Traumatic brain injury (TBI), whether mild or severe, can have a devastating impact on interaction with 3 family, job, social life, and community. Trauma to the brain can occur during an automobile accident when the skull strikes an object, such as a steering wheel or windshield, or it may occur when head and neck are forcefully and violently thrust in a particular direction. When a moving head comes to a quick stop, the brain continues in its movement, striking the interior of the skull, causing bruising of the brain (contusion) and bleeding (hemorrhage). The brain opposite the site of impact is pulled away from the skull, injuring the brain in that area. There may or may not be an 9 open wound to the skull for a traumatic brain injury to occur.
There are two categories of Traumatic Brain Injury: mild and severe.
A person suffering from a mild traumatic brain injury may experience loss of consciousness and/or 13confusion and disorientation shorter than 30 minutes. The injured may have headache and cognitive problems such as difficulty thinking, memory loss, attention deficit, mood swings, and frustration.
The signs and symptoms of a traumatic brain injury vary in degree of severity and amount of recovery time. In a severe traumatic brain injury, the injured experiences loss of consciousness for over 30 minutes after the injury, with memory loss. When the skull is penetrated, loss of consciousness is longer than 24 hours, and may range from impairment of higher level cognitive functions to comatose states. There may be limited function of arms or legs, abnormal speech or language, loss of thinking, and emotional problems.
Injury to the spine, pelvis, and extremities (arms, legs, hands, and feet) from an auto accident can be mild, moderate, or severe, depending on the direction, force, point of impact, and the body structures involved.
When a vehicle is struck, the body of the driver or passenger continues the motion of the vehicle until it is restrained or stopped by either the steering wheel, windshield, airbag, seat belt, interior of the car, or objects outside the car if the injured is thrown from the vehicle. At the time of impact, bony structures in the neck, mid back, lower back, and pelvis can misalign and be crushed.
On impact, the softer tissues that hold bones together (muscles, tendons, ligaments, and discs) are 31stretched and torn, while nerves that pass between bones are irritated and damaged, causing pain and lack of function to joints and other areas of the body the nerves supply.
Even the act of a car spinning out of control without actually striking an object, for example on an icy roadway, can cause misalignment and damage to bones, joints, and nerves.
A whiplash or hyperflexion/hyperextension injury to the head and neck is the commonest motor vehicle accident injury. When a moving or stationery vehicle is struck either from behind or in front, the body of the driver or passenger in the vehicle lifts upward and is thrust forward or backward, depending on the direction of impact. At that time the head, weighing 13 pounds, whips forward or backward. When this happens, neck and spinal muscles suddenly contract to brace the body.
The entire spine can be involved in a whiplash injury, causing pain in the head, neck, shoulder, mid back, lower back, and pelvis. The sudden abnormal motion caused by a hyperflexion/hyperextension injury creates misalignment of the head and neck and may cause damage to muscles, tendons, ligaments, and 44discs that hold the joints together.
A T-Bone or Broadside impact to a vehicle can cause a side to side injury much like a whiplash; in this 47case the direction of force and impact is from the side. Like a whiplash, the entire body can be involved.
As with a whiplash, a broadside impact injury is not always apparent immediately after a motor vehicle accident. Because symptoms may appear days and even months later, medical and chiropractic evaluation and treatment is essential immediately after an accident to detect and correct any damage. An injury that is corrected within the first 48 hours after an accident has the greatest chance of complete recovery without permanent impairment.
Motor vehicle accidents are a common cause of traumatic stress with accompanying emotional distress, which can lead to post-traumatic stress, depression, and anxiety. In any given year, approximately 1% of 56the US population (over three million individuals) will be injured in motor vehicle accidents. The majority of those who survive a serious motor vehicle accident do not develop mental health problems that warrant professional treatment. However, there are certain risk factors that predispose an individual to motor vehicle accident post-traumatic stress disorder.
Poor ability to cope in reaction to previous traumatic events, or pre-accident mental health problems such as depression, limits the ability of an individual to withstand a new traumatic event. Lack of social 63support from family and friends may also limit ability to cope.
The amount of physical injury during an accident and, in many cases, potential threat to life may cause an extreme stress reaction. Loss of significant others from the accident may also contribute to motor vehicle accident post-traumatic stress disorder.
Delayed rate of physical recovery from a motor vehicle accident injury adds emotional stress. Lack of social support from friends and family also delays emotional recovery. The level of active reengagement in both work and social activities may determine the degree of emotional recovery from a traumatic accident.
Muscles in the head and neck that are directly and indirectly connected to the jaw may contract and 75misalign the temporo-mandibular joint (TMJ) during a motor vehicle accident. Misalignment of the TMJ causes pressure on nerves that travel to the face, causing pain and abnormal and limited movement of the jaw.
Symptoms of TMJ disorder may include:
- Pain or tenderness in the jaw
- Aching pain in and around the ear
- Difficulty or pain with chewing
- Facial pain
- Locking TMJ, making it difficult to open or close the mouth
- Limitation of movement
- Clicking jaw, with pain or limited movement
- An uneven bite
Uncorrected misalignment of the neck as a result of a whiplash injury, or other injury to the head and neck, can cause continuing misalignment of the TMJ with its symptoms.
Carpal Tunnel Syndrome (CTS) may occur with motor vehicle injuries and display the following symptoms:
- Numbness, tingling, or burning in the thumb and/or first three fingers
- Loss of dexterity in the thumb and/or fingers
- Pain in the hand that may go up to the arm and shoulder
- Inability to grasp or pinch an object
- Frequent dropping of objects
CTS occurs when a bone in the wrist, called the lunate, is thrust forward and misaligns in that position when the hand is held in sudden or prolonged extension with accompanying force applied to the upturned palm. The lunate presses on a nerve, causing pain in the wrist, palm of the hand, fingers, and 100up the arm, with limited movement and grip strength. In a motor vehicle accident, this injury may occur 101when a driver or passenger extends the arm in an attempt to brace the body to avoid impact and pushes 102against a solid, stationery object, such as a dashboard.
It is common for a victim of a motor vehicle accident to experience dizziness and vertigo. Dizziness is a 105sensation of unsteadiness and a feeling of movement within the head, while vertigo is a sensation of 106rotation or movement of one’s self or of one’s surroundings. There are four leading causes of vertigo or 107dizziness that can occur after a crash.
The most common cause of dizziness following an auto accident is cervicogenic dizziness: dizziness from a neck injury. A whiplash injury, and other injuries to the head and neck, effect the area of the brain that controls balance, coordination, and spatial awareness.
The area of the neck beneath the skull is sensitive to position of the head in relation to the rest of the 113body. When this area is damaged with injury to the head and neck, information about body balance and position is interfered with, causing light-headedness, dizziness, vertigo, and often migraines.
Benign Paroxysmal Positional Vertigo, or BPPV, can be triggered by violent movement of the head, as during an auto accident. Sudden, violent movement of the head causes small calcium crystals in the inner ear that are sensitive to body position to be jarred from their usual position in relation to other areas of the inner ear. When this happens, the dislodged calcium crystals send messages about posture to the brain that don’t make sense, causing dizziness.
When blood vessels of the neck are damaged, blood flow is restricted to the brain, causing dizziness.
If the head hits something at the time of an accident or if the crash was severe, the injured can suffer a mild traumatic brain injury, with fuzzy thinking, confusion, vertigo, or memory loss.