Motor vehicle accidents are the leading cause of traumatic brain injury in the United States. Serious neck injuries and head trauma are also not uncommon. These injuries are life changing for both the victim and their carers. The rate and extent of recovery varies from person to person but with proper physical and cognitive rehabilitation they can be improved.
Types of brain injury
The sudden impact of a motor vehicle collision can cause serious injury to the brain. When the head stops abruptly the brain keeps moving and is slammed against the inside of the skull damaging the tissues and nerve fibres.
If the impact fractures the skull the bone can be depressed into the brain tearing the tissues and will require surgery to remove the bone fragments. Even when there is no direct impact the force with which the brain is moved can cause nerve fibres to be stretched, twisted and damaged.
These injuries also contribute to secondary injuries which can cause widespread additional damage to the brain. Swelling of the brain, hematoma and contusions or bruises to the brain, all create a build up of intra cranial pressure. Unrelieved this pressure can cause permanent damage to the brain cells and nerves.
Treatments to relieve intra cranial pressure depend on the severity. They range from medication to reduce swelling through induced coma and hypothermia to slow blood flow. Surgery is only used in extreme cases or when non-invasive methods are not working.
Effects of brain injury
Loss of conciousness is usual with a brain injury and can be as mild as a short term concussion or as serious as a patient remaining in a permanent vegetative state.
Between these two extremes are ten stages of recovery. In the first three there is very little response to external stimuli. The patient may react to loud noises but they have no awareness of what is happening. They are incapable of doing anything for themselves.
Stages four to six involve regaining awareness of their surroundings. The patient's confusion is evident and they require substantial assistance. During stages seven and eight the patient begins to be more self sufficient. They can do normal activities with only a little help but get tired very easily.
Stages nine and ten bring a patient back to a normal functioning level. It is important to understand that a normal functioning level may not be the same as it was prior to the accident.
Other long term effects of brain injury may include severe depression, mood swings, short term memory problems, blurred vision, slurred speech, seizures and coordination problems. Not all patients will reach full recovery.
Neck injury
The spinal cord connects the brain to the nerves of the body and is protected by vertebrae. There are seven vertebrae in the neck and if one of these is broken or moved out of alignment the bone can press into the spinal cord and break or damage it.
An injury to the spinal cord in the neck can cause paralysis and may impair breathing. The severity increases the higher up in the neck the injury occurs. A patient who sustains an injury to the first three vertebrae will have only limited movement of the head and neck while damage to the seventh vertebrae may allow movement of the arms and some hand function.
Whether the effects are permanent will depend on how severe the injury is. Even with permanent damage treatment and rehabilitation can often make some improvement. Surgery to remove bones pressing on the spinal cord may be required.
A cervical herniated disc is a pinched nerve in the neck. Although it is painful, the pain can be controlled by medication and with rest most people recover within a few weeks. Usually there is no permanent damage however if it doesn't improve after several weeks surgery may be required.
Head trauma
Common injuries in motor vehicle accidents include fractures of the nose, jaw, midface, cheekbone and eye socket.
While fractures are painful only fractures to the internal nasal bones, midface and breaks which penetrate the skin are serious enough to require surgery.
Lacerations may need stitches to help stop bleeding and protect the underlying tissue. Cleaning of the wound to prevent infection is essential as are a tetanus booster, antibiotic ointment and a sterile bandage.
People who have permanent physical or cognitive impairment often have difficulty coming to terms with the fact that they will never be the same as they were prior to the accident. Family members and friends also often struggle with the changing relationships. Asking for help when it is needed is essential to long term adjustment and success.