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Mild Traumatic Brain Injury: Neuropsychological Causality Modelling

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Book cover Psychological Knowledge in Court

3.3. Causality Conclusions

This chapter has focused on group data regarding outcomes following mTBI. However, in both the clinical and the medicallegal context, it is not the group but rather the individual who is the focus of interest. The question is no longer “What factors influence outcome following mTBI?” but rather “What is causing the symptoms or problems in this particular case?” The clinical arena can accommodate an ambiguous interactive systemic model of causality, but a legal arena is seeking to assign definitive responsibility. Also, in the individual case, it is often very difficult, if not impossible, to attribute mildly abnormal findings such as slightly more proactive memory interference than normal, mild balance difficulties, occasional visual imperceptions, headaches, dizziness, fatigue, and memory complaints to a particular etiology. Such a pattern of symptoms could represent (1) brain dysfunction, (2) a normal population variant, (3) pre-existing mental health problems (e.g., depression and anxiety), (4) pre-existing or coexisting medical problems (e.g., chronic pain syndrome, multiple sclerosis, hypertension, acquired immunodeficiency syndrome, alcohol-abuse-related complications), (5) inadequate patient effort on examination or outright malingering, or (6) a combination of these factors. Furthering the difficulty in determining etiological factors is weighing the degree to which pre-existing poor coping skills, selfbeliefs/ expectations, poor social support, medical iatrogenesis, or litigationbased iatrogenesis might amplify and extend residual post-mTBI problems. A conservative but limited approach for the health care provider might lie in time-tested, clinically validated diagnostic evaluations, a careful history of preinjury and postinjury symptoms and functioning, and a reliance on the medical linear model of causality. However, an increasingly used approach relies on the examination of multiple potential predisposing factors, causative agents, and perpetuating factors that interactively influence each other. Causality determination requires (1) examination of all relevant etiological events or factors, (2) investigation of the initial clinical presentation as being more or less consistent with those potential causative agents, (3) tracking ongoing or emerging symptoms as being consistent with the medical literature regarding potential causative agents and not consistent with other potential etiological factors, and (4) examination of findings from diagnostic procedures as being consistent with the clinical history, the nature and course of symptoms, and suspected explanatory causative factors. Only if a chronologically consistent and clinically logical pattern of results emerges after an alleged causal event can findings be attributed to it.

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Authors and Affiliations

  1. James A. Haley Veterans Hospital, Tampa, FL, 33612, USA

    Rodney D. Vanderploeg Ph.D., Heather G. Belanger & Glenn Curtiss Ph.D.

Authors
  1. Rodney D. Vanderploeg Ph.D.
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  2. Heather G. Belanger
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  3. Glenn Curtiss Ph.D.
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Editors and Affiliations

  1. Department of Psychology, Glendon College, York University, Toronto, ON, M4N 3M6, Canada

    Gerald Young

  2. Comprehensive Pain Program, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada

    Keith Nicholson

  3. Andrew W. Kane & Associates, S.C., Milwaukee, WI, 53211-3439, USA

    Andrew W. Kane

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© 2006 Springer Science+Business Media, Inc.

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Vanderploeg, R.D., Belanger, H.G., Curtiss, G. (2006). Mild Traumatic Brain Injury: Neuropsychological Causality Modelling. In: Young, G., Nicholson, K., Kane, A.W. (eds) Psychological Knowledge in Court. Springer, Boston, MA. https://doi.org/10.1007/0-387-25610-5_16

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