Traumatic Injuries

Traumatic brain injury is a head injury caused by any sudden physical damage to the brain. This usually occurs as a result of a sudden forceful blow to the head that can be caused by either the head hitting a nonmoving object such as the steering wheel of a car; a moving object hitting the head, such as would be seen in a violent assault; or something passing through the skull and piercing the brain. According to the National Institute of Health, the major cause oftraumatic head injury in the United States is motor vehicle accidents.

The most recognized cause of a head injury resulting from an accident is the skull’s sudden, if not immediate deceleration as a result of striking a blunt object such as a steering wheel, dashboard or even air bag. When the skull’s momentum is stopped, the brain’s momentum within the skull does not automatically stop at the same time. The brain can be compared with a piece of jello within a container. While the container may stop, the jello within carries the momentum and squishes against the hard walls of the container. This is precisely what happens with the brain in a closed head injury. While the skull’s momentum stops in an instance, the brain, a much softer and malleable organ, continues to carry momentum and is squished or pressed against the hard skull. This can then lead to one or more of three separate processes that work to injury the brain: bruising, tearing and/or swelling.

There are two types of brain injuries. “Closed head injury” and “open head injury”. These two types of injuries almost define themselves.

“Closed head injury” means that the skull is not fractured. These injuries can be more difficult to recognize and understand because of the relatively benign appearance of the injured body part. However, due to that fact, closed head injuries can at times be more dangerous as they are not readily recognized, and because there is no fracture to the skull, swelling and bleeding of the brain creates pressure and additional damage to brain tissue.

“Open head injury” means that the skull has been fractured. Obviously, this can cause severe injury but there are also times where the fracturing of the skull may work to alleviate built up pressure caused by bleeding and swelling which can in turn minimize the long term brain damage.

To view an image of the anatomy of the brain and its labeled parts, select the option below:

Anatomy of the Brain

The damage resulting from a traumatic brain injury depends upon the area of the brain that is damage. Many traumatic brain injuries are caused by what is commonly referred to as “focal damage” which only affects a small portion of the brain where the specific point of impact occurred. In other situations “diffuse” brain injuries can result when the traumatic impact causes the brain to move back and forth within the skull causing damage to larger areas and multiple regions of the brain.

The brain is generally divided into two “hemispheres”: the “right hemisphere” and the “left hemisphere”. The right hemisphere is associated with relationship tasks and spatial abilities and controls the left side of the body. The left hemisphere controls the right side of the body and is associated with the production and understanding of language, and logic. [See Brain Anatomy, Brain Injury Symptoms]

Specifically, the brain is made up of three main parts: the forebrain (consisting of the cerebrum, thalamus and hypothalamus), midbrain or brain stem (consisting of the tectum and tegmentum) and hindbrain (consisting of the cerebellum, pons and medulla). The cerebrum is the larges part of the human brain and is divided into four sections referred to as “lobes”.

They are the frontal lope, parietal lobe, occipital lobe and temporal lobe. Each lobe is associated with different functions of the human body.

Frontal Lobe:  Planning, speech, reasoning, emotions, judgment, intellect, creative thought, and coordination of movement, sexual urges, problem solving and abstract thinking.

Parietal Lobe: Orientation, perception of stimuli, movement, and orientation.

Occipital Lobe: Vision and reading.

Temporal Lobe: Memory, hearing, fear, some emotions, visual memories, auditory memories, and speech.

The cerebellum is another crucial piece of the brain. The cerebellum, which is commonly referred to as the “little brain”, is associated with the coordination and regulation of movement and motor-vestibular movement and learning.

Symptoms of a brain injury can be confused with other problems just as brain damages to the frontal lobes can result in various ongoing effects such as those listed below.

• Dramatic increased or decreased talking
• Impaired perception for taking risks or abiding by rules
• Diminish or heightened outward socialization
• More frequent attention deficient
• Reduced problem solving abilities
• Reduced creative abilites
• Impaired spontaneous responses
• Peculiar sexual habits if the Orbital frontal lobe is damaged
• Reduced sexual drive if the Dorsolateral frontal lobe is damaged
• Complete loss of smell
• Complete loss of taste

The central nervous system controls the behavioral movements of the human body. It is responsible for taking sensory information and responding to it.

The central nervous system is made up of two primary components: 1) the brain and 2) the spinal cord. The spinal cord collects sensory information from the peripheral nervous system and transports that information to the brain where the brain’s primary function is to receive that information and direct the appropriate motor responses to the information received.

Car accidents are the leading cause of spinal cord injuries in the United States of America, making up approximately 50% of all new spinal cord injuries in this country every year.  That amounts to over 5,000 new spinal cord injuries a year that are caused by car accidents.

