Severe Brain Injury Deficits: Physical and Neurological

 Severe Brain Injury Deficits: Nancy Part Eighteen 

As brain injury is far more than a cognitive disorder, and also because so many severe brain injuries occur as a result of catastrophic forces on the human body, we try to focus on the physical and neurological aspects of the injury with each participant in TBI Voices.  Nancy’s severe brain injury deficits included those from the injury to her eye and orbit bone in the wreck.  I asked her Mom about these issues:

Are her eyes damages? 

Yes.  She has a scar on her left cornea that’ll, that has shrunk quite a bit in size since, you know, over the eight years or seven and a half years.

Can she see out of her left eye? 

She can.  Darkness is tough because the wider the pupil is the more she can start seeing that and it’s like walking in fog, she says it’s kind of foggy down there.  So her other eye is fine.  They don’t track exactly the same, they are so many millimeters off horizontally and her right eye is the strong eye, it’s the one that does a lot of the work.

Does she have difficulty with coordination, balance, walking because of that tracking issue as severe brain injury deficits? 

She has balance issues with anything leaning forward.  Like if I ask her to bend over and pick up something off the floor she doesn’t, it takes her a while to want to bend forward or she’ll squat or she’ll pick it up with her feet.

What other physical injuries did she suffer other than the facial, skull and brain injuries?  Anything else? 

Not that we know of.  There’s no neck, spine.  She did complain of almost like a sciatic nerve problem down her legs and her buttock area where it would be really sensitive but there wasn’t anything diagnosed that way.

No brain stem damage? 

No.

No cerebellar damage? 

No.

Let’s talk about the balance issues as one of her severe brain injury deficits.  Has that been specifically diagnosed as secondary to this injury or is that just something you observe? 

Secondary to this injury.  Because I discussed it with many physicians and they either figure it’s something that she feels when she’s leaning forward with her brain, that the brain is actually moving or she might be experiencing a slight, uh, like a vertigo or a dizziness.

Has she been tested for vertigo? 

Yes.  She had a slight nystagmus situation going on when she got home into therapy so that was like a month and a half later.

Were they able to correct that and get it to fairly minimal levels? 

Yes.

Does she have periodic periods where it comes back and she gets these floods of vertigo and balance issues because of her severe brain injury deficits? 

She complains about being dizzy every once in a while.  She says, I think I’d better sit down, I’m getting dizzy.

Is that related to the activity that she’s doing or just seems to come out of nowhere?  

Kind of comes out of nowhere.  It doesn’t seem to be like a blood pressure issue or –

Has she had any follow up therapy for the balance issues as severe brain injury deficits ? 

No.

I ask this question at the same in most interviews when people tell me that the temper problems come basically without any build up. They just are there. This also is one of the severe brain injury deficits that I hear about all of the time.

Does she have any problems with seizures as severe brain injury deficits?

No.

Never had any diagnosis of seizure?

Never diagnosed with seizures.  She was on seizure medication to prevent them in case that they happened for the first six months.  But she never had any seizure activity.

Does she have absence spells where she’s awake, eyes open, but she doesn’t seem to be responsive?

Only when the television’s on or something’s distracting her like the television.

Does she get lost?  

Out in the world?

Other than being a little confused does she actually just not know where she is for a few minutes or, anything like that?

I don’t think so.

Does she ever talk about strange smells as one of the severe brain injury deficits ?

No but she does not smell acutely.  She doesn’t distinguish between an orange and a lemon.

Has anybody formally given her a smell test?

Yes.  I don’t remember. I don’t know who did. Taste is also another thing.

What does she eat?

Carbs.

Sweet, spicy, salty?

Sweets, breads.  No, no, no spicy.  Uh, salt she likes.  She doesn’t like hot or spicy things.  She’ll eat noodles, rice, toast, butter, peanut butter.  She’ll have apples if they’re at room temperate and if I cut them, or, if I cut them for her.  She loves pears.  But there’s nothing that is, like, has any spice of life to it.  Oranges, citrus like that.

She doesn’t taste subtle flavors which could be one of the severe brain injury deficits?

Right.  I would think it would like eating oatmeal 24/7.

Can she smell at all?

I think she can, yeah.

What is it, why do you bring up the fact that she doesn’t smell or has difficulty with smell?

Well I think that it has a whole bunch to do with that ADL process of staying clean, you know, you’re a girl you’re supposed to smell good and she, I hate to use the impression, but she could smell like a goat herder and not care.  And she could have dirty hair and not care.  Whereas that’s part in her life where she wants to be that clean, pretty smelling girl in the classroom.  I don’t know how to describe it.

Is that changing at all?  Is it starting to evolve?

I don’t think so but she, she’s getting to like to take baths better, you know?  She likes the bath.  She’ll, she’ll take one without you asking her whereas before you almost had to drag her in, you know?

Loss of smell is clearly correlated with frontal lobe  severe brain injury deficits.  The olfactory nerve, which is the nerve which governs most of smell, is a cranial nerve which runs from the nose, directly into the brain.  The area where the olfactory nerve enters the brain is on the underside of the frontal lobes, adjacent to a particularly sharp part of the bone on the inside of the skull. This part of the skull is called the cribriform plate.  When the brain is set in motion in a high speed crash, the olfactory nerve and the adjacent parts of the frontal lobes are forced against the cribriform plate, often severing the olfactory nerve and causing lesions to the “orbital frontal” part of the brain.  Even with MRI, lesions to this part of the brain are hard to image, so the most reliable clue that such damage has occurred is to do a smell test.

Clearly, Nancy not only has lost her sense of smell, we know that Nancy has suffered damage to the underside of her frontal lobes, because of the subtle but significant changes in her behavior and maturity, and her severe brain injury deficits such as the not being age appropriate in bathing.

Next in Part Nineteen – The Need for Further Reassessment Nine Years After Severe Pediatric Brain Injury

By Attorney Gordon Johnson

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