In this paper, the authors identify the different perspectives when considering the psychological consequences of low velocity impacts. Views understandably range from ‘no physical damage, no medical injury, rapid treatment and claim resolution’
Characteristics of low velocity impact
Low speed road traffic impacts have four main characteristics:
- Structural damage
- Physical injury-overt
- Physical injury-hidden
- Psychological injury
Structural damage to the claimant’s vehicle is likely to be modest, requiring low cost repair and brief ‘time off the road’. When the change in velocity’ of the occupant is less than 10 kmh, impact have been shown not to produce forces on the human spine which cannot be resolved by that structure i,e., at these speeds, physical injury to the neck is negligible. Observable physical injury may be minor with the claimant initially not even attending hospital immediately after the index impact. GP attendances vary with infrequent referral to hospital. Pain and discomfort may be experienced at a later stage, requiring hospital investigation.
Psychological injury will depend on three factors:
- Reaction to actual impact (level 1) e
- Reaction to, and anticipation of, potential impact (level 2)
- Level of ‘ insult’ to the head and neck (e.g. sudden jolting + +) and neurocognitive effects (level
The actual impact, itself is by definition small in these cases, structurally, physically, and in terms of level I psychological injury. The post-trauma, depressive and phobic after-effects, which can be attributed to the actual impact itself, are invariably small, of short duration and of minimal or no clinical consequence. However, whereas the structural and, to an extent, the physical consequences are directly related to the actual impact, psychological injuries stem from both the actual impact and the potential impact It is frequently the case, clinically, that a claimant will be preoccupied with his/her own view of ‘what might have happened’ reinforced by the ambulance and /or police service comments about ‘ho w lucky’ they were not to have had more severe injuries.
Psychological reactions to potential serious impact can result in symptoms of mood and sleep disturbance, with intrusive imagery centred on the ‘ what if’ situation, plus phobic travel anxiety and avoidance based on, again, a fear of a further collision ‘like the one that almost happened’. To many this convoluted logic will sound irrational, but to those who have, in their own minds, 6 almost been in a serious accident’, these reactions are ‘very real’. They can result in significant disruption psychologically, socially and occupationally. It is commonly found that individuals who have had low impact accidents become anxious, or even phobic, about travelling at high speed for example on dual carriageways or motorways. Their logic is that if a low velocity incident could be so traumatic, how much worse would be a high-speed incident?
The mechanism of the impact may result in certain sudden neck and head movement, which can cause potential neurological and neurocognitive effects (Level 3). These are frequently described as post concussive syndrome and may require a specialised neuropsychological assessment, if symptoms persist beyond a few months.
Neuropsychological sequelae of minor RTA’s
A percentage of people involved in minor RTA’s will suffer mild-moderate brain injury where they experience difficulties with poor concentration, slowed thinking, poor memory, headaches, dizziness, sensitivity Co noise and light and mood disturbance. This is usually referred to as a post-concussive syndrome (PCS). In the past these difficulties were often considered to be psychogenic in origin and thought to relate to pre-existing psychological vulnerabilities, compensation claims or were secondary to emotional trauma. In the 1980’s an organic basis for PCS was found in the form of microscopic diffuse axonal injuries in the brain so it is now considered to be a combination Of both organic and psychological factors. Most who experience it will make a full recovery within 3 months although a small percentage will continue to have persistent symptoms o Factors associated with delayed recovery are older age, pre accident psychopathology or pre accident alcohol/ drug problems. Neuropsychological assessment of individuals with PCS shows difficulties with impaired speed of information processing and divided attention but can also include impaired visuospatial and verbal memory. The severity of the neuropsychological impairment correlates with the severity of PCS symptoms and resolve as symptomatic recovery occurs.
Duration and prognosis of low velocity impact psychological injuries
The psychological outlook following low velocity impacts is good. The level 2 psychological reactions cited above are, in most cases, short lived provided the claimant is encouraged by family and GP to try and get back on the horse’ in terms of driving, passenger travelling, and general socialisation.
Typically duration of symptoms may be 1-6 months. There are exceptions to this with a reaction becoming so entrenched that brief cognitive behavioural therapy is warranted but this is atypical.
The role of pre- existing symptoms etg., recent depression, travel anxiety and vulnerability or predisposition to stress reactions need to be taken into consideration and will often ‘ make sense’of why a reaction to an apparently minor impact has been so pronounced. In the case of level 3 post concussional symptoms, it is important to carefully assess neurocognitive function to include or exclude temporary or chronic dysfunction.
Brief intervention and treatment
As mentioned above, brief encouragement or intervention from supportive family and GP can result in the claimants re„exposing’ him or herself to the feared (and avoided) travel situation and gradually, as a result, regaining confidence. Brief advice concerning the logic surrounding what if’ perception also reduces the preoccupation with highly anxiety o inducing alternative outcomes Brief cognitive behavioural therapy may occasionally be required (5-10 sessions).
It is important to differentiate between a minor, short lived emotional reaction which is ‘normal’, “not clinically significant” or disruptive’ from a significant psychological reaction which, with appropriate family, primary or secondary care, will be short lived and limit the risk of significant disability.
Reference: Koch HCH & Kevan T (2005) Psychological injuries. X Pl.St Albans.