Spinal cord injuries suffered in car accidents are due to trauma to the spinal region that results in compression, dislocation, fracture or crushing of the vertebrae that protects the spinal cord and other nerve fibers.  Also, much like with traumatic brain injuries, resulting pressure to the spinal cord by way of bleeding, swelling or excessive fluid buildup may also cause additional injuries even weeks after the initial traumatic event. The damage to the vertebra whether due to compression, dislocation or otherwise, will have a corresponding impact on the sensitive nerve fibers and spinal cord in and around the injured region.  These nerve fibers can be pinched, partially torn or worse yet, completely severed.  Paralysis occurs when the spinal cord is completely severed, but when the tear or obstruction is only partial, the individual will still have some movement and/or sensation below the injury site depending upon the severity of the injury.

Injuries to the spine can have such serious consequences because of the corresponding damage to the function of the central nervous system. The severing, tearing, compression, or pinching of the sensitive nerve fibers and spinal cord has a direct impact on the collection of sensory information and relay of that information to the brain. The injury also has a similar effect on the relay of information to the body’s muscles from the brain directing bodily movement.

Think of it as road construction. The nerves and spinal cord are a lot like a main highway through a busy town. When everything is functioning properly, the information (vehicles) flows freely to and from where it needs to go. When the road is partial damaged (lane closure) the flow of information becomes backlogged and does not flow as freely or as quickly as it normally would. Some information does not get through while other information is delayed. When the road is completely closed down, the information does not pass through at all. Because the sensory gathering and information flow is obstructed, the brain is unable to receive the sensory information and direct the appropriate response.

The most serious consequence of a spinal cord injury is paralysis or inability to move of function and loss of sensation. The degree and location of the paralysis or loss of sensation depends almost entirely on the region of the body that is injured. Paralysis and/or loss of feeling or other senses occur below the injury site because the injury to the nerve fibers blocks or obstructs the relay of information from those regions up to the brain. As a result, information cannot be gathered from the areas of the body below the obstruction and the brain cannot then relay information down to those areas to direct movement. Spinal injuries are most common in the neck (cervical region) and lower back (thoracic and lumbar regions). A severe injury to the cervical region can result in quadriplegia or loss of use of legs and arms as well as impairment of ones ability to breath. Severe injury to the thoracic or lumbar region may result in paraplegia or loss of use of ones legs as well as sexual function and bowel control.

Injury to the central nervous system, the head and brain (traumatic brain injury – TBI, spinal column or nerves often require long rehabilitation and therapy resulting in time off of work, lost wages, and extensive medical bills that can place your financial security at jeopardy regardless of who is at fault for the accident.

Gourley, Rehkemper & Lindholm’s attorneys are available 24 hours a day for emergency situations, and during regular business hours for non-emergency legal advice and assistance – just call us at 1-866-743-6652.

Burn injuries are one of the worst injuries that can occur in an automobile accident.  Depending on the type and severity burns are often catastrophic whether or not they result in death.  The pain involved with such an injury is extraordinary.  This is because burns affect so many parts and functions of the body including skin, muscles, nerves, bones, the circulatory system and the respiratory system.   Further, this type of injury often has a lifelong effect on the victim given the likelihood of scarring and disfigurement associated with severe burns.  Treatments include everything from topical ointments to scar revisions therapy and skin grafts.   The psychological effects of a burn can also be severe and require therapeutic intervention.

There are many burns that can occur in a car accident.  These include thermal burns, chemical burns, and electrical burns.  Other burns, such as light and radiation are not as common place in an automobile accident.   The most common type of burn is a first degree burn which is also the least severe.  First degree burns generally involve only the top layer of skin and can cause pain, discoloration and swelling.  Second degree burns penetrate deeper and involve the second layer of skin as well.  Such burns are sometimes accompanied by blisters in addition to the above effects.  Third degree burns are the most severe and require the most treatment and prolonged care.  Such burns can result in permanent disfigurement or even death if severe enough or not treated.  If you suspect you may have suffered from such an injury following an accident, even if you are not sure, seek immediate medical attention.  For further information on initial treatment of burns click here.  Sometimes following an accident an individual can be disoriented or in shock and not realize that they have been burned, or burned as severely as they are.  Further, immediate treatment is the best way to ensure that the effects of a burn are minimized.

According to the American Burn Association in their 2011 fact sheet, nearly 450,000 patients were treated for burns last year.  Of those, 3,500 resulted in death.  45,000 required hospitalization for acute burn care. 

