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Traumatic Brain Injury (TBI) & Nerve Damage

7/27/2008
Christopher M. Davis
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Skateboarding fall causes traumatic brain injury
Click here to go to the Seattle Times story.
By lunchtime, A.C. Thomson can't remember if he brushed his teeth that morning.
The part of the 15-year-old's brain that's responsible for short-term memory is still not working quite right. The nerve-endings and electrical currents haven't fully healed.
There's more A.C. can't recall.
He has no memory of April 22 and an afternoon skateboarding session with a friend that nearly ended his life.
A.C. held onto the side of a pickup truck that was going 30 mph. He fell, hit his head and was run over.
He doesn't remember being in a coma.
His mother sat in rush-hour traffic and watched the helicopter carrying him from Everett whirl overhead on its way to Harborview Medical Center in Seattle. His father stood alone at Harborview Park when the chopper's blades twirled and it lifted off.
A.C. broke multiple bones from his head to feet in the accident. In the emergency room, doctors hooked up A.C. to machines, inserted a breathing tube and a feeding tube, and placed a bolt in his skull to monitor the pressure inside his head.
"My first impression when I looked at him was that he wasn't going to make it," the boy's grandpa, Warren Cronkhite, said.
What hurt A.C. most was the hardest to see. He suffered a traumatic brain injury.
On the scale doctors use to categorize comas, A.C. was rated just below the most severe.
It took agonizing weeks for the Kamiak High School freshman to wake up. And it's still not clear if A.C. is back.
"What really is unknown is the long-term impacts and effects. That's what we're holding our breath on," Art Thomson, A.C.'s dad, said. "We had a son before the accident and you envision his future in a certain way. ... What I think about the most is where he's ultimately going to end up."
A.C. is now back home in Everett and trying to catch up on the months he missed. His friends, relatives and doctors are trying to determine just how much of A.C. is back.
"It would be unlikely that he would return to his baseline levels," Dr. Terry Massagli said. She's the pediatric rehabilitation doctor at Children's Hospital and Medical Center overseeing AC's recovery. "That said, it takes a year to figure out where someone's at."
With his blond hair buzz-cut short, A.C. fidgets while he sits, the only noticeable sign of his physical injuries a slight limp and a change in the way his voice sounds.
He uses a new phone to help him remember tasks and appointments. A tutor from the Mukilteo School District visits a couple times a week to help him catch up on school work. On Tuesdays and Thursdays, A.C. goes to Providence Everett Medical Center for speech, occupational and physical therapy.
"I've never said the word therapy so many times in my life," A.C.'s mom, Susie Thomson, said.
What A.C. wants most to do, his doctors have strictly prohibited.
A.C. aches to get back on his skateboard. An independent boy, A.C. liked riding his skateboard - a longboard, the kind with bigger wheels that are meant for speed, not tricks - to get places faster, he said.
Until doctors know the full extent of his brain injury, they've told the teenager to keep both feet firmly on the ground.
His head can't absorb another hard blow.
"That's a typical strategy, we're making the rules now," Massagli said.
On the afternoon of the accident, A.C. and a friend, also 15, were riding their skateboards when AC's sister's boyfriend, 17, drove by in his pickup truck.
A.C. asked the older boy for a tow.
"We were just trying to get up the hill," A.C. said.
Although his parents bought him a helmet long ago, he wasn't wearing it. He said he didn't like the way it felt or the hassle of having to carry it around.
In skater slang, catching a ride by hanging onto a moving vehicle is called skitching, short for skateboard hitchhiking. Skitching is not only dangerous, it's also illegal.
"We've all done things like what A.C. did and got away with it," Art Thomson said. "A.C. didn't get away with it."
"That time," A.C. adds.
A.C. admits he's skitched before without problems. He's also been injured before falling off his skateboard.
About a year ago, A.C.'s mom got a call from the Mukilteo Fire Department that A.C. had fallen and hurt his head. He needed a few stitches, his mom said.
"This is why I'm on pins and needles all the time," she said. She cringes when her phone rings. She fears what might happen next.
A.C.'s mom can't remember exactly when doctors told her A.C. would live.
The night of the accident is a blur: A.C. on the ground, rushing to Seattle, the hours in a crowded hospital waiting room, spending the first night of several sleeping on the floor of the intensive care unit.
At first, doctors said they were doing all they could. Later, they gave hints of a long road to recovery.
Six days after the accident, his grandmother called relatives and left a simple message in a shaky voice: "A.C. just talked."
After about two weeks, A.C. was moved from Harborview to Children's.
In the movies, people in comas remain still in a hospital bed and one day suddenly open their eyes and come out of it. The reality for A.C. was much different.
Over the weeks, his brain slowly allowed him to regain consciousness.
At times, he'd open his eyes, but he didn't seem to see, his father said.
There were great moments when A.C. responded to doctors and family. He gave a thumbs up sign, played with an iPod and pointed at the letters that make up his name. On Mother's Day, unable to speak, he wrote messages to his mom on a white board.
Then there were times when A.C.'s mind wasn't working.
A.C. had to relearn how to control some of the body's most basic functions.
He struggled in restraints to get out of bed despite casts and broken limbs. He squirmed his way out and threw punches at nurses when they tried to tie him back down.
As language began to return to the boy, A.C. hurled curses. The nurses and doctors assured A.C.'s mom and dad it was a healthy sign, that the teen was waking up.
One day, he asked his mom why he was in the hospital.
When she told him he crashed on his skateboard, he didn't believe her. A.C. called his sister, Carly, then a junior at Kamiak.
"A.C. just stared at the phone and then started crying after he hung up," his mom said.
Then he called Carly's boyfriend, the boy who drove the truck that ran him over.
A.C. cried more after that.
He spoke more, too.
The doctors told the Thomsons there would be changes in A.C., good and bad.
The boy has more to say - and that's good.
His grandmother, Lil Cronkhite, heard unexpected words from A.C. after she told him she loved him.
"I love you, too, Grandma," A.C. said back. Before his accident, he never would have said something like that.
"He's very sweet now. Maybe he realizes how lucky he is to be alive," the grandmother said. "It's a miracle that he's doing so well."
Still, school looms in the fall and it's unclear how A.C. will handle the rigors of the school day.
Massagli, his doctor, worries that he may have difficulty paying attention for long periods of time. His mind may not yet be up to complex tasks such as English essays or math problems.
"The difficulties don't show up until they're challenged beyond automatic activities," Massagli said.
Doctors may not know the lasting effects of A.C.'s brain injuries until more tests are done next spring.
A.C.'s accident also may have lasting repercussions for the boy who drove the pickup truck.
He's under investigation by Everett police for vehicular assault. Snohomish County prosecutors will decide whether to pursue criminal charges.
"A couple of people made bad decisions that day," Art Thomson said.
The family doesn't blame the boyfriend at all.
"We hope he doesn't get in a lot of trouble," A.C.'s mom said.
A.C. offers an apology to the older boy. "I'm sure it wasn't his idea," A.C. said.
Today, A.C.'s parents aren't angry. They want the best for their son, for him to make better choices next time.
The family is grateful for the community support they've received. Friends have helped raise around $45,000. Medical bills are nearing a quarter million dollars.
As the family cared for A.C. in the hospital, neighbors and friends helped look after the family. They washed the family's cars, mowed the lawn, cleaned the carpets and made countless meals. A.C.'s high school friends wore T-shirts that read, "BOKAC," for "Be OK AC."
The support allowed the family to focus on the hurt teenager, a move his doctors said helped speed A.C.'s recovery.
"They should continue to maintain their hope and be encouraged by his progress so far," Massagli said. "He's going to continue to improve."
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