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She looks the same, but she isn't
ByJO CIAVAGLIA
BucksCounty Courier Times
Victoria Krzywonos looks the same as she did before a hit-and-run driver left her brain damaged three months ago. That's the problem.
The 14-year-old says she isn't the person she once was. She can't remember things. She has trouble organizing and concentrating.
Physically, though, she looks exactly the same — no scars, no slings, no casts, no crutches.
That might explain why, after she returned to Carl Sandburg Middle School earlier this week, classmates thought she was acting, well, not like Victoria.
“I don't know if they think I look the same, so I'm the same person,” she said. “I am not the same person.”
Principal Dawn Kelly says confused students appeared in her office wondering why Victoria didn't remember who they were, how she knew them or why she takes longer to do things. They didn't seem to understand the severity of Victoria's brain injury.
So the principal invited the trauma team overseeing her rehabilitation to explain it Wednesday morning.
The audience of ninth-graders included Victoria, who sat near the front row, occasionally resting one outstretched leg on the lap of her mom, Jennifer. Behind her, students clapped and cheered whenever the principal mentioned Victoria's name.
THE ACCIDENT
Victoria was one of two Sandburg ninth-graders seriously injured Oct. 14 after they were struck by a car on Forsythia Drive South in the Middletown neighborhood where they live. The teens had been talking before the accident happened.
The driver, Forrest Earl Brown, 35, of Abington, faces a multitude of criminal charges, including two counts of being involved in an accident that involved death or injury, a third-degree felony. His trial is scheduled for March 13.
The other student, Brad Bamka, also 14, hasn't returned to school, Kelly said. He suffered severe leg injuries in the accident.
After the crash, Victoria's father, Scott, rode with her in the medical evacuation helicopter to The Children's Hospital of Philadelphia. A former cop, he had seen accident injuries like this before.
“I thought she was going to die,” he said.
Victoria was sitting on the curb when the car struck her. The force pushed her body onto the hood, where her head cracked the windshield. She landed 70 feet from where she was hit, Scott explained. Her right leg broke in two places and her pelvis fractured in three spots. Her thigh sustained a massive, deep laceration.
By far, though, the head injury was the worst. Her skull was fractured and her brain was bleeding.
There was damage to her front lobe, which is associated with reasoning, planning, parts of speech, movement, emotions, and problem solving. Her temporal lobe, associated with perception and recognition of auditory stimuli, memory, and speech, also were damaged.
She had a diffuse axonal injury, meaning that her brain had rotated inside her skull. The twisting motion stretched and sheared large nerve fiber pathways that let nerve cells communicate with each other. That created microscopic damage throughout many areas of the brain.
The injury most commonly occurs in high-speed car accidents. Patients with that type of injury usually face a poor prognosis and typically experience memory impairment and reduced cognitive function.
Before the accident, Victoria was an honor student, a math whiz who scored at the advanced level on the state assessment tests, Scott said. Now her cognitive abilities test at the lower end of average.
“Her friends think she is back to normal, but she is not,” Scott added.
Think of the brain like a wad of Play-Doh suspended in water and surrounded by a hard shell that protects it, Gayle Chesley, a CHOP pediatric psychologist, explained to students. Heavy impact or high-speed force can cause the brain to move or bang against the skull, which can damage the nerve pathways.
Unlike a broken bone, a broken brain pathway doesn't heal. Instead, the brain looks for new pathways or other parts of the brain take over the functions of the damaged parts.
NEW LEARNING
People with traumatic brain injuries often recall “well-learned” information, like the alphabet or numbers and most personal memories before the accident, though there may be missing pockets of memory, Chesley said.
But “new learning” — what they learn after the accident — is more difficult to retain. Some people experience brain damage that affects how they behave, their sense of humor, personality or mood. Some can't stop laughing or speak at inappropriate times or volumes, Chesley said. In Victoria's case, the only emotion she expressed, at first, was happiness. She can now control the full range of moods.
Some brain-damaged people can recover, but it takes at least a year or longer, Chesley explained. And some functions and abilities may never fully return.
Weeks after the accident, Victoria couldn't remember some things that had happened months earlier. She'd meet someone and almost immediately forget that she had met them and she couldn't remember what she did five minutes earlier, speech and language pathologist Amy Colin said.
She had to learn how to brush her teeth, shower and dress herself, occupational therapist Sara Ulmer said. She'd forget when to do things or what order to do them in.
Her memory has improved significantly — almost miraculously — and part of her rehab is learning new retention strategies to help compensate for the injury, team members said.
“Victoria has been through a lot,” Ulmer added.
For now, she is happy to be back at her old school, attending classes part time. She's taking math — her favorite subject — English and is in a special learning-support program.
Victoria knows people will have questions. After all, she would. She doesn't mind if they ask.
“People want to know if it changed me or how it changed me,” she said after the assembly.
If she can't remember a face, name, event or something else right away, please don't be offended, she said.
“I'm not lying.”
COMMON PROBLEMS ASSOCIATED WITH
TRAUMATIC BRAIN INJURY
- Memory loss/gaps
- Difficulty maintaining attention/concentration
- Fatigue
- Difficulties with problem-solving, daily planning/organizing
- Impulsivity
- Changes in language ability
- Limited physical movement
- Sudden, uncharacteristic mood changes
Source: Children's Hospital of Philadelphia