Everything we do, think, and feel is made possible by the workings of our brain: our perception, cognition, movement—everything. Most fundamentally, our brain provides the seat of our personality and our sense of self. It gives form to the person we are and, for children, the person they might become. That’s why a child’s traumatic brain injury (TBI), one of several common auto accident injuries, is a parent’s worst nightmare. Although the parent’s son or daughter physically survives an accident, the child is in some significant way not the same.
Such a child faces an uncertain rehabilitation process. Improvements will be made, parents are told, but it is unlikely that their child will return to the level of functioning before the injury. Changes will persist in how he or she navigates the world. The child may struggle to learn, to speak or to control his or her impulses, for example. Once parents learn this, they must somehow cope with the loss of the image they held of their child, and to form a new one that reflects the realities of their child’s injuries.
Because I believe traumatic brain injury in children—typically occurring in accidents involving cars—represents such an important subject, I’d like to cover the basics of how brain injury can occur in children. I’m certainly not a neurologist, but over the course of my career as a personal injury attorney, I’ve learned that there are a few principal ways in which the child’s brain can suffer trauma as a result of an auto accident.
There are two basic scenarios that lead to brain injury. The first is when the child’s head is relatively stationary and is hit by a moving object—a child runs out into the street and is struck by a car, for example. The second is when a child’s head and body are moving—as they are when the child is riding in the car—and abruptly stops upon contact with a stationary object—the dashboard, for example. In both of these scenarios, a great deal of physical force and energy is abruptly transferred to the child’s head and brain.
Upon contact with the object, the child’s brain—which sits inside the skull, surrounded by a layer of protective fluid—will move violently, probably striking the inner wall of the skull. This contact typically leads to the brain being bruised, resulting in “contusions,” as they are called. These contusions will certainly occur in the region of the brain nearest to the point where the child’s head contacted the object. They may also occur, however, on the opposite side of the brain, especially in accidents where the child is moving. Imagine it: upon contact, the child’s head suddenly stops, but the brain continues moving—first forward, striking the skull, and then backwards, only to strike it again.
Contusions represent injuries to the outer layer of the brain, known as the “cortex” or “grey matter,” composed of the tips of the brain cells. As a result of the violent movement I just described, injury can also occur to the inside of the brain—the “white matter,” which is made up of the long wire-like extensions of the brain cells: the “axons.” That’s why this type of damage is known as “diffuse axonal injury.” Injury to the inner part of the brain is especially likely when the accident causes the brain to twist, stretching and breaking these long axons, killing the cells of which they are a part.
Contusions and diffuse axonal injury represent the most immediate trauma that can be caused by an auto accident. Further injury can also occur as the result of complications from this damage. Delayed injuries can occur if bleeding inside the head creates excessive pressure, which can prevent adequate blood flow to the brain. Increased pressure can also build if there is “edema,” or swelling of the brain. Immediate medical treatment following the accident is the best way to prevent this type of secondary damage.
I hope this article has given you a basic understanding of the basic physical mechanisms that underlie brain injury. TBI in children is—I’m sorry to say—a common result of auto-related accidents. Fortunately, there is a great deal that can be done to prevent these injuries, and with proper medical care, rehabilitation and legal representation, injured children can make astounding recoveries. These recoveries may take time, but they are a testament to the devotion of loved ones, the skill of medical professionals, the expertise of qualified attorneys and—finally—the adaptability and plasticity of our amazing brains.