Amputation and dismemberment injuries are some of the worst injuries that can occur in an automobile or other accident.  Amputation and dismemberment injuries involve the loss of a body part typically from severe trauma to a limb.   They are particularly prevalent in motorcycle and pedestrian accidents.  The effects of these types of accidents are extraordinary and numerous.  The pain can be excruciating and the long term effects even worse.  These effects include the learning to live, work and enjoy life again in a different way than a person has in the past.  In some instances such as the loss of one or both arms or legs, this learning process can be long and excruciating in and of itself.  Another result of these types of injuries is the cosmetic change or the change of a person’s appearance.  Learning to live with a new disability and how that affects a person appearance including how others react is a long and difficult process in and of itself.   Also and very importantly, the emotional trauma of such a life altering injury cannot be understated.  The emotional healing process is often overwhelming to a person and their family who has suffered such an injury.   Yet another life altering effect is the ability of someone with such an injury to return to work or earn a living.  If such an injury  affects a person job or prevents them from working, their families wellbeing is at risk.

There are a number of programs available for those who have suffered these types of injuries.  The following are a few that might be helpful:

1. National Amputation Foundation– Founded in 1919 for war veterans, the NAF now helps all amputees across the country regardless of the cause.
2. Amputee Coalition–  described as the leading organization on limb loss, dedicated to enhancing the quality of life for amputees and their families, and improving patient care for limb loss
3. Amputation Overview– For a medical description of the causes procedure and effects.

From a legal and insurance perspective, all of these extraordinary effects must be understood, considered, and adequately addressed when dealing with an insurance company or making a claim in such life-altering situation.  If they are not, the compensation that an Iowan is entitled to if they have endured such an injury is at risk.   If you or a family member has suffered this or another type of catastrophic injury, we would welcome the opportunity to speak with and work through the situation with you.

Fracture and dislocation injuries are one of the more common injuries that result from car, motorcycle, biking, pedestrian and other accidents.  Fractures refer breaks to bones while dislocation generally refers to a joint being forced out of its natural position in the body.  Fractures can occur to any bone in the body while dislocations can occur at any joint in the body.

Fractures can vary greatly in severity.  In some instances a person can suffer a hairline or very small fracture that can go unnoticed immediately after an accident.  Hairline fractures are not complete or displaced breaks of a bone. While they are typically the least severe type of fracture, they can certainly lead to ongoing pain and difficulty in using a certain limb or part of the body.  On the other end of the spectrum in the most severe cases, bones can be broken or crushed completely and break in one or more locations and in to multiple pieces.  These injuries are typically much more severe and can result in temporary or permanent disability and severe pain.

Types of fractures that often occur in roadway accidents whether motorist or pedestrian collisions include the following:

• Greenstick Fractures- an incomplete fracture where a bone is bent as opposed to a clean break.  This injury is often seen in children as their bones are more pliable and less brittle
• Comminuted- this is where a bone breaks into more than one pieces
• Oblique- this is where a break has a curved pattern as opposed to straight across
• Hairline-  as stated above, these are the smallest fractures which can result from stress to a bone over time or trauma such as in a car accident
• Transverse fracture-  a fracture that results in a right angle to a bone’s axis
• Buckle fracture- also called an impacted fracture where two ends of a bone are forced into one another

Fractures can also lead to other serious or life threatening complicaitons.  This can occur if the fractured bone punctures an organ or damages nerves or blood vessels or other surrounding tissue. Accordingly the pain can be excruciating and the long term effects very severe. Severe injuries to bones can result in permanent disability and pain in the some circumstances.  When this occurs, there can be life changing impacts on your appearance, family, work, and overall enjoyment of life.

Dislocations are differ in that they refer to an injury to a joint as opposed to a bone.  However they can be just as severe as a fracture.   A joint is where two bones come together and if those bones are forced out of their natural position, a dislocation results.  Dislocations most commonly occur in the shoulders and fingers.  However some of the more severe occur in the elbows knees and hips.  In many, circumstances they can return to normal function in a few weeks.  However, oftentimes times dislocations result in a person being more prone to the same injury in the future.

Both dislocations and fractures can require reduction whereby a doctor’s attempts to manipulate the bone or joint back into place.  In some instances surgery is required followed by  physical therapy, occupational therapy, and/or other treatment.  In the most severe cases, both can result in permanent and debilitating effects.  From an insurance and legal claim standpoint, the short and long term treatment and effects need to be thoroughly understood and adequately addressed when dealing with such an injury, regardless of the severity. If not, an Iowan that suffers a dislocated hip, a compound tibia fracture or other such fracture is at risk of losing the compensation that an insurance company is required to pay under Iowa law.