CHARLESTON -- A fall "even from a low height" such that of a playpen could have caused the injuries Piersen Eaker received, a physician testified Tuesday.
Pathologist George Nichols was one of two witnesses who told the jury at Patricia Brant's trial that shaking was far less likely to be the reason the 22-month-old boy suffered permanent, disabling injuries two years ago.
The testimony from the two experts concluded the defense's evidence in the case in which Brant is accused of shaking Piersen while in her care on Feb. 14, 2014, at Treasured Tots Day Care in Charleston, which she operated at the time.
During her own testimony during the trial, Brant said she placed Piersen in a playpen and left to use the restroom. She said when she returned she found him on the floor, sitting but slumped over, unresponsive and having difficulty breathing.
Trial evidence has also showed that Brant was the only adult at the day care when Piersen was injured.
Nichols, the president of a medical legal consulting firm, said he reviewed the medical records of Piersen's treatment and police reports about the case. He said he concluded that the child's injuries were "consistent with impact of the head."
He specifically noted a location on the back of Piersen's head he said he felt was hit and caused the bleeding and other damage to the boy's brain.
Contradicting earlier testimony by Carle Foundation Hospital doctors who treated Piersen, Nichols said the boy's retinal hemorrhages were "secondary" and not directly because of shaking or the impact of a fall.
Instead, he said he felt the retinal bleeding was caused by increased pressure from swelling in Piersen's brain that restricted blