As insurance professionals, when we manage motor vehicle injury (MVA) claims we conduct a range of activities like interviewing clients, reviewing medical documentation, and liaising with a range of healthcare professionals. As a result, we gain a lot of medical rehabilitation knowledge -knowledge that is invaluable in the rehabilitation planning process. The more we know about the parts of the body that are most commonly injured in MVAs, the greater our insight into how to most effectively manage file progress, as well as empathize with our clients.
The big three: brain, spine and shoulder
To allow us to do all that we need and want to do, we require our brain to interact with all of our various body parts. Especially important in terms of mobility are our spine and shoulders -- precisely the areas that are most commonly damaged due to a collision. Enhancing our anatomy knowledge and, in turn, our injury knowledge, should lead to maximum MVA outcomes for your clients.
Acquired brain injury
Each part of the brain is responsible for facilitating different types of behaviours. If your MVA client has been diagnosed with an acquired brain injury (ABI) or you suspect an ABI, knowing the location of the lesion, as well as observing the MVA client's day-to-day activities provides invaluable insight into the nature of the injuries. For instance, the frontal lobe, which is the area right behind the forehead, is responsible for all planned voluntary behaviour including:
• determines our consciousness so that we know what we are doing
• determines personality
• initiates activity in response to our environment
• establishes our memory of habits and motor activities
• controls our emotional response, creates judgments and controls inhibition
• controls language, creates word associations, and assigns meaning to words
Consequently, an MVA client who has damage to the frontal lobe may experience any or all of the following:
• inability to focus on tasks and/or plan and sequence the movements to conduct tasks that involve multiple steps
• changes in social behaviour such as loss of spontaneity
while interacting with others and inappropriate sexual behavior
• persistent focus on a single thought
• personality and mood changes
• difficulty with problem solving including loss of flexible thinking
• inability to express language
By contrast, the parietal lobe, which is near the back and top of the head, is responsible for perceiving, analyzing and assembling touch information from the body. Overall, this lobe integrates our various senses to understand concepts and make sense of the world. With damage to the parietal lobe, your MVA client may not have difficulty with focusing, problem solving or social behaviour, as may be the case with damage to the frontal lobe, however, your client may experience:
• inability to attend to more than one object at a time and/or name an object
• difficulty locating the right words for writing
• problems trying to read or do mathematics
• difficulty drawing objects and/or distinguishing left from right
• lack of awareness of certain body parts and/or surrounding space resulting in problems with self-care
• inability to focus visual attention and problems with eye/hand coordination
Another important part of the brain is the optical lobe-- responsible for vision. Difficulty locating objects and/or seeing objects accurately, as well as other vision defects can result when the optical lobe is injured. For instance, post-MVA your client may not be able to recognize words or how objects move or be able to identify colours, reading and writing.
With the Optical Lobe responsible for vision, the temporal lobe is responsible for hearing and memory, as well as some visual perceptions, categorizing objects and controlling what is expressed. It is located at the side of the head above the ears. Problems with hearing, difficulties with some memory, visual perceptions, categorizing objects and speech, including expression and understanding language and reading and writing may be observed in a client who has damage to the temporal lobe. Agitation, irritability and childish behaviour may also result.
Poor balance, dizziness, and tremors are commonly observed due to injury to another area of the brain, the cerebellum. Located at the base of the skull, the cerebellum is responsible for coordination and voluntary movement, bal- ance and equilibrium, and some memory of reflex motor skills. Accordingly, common issues post-MVA also include slurred speech and the inability to walk, make fine and/or rapid movements or reach out and seize objects.
Connecting the brain to the spinal cord is the brain Stem, which is responsible for a range of functions -everything from breathing, heart rate and swallowing to sweating, blood pressure, digestion and temperature control to reflexes when seeing and hearing. The Brain Stem also determines our level of alertness, ability to sleep, and sense of balance. With this range of functions, damage to the Brain Stem can result in a range of issues:
• difficulty breathing
• abnormal changes in heart rate and blood pressure
• difficulty swallowing food and water
• problems with organizing/perception of environment
• dizziness and nausea
• problems with sleeping and decreased alertness
Spinal cord injury
The spinal cord and its nerve pathways carry information from the brain to all areas of our bodies. It is made up of three regions, each with distinct responsibilities:
• Cervical spine: extends from the base of the skull to shoulder level and made up of seven cervical bones or vertebrae. Its main responsibility is for flexion, extension, bending and turning of the head and it contains the cervical nerves that supply movement and feeling to the arms, neck, upper trunk and diaphragm.
