It is common knowledge in the brain injury community that the public does not understand the seriousness of head trauma. Television and movies are filled with images of brain injury that are wrong and can make working with brain injured patients much more difficult.
This current study1 compared current perceptions in the general public about traumatic brain injury (TBI) with perceptions shown in previous studies conducted up to 13 years ago. The goal was to see whether public awareness has increased over the years, and to look at misconceptions that could affect outcomes in personal injury litigation cases.
179 individuals conducting business at a motor vehicle department in Rhode Island participated in the study by completing a 19-item survey. The mean age of participants was 42.5 years, with 45% male and 55% female. Nearly half (46.2%) reported some exposure to TBI in the past, with 17% reporting having suffered a TBI themselves, 13% indicating that a family member had suffered from a TBI, 11% noting that they encountered TBI on a daily basis through work, and 6% stating they had a friend who had suffered from TBI.
The 19-item survey evaluated knowledge about TBI, its cause, effects, and recovery from it, with 11 items drawn from previous surveys created by Gouvier2 and Willer.3 The study authors also created 8 items designed to specifically address issues relevant to head injury litigation. Participants chose between “true”, “probably true,” “false,” or “probably false” when answering survey questions.
Questions addressed such areas as memory loss after TBI, functional ability after TBI, the ability to return to work after moderate or severe TBI, whether complete recovery from a severe head injury is possible, learning ability after TBI, and whether brain damage matters in functioning. The forensic questions addressed whether it is possible to fake brain damage, the motivation for litigation, how brain damage is determined, whether being drunk at the time of injury “lessens” the impact of the injury, the ability to return to vocational functioning after TBI, and whether TBI affects men and women differently.
The percentage of misconceptions/wrong answers to questions about TBI in this study was overall very similar to the results obtained years ago in previous studies, especially in regards to moderate to severe injury. For instance, 42% of respondents believed that a second blow to the head could improve memory functioning after TBI, based, the authors believe, in part of the role of media and even cartoons in educating the public about TBI. Study participants were more knowledgeable about mild TBI in this study than in Gouvier’s previous study, with a larger number of respondents realizing that brain damage can occur without loss of consciousness, or from whiplash injuries.
The forensic questions showed that 25% of respondents believed it would be easy to fake brain injury, and 40% of those surveyed believed that most litigation surrounding brain injury is to obtain money, and not related to a real injury. 60% of the respondents believed that severe brain injury does not disrupt vocational functioning, and 66% believed that an X-ray was the only reliable way of determining if someone has suffered brain damage from TBI.
Perceptions about TBI were not affected by age, gender, or educational level. Exposure to those with TBI (self, family, friends) did decrease the number of true answers to the item, “The only sure way to tell if someone has suffered brain damage is by an X-ray of the brain.”
Discussion
Based on study results, the authors note, “…no significant change in the level of knowledge about moderate to severe brain injury has taken place within the last 8-13 years…geographical region is also unrelated to TBI misconceptions.”
The effect of the popular misconceptions noted in the study on patients with TBI can include frustration in themselves and others, and “may impede re-integration back into the community,” note the authors. The authors note that education, including initial assessment with a survey and providing materials, is important not only for patients and family members, but for insurance providers and workmen’s compensation carriers in obtaining adequate care for this group.
The authors raise concerns about the large percentage of pre-existing misperceptions found during the survey about the ability to fake brain injury, that all litigation is financially motivated and not based on true injury, and that X-rays are the only reliable indicator if brain damage has occurred, on jurors during litigation. They conclude,:
“It would seem wise for attorneys to invest substantial time and effort in educating jurors about the realities of TBI, in turn counteracting false beliefs and reestablishing proper impartiality in the jury.”
They feel this should be combined with ongoing public education about the effects of moderate and severe TBI to counteract misconceptions, which have overall changed little in the past 13 years.