More than just a quick emergency room visit or short-term hospitalization may be needed after an auto accident causes injury to the neck or head. Cautious care with vigilant attention to details are immediate and vital needs. Loss of consciousness or a semi-conscious state (difficult to arouse, incoherent speech, dazed and confused) signal head trauma, but do not indicate severity or whether other injuries were sustained. Bloody or clear discharge from nose or ears are signs of probable cerebral hemorrhage or cerebrospinal fluid leakage, indicative of more severe trauma requiring quick emergency medical response. Pallor and diaphoresis (sweaty, yet cool to touch), uneven breathing (or sudden lack of it), deep cuts or lacerations which bleed profusely or puncture wounds also indicate serious injury. Care should be taken to not make conditions worse with well-meaning but ill-advised actions.
Fortunately, first responders usually provide appropriate medical intervention. Public awareness programs and Red Cross emergency response classes emphasize the ABC's (airway, breathing, and circulation) along with the importance of stabilizing the neck to prevent further injury. If neck fracture is suspected, the injured person should not be moved before paramedics arrive unless there is an immediately life-threatening situation, such as fire. Our 911 system makes it easy to obtain quick transport via trained paramedics to a hospital or trauma center, where further evaluation and treatment prevent complications. Staff are trained and have equipment enabling them to assess whether there are fractured vertebra, skull or facial bone fractures, or hematomas (blood-filled abscesses) within the skull. Depending on size and location, hematomas can create additional damage to vital brain structures or impose life-threatening pressure due to overfilling the limited space within the rigid skull compartment. Emergency surgery may be needed to drain hematomas, to repair or prevent blood vessel hemorrhage or cerebrospinal fluid leakage, or to stabilize fractures of vertebra, facial bones, and the skull. These bones are like medieval armor, normally protecting the spinal cord, brain and other sensitive structures like nerves and blood vessels. However, when fractured, sharp bone fragments may move, cutting or severely damaging what they usually protect.
Perhaps not as obvious, but just as important, continued caution and vigilance are vitally important in follow-up care. Hours or days after the trauma occurs, the full extent of head trauma or brain injury may not be fully apparent. Similarly, irritation of the spinal nerves, or the peripheral nerves as they exit through vertebral foramina, may be more than initially assessed. Increasing edema may create more pressure and damage to the brain, spinal cord, or peripheral nerves. Hemorrhage or cerebrospinal leakage may not have been apparent in mild cases, or may occur secondary to edematous pressure on damaged structures. Infections can create additional dysfunction; open lacerations, fractured bones that pierce the skin, or surgery may allow access for bacteria. Stress of injury causes surges of neurotransmitters, wreaking havoc on already compromised systems.
Detailed physical examination and thorough evaluation by a physician specializing in treatment of similar conditions should be scheduled. Additional diagnostic tests such as MRI (magnetic resonance imaging) or CAT (computerized axial tomography) can provide vital information about progress, or its lack. Early rehabilitation efforts should not be prematurely discontinued or precluded due to slow progress or plateaus in improvement. Appropriate treatments and additional assessments from allied health professionals often show results after these recovery delays. Home health care aids may be needed, either temporarily or on a longer basis, as well as adaptive devices to aid in return to pre-injury activities.
Spinal cord trauma may lead to functional deficits; motor and sensory nerve function assessments are warranted before and after edema resolves. Pain and weakness may occur due to pinched nerves or herniated discs, or be associated with soft tissue injuries of the surrounding muscles and ligaments. Physical therapists' evaluation and treatments should be initiated early to not only provide relief but also to prevent increasing dysfunction.
Cognitive and motor skill deficits due to head trauma or brain injury also require specialized rehabilitation. Prompt evaluation and treatment interventions by allied health professionals such as clinical neuropsychologists, speech therapists, and occupational and physical therapists may be needed to regain diverse functions disrupted by brain injury. Difficulties in language expression or processing (termed expressive or receptive aphasia) restrict normal functioning. Attention, memory, or executive functions (ability to follow simple instructions or perform multi-step tasks) may be compromised in varying degrees.
Thought processes (cognition) and thought-induced motor actions are dependent upon intact brain pathways and complex neurophysiological interactions for normal functioning. Focal contusions may create disruptions only at a localized region of the brain in contrast to more diffuse axonal
injuries. However, research studies demonstrate that even focal lesions may cause damage to remote brain structures, creating widespread disruption of cognitive networks. PETscans and MRI brain scans demonstrate structural improvement in head trauma patients receiving cognitive therapy compared to those with similar injuries not receiving early therapeutic intervention.
Brain injury recovery occurs through at least three mechanisms: compensation, adaptive neuroplasticity, and reduction of diaschisis (reduced use of distant brain areas connected to the injured area). Diaschisis can be reduced during early stages of recovery, as treatments stimulate neurophysiological mechanisms causing this process to reverse. Compensation occurs through treatments utilizing skill retraining or internalizing alternative strategies, often employing adaptive devices to assist with activities otherwise precluded by these deficits. Adaptive
neuroplasticity is a use-modulated reorganization of cortical structures, similar to mechanisms of training and learning throughout life. Repair and adaptation after injury may be promoted by stimulating alternative neural pathways, evolving to improve brain function.