• Thoracic spine: attaches to the ribs in the chest region and made up of twelve vertebrae. The spinal canal in this region is smaller than the cervical or lumbar areas, making it more at risk if there is a fracture. Its main responsibility is rotation and it contains the thoracic nerves that supply movement and feeling to the trunk and abdomen.
• Lumbosacral spine: extends from the waistline down the lower back to the base of the spine. Its main responsibility is bending forward and backward as well as side-to-side and it contains the lumbar and sacral nerves that supply movement and feeling to the legs, bladder, bowel and sexual organs.
With each region of the spine responsible for different functions, the type of spinal cord injury (SCI) depends on which region is injured and the severity of the injury:
• Complete SCI is damage to the spinal cord that results in complete and usually permanent loss of function below the level of the injury.
• Incomplete SCI is damage to the spinal cord that is partial; some motor and sensory functions remain so there may be some feeling but little movement, or some movement and little feeling. The effect on functioning depends on the area of the cord injured. The degree of loss varies because the amount of damage differs from person to person.
• Paralysis due to SCI is the inability to move or feel because of injury or disease to the spinal cord. Degree of paralysis depends on where the spinal cord is injured and the severity of the injury (e. g., partial or total paralysis of the arms and legs). For instance, paraplegia is impairment or loss of movement or feeling in the thoracic, lumbar or sacral (but not cervical) segments of the spinal cord, whereas tetraplegia is paralysis of the four limbs due to cervical (neck) injuries and hemiplegia, also known as Brown-Sequard Syndrome, is paralysis to a side of the body. It is usually caused by injury to the spine in the region of the neck or back. For instance, hemiplegia may be the result of acquired brain injury or stroke if one side of the spinal cord is damaged but not completely severed.
Common shoulder injuries
Unlike most other joints in the body that only need to flex and extend, the shoulder needs to move in multiple directions. While this adds mobility, it makes the shoulder less stable -- what the shoulder joint gives up in stability, it provides in facilitating mobility. The inherently unstable nature of the shoulder makes it an obvious candidate as one of the most common types of MVA injuries.
Technically, the shoulder joint is where the upper arm bone -- called the humerus -- attaches to the shoulder blade -- called the scapula -- and the collar bone -- called the clavicle. The shoulder refers to the group of structures in the region of the joint including muscles, tendons, ligaments and cartilage. If your MVA client reports the following symptoms, a shoulder injury may be present:
• poor posture and sharp pain with movement greater than 90 degrees; may be due to impingement syndrome, which occurs when the soft tissue becomes trapped, causing the loss of the mechanism's gliding action.
• limited range of motion sometimes accompanied by pain and sometimes without pain; may be due to a rotator cuff tear, which occurs when the muscles partially and/or completely tear because of trauma or, over time, the muscles can degenerate.
• General pain, tender to the touch and only limited, painful movement; may be due to tendonitis, which occurs when the tendons attached to the shoulder become inflamed because of trauma or repetitive muscle strain.
• Immediate, severe pain that can extend down the arm (mimicking a WAD III injury) with the inability to move the arm and the shoulder visibly displaced; may be due to shoulder dislocation, which occurs when the upper arm bone pops out of the cup-shaped socket that is part of the shoulder blade caused by trauma to the shoulder joint.
Common injuries, not so common knowledge
It's one thing to know that the brain, spine and shoulders are likely targets for injury in MVAs, it's another thing -- and very beneficial -- to know how these body parts function and consequences when they are not functioning optimally. Enhanced empathy, communication, and efficiency are just some of the many ways anatomy knowledge helps improve file management.
Judy Farrimond is supervisor of complex and catastrophic services and Angela Veri is national director of customer relations at Sibley and Associates.