain injury are a crucial step in the recovery process. While these processes can take several weeks to complete, every step can help unveil or identify information that can make a difference for treatment, rehabilitation, and recovery for injured adults.
Dr. Steve Tutty and his team are currently providing personal injury evaluations, alongside counselling and testing services for children, teens, and young adults, through Manhattan Child Psychology in New York (Manhattan Child Psychology). He plans to continue this work for several more years before concluding what will amount to four decades of service.
Amelia Hart, a psychology graduate from the University of Hertfordshire, has a keen interest in the fields of mental health, wellness, and lifestyle.
