BRAIN INJURY IN THE INTERNET AGE:
HOW WILL OUR CLIENTS KEEP UP?  [ back to List of Articles ]
Harvey A. Hyman, Esq.

Attorneys who specialize in brain injury litigation tend to work in large urban centers like Atlanta, New York, Houston or San Francisco. Not surprisingly they hook up with a clientele with a substantial number of highly educated, affluent, middle-aged professionals who were participating in the mainstream economy when injured.

The frontal lobes take up one third the volume of our brains. They lie right behind our forehead and eyes, surrounded by sharp ridges of bone, such as the ethmoid. They face wherever we are looking. Many traumatic brain injuries (TBIs) occur primarily to the frontal lobes, because our clients strike their foreheads against steering wheels, dashboards, windshields, sidewalks, curbs and roads. Traumatic damage to the frontal lobes are virtually always associated with a decline in perception/reaction time and cognitive processing speed, which can be measured through tests such as finger tapping, Trailmaking, Symbol Digit or Pace Serial Addition. Patients who tell their neuropsychologists they are having trouble with "attention" or "concentration" are generally suffering from reduced information processing ability. In other words, they have suffered a decline in their capacity to take in, process and recognize perceptual data; encode it; or retrieve it; or some combination thereof. According to Dorothy Gronwall, this decline in processing speed mirrors a "slowing of our central nervous system clock."

The traumatically induced loss of cognitive processing speed tends to worsen geometrically with the number and complexity of stimuli which demand attention and response. Novel situations or having to make any immediate, forced choices or decisions, frequently push the person with this impairment into "overload." Visual disturbances, fatigue, depression, headache and distractions in the external environment, such as noise, make it even harder to keep up or stay on track. The problem is not lost brain storage capacity, but a decline in the speed and efficiency with which the injured brain processes information. An engineer who takes 10 times longer to make accurate calculations or drawings than he did be- fore his brain injury is still capable of getting out the product, but his earning potential will take a serious hit, because he has become too slow for the pressured work environment, where time is always of the essence.

In proving future vocational economic losses from this decline in cognitive processing speed, neurolawyers can and should speak in terms of the Information Technology (IT) Age that we are living in. How do we define the IT Age? One useful distinction is between "rival" goods and services, which are physical, finite and get used up by one person or a small number of consumers (e.g., a cheese burger or a haircut) and "nonrival" goods and services which can be shared an infinite number of times by an infinite number of people without being used up or destroyed (e.g., the information content on a CD-ROM). As time goes by "rival" goods and services will decline in economic importance, because we have become so efficient in making them. Fewer, less trained and lower paid workers are all that is required. The action is now with IT.

Rightly so, the IT Age has been likened to the Industrial Revolution, when steam power and electricity ushered in rapid economic growth and profound social change, with one big difference. The pace of innovation and technological change is accelerating much quicker now than during the 19th and early 20th century. The emphasis is on mobility (cell phones. Palm Pilots, lap top computers) and speed (Pentium microprocessor chips, DSL, fiber optic cables). Today's desktop PC gives the working person the power of yesterday's mainframe "supercomputers." The home environment is now becoming "wired" for combinations of "information appliances," which can link the stereo, TV and web browser to the computer. Everyday more people are banking, investing, making air travel arrangements, buying cars, even grocery shopping on-line. In the workplace the use of intra-nets, e-mail and two-way audio-video conferencing is becoming commonplace. For law and medicine, as for sales and marketing, the overhead slide projector of the past has given way to lap tops, LCDs, Elmos, Power Point software and CD-ROMs. Research has gone from leafing through dusty law books to Lexis, West Mate, FindLaw and others. Complaints are e-mailed to the clerk instead of filed by hand.

The Internet is now the largest and fastest growing mode of communication on the planet and "ground zero" in the development of the Internet is North America and Europe. This is not a chance occurrence. In 1991 the federal government enacted the High Performance Computer Act to promote and encourage commercial activity on the "net." By December 1998 there were 60 million PCs hooked to the net in the USA. The number of e-mails sent in 1997 was 3 trillion. It is estimated that 7 trillion e-mails will be sent this year. Polls show that 20 million US residents regard the Internet as an "indispensable" tool for business. Currently 85 of the Fortune 500 companies list their URL in print and TV ads. Web hosting has gone from 30 million to 60 million between 1998 and 1999. In July 1998 there were 300 million web pages. New pages are being born at the rate of 1.5 million a day. IT traffic is doubling every 100 days. Each month 10,000 new domain names are registered. There are now 5 million registered domain names of which 3 million are for business purposes. Polls show people use their time on the web 65 more for business than personal reasons. There are currently 100 million users of the Internet. It is estimated by various analysts that there will be 500 million users by the end of next year. To stay competitive in the IT economy one must latch onto and master ever changing IT gadgets, concepts and buzz words, all evolving at breakneck speed. A few examples should suffice. Elementary schools across the country teach computer skills to our children, and ask them to go "on-line" to get the facts for their reports. High schools are posting course information and grades on "intranets". Many colleges require students to apply on the "net." Upwards of 600,000 scholarships for college can be accessed by the "net." Essential information from our government is posted on the web about everything from tax breaks, to applying for Medicare, to identifying unsafe cars and prescription drugs. Many employers, employment agencies and headhunters advertise positions on the web, where job board entries and job fairs appear with regularity. The recent market "shake out" of smaller, "dot corn" retailers (when the Nasdaq fell 700 points) points to the fact that retailing has become very competitive and only the most efficient dot corns will survive. However, this in no way signals a halt in the development of IT or its relentless transformation of the American workplace.

Part of the IT Age is impatience with slowness. Channel surfing on TV with the remote control is tortoise-like compared to the web. Compu-Master reports that the average person will stay with a new website download for no more than 8 seconds, before making a decision to stay and browse or move on. For people who have spent months or years building a website, this is depressing news, yet the reality is, we must make instantaneous decisions, because there is so much information "out there" in cyberspace, and so precious little time to grab it. My point is that a TBI was always a source of impairment, disability or handicap in societies of the past; but in our IT society the disadvantages of a TBI are magnified because the speed demands on our cognitive processing are in hyper drive compared to prior generations. Somehow, some way, I think we should try to incorporate this point in the presentation of the damages portion of clients' cases. I am sure the defense would say computers have been a boon to people with TBI because of computer-based cognitive therapies, video-conferencing with medical specialists in far-off cities and being able to access therapeutic information on the web. The helpfulness of computers in those respects can be fully acknowledged without undermining the larger point that cognitive processing speed demands in the IT Age are extremely high now, and are likely to keep climbing.

Some textbooks with helpful discussions about cognitive processing speed are "Rehabilitation of the Adult and Child with Traumatic Brain Injury" 2nd ed. By Mitchell Rosenthal, PhD et al. (1990, F.A. Davis Company of Philadelphia, PA); "Cognitive-Communicative Abilities Following Brain Injury" by Leila Hartley (1995, Singular Publishing Group, Inc. of San Diego, CA); and "Neuropsychological Assessment" by Muriel Lezak 3rd ed. (1995, Oxford University Press). Some websites with "web facts" (statistical data about the web) are htnet.net; and pcworld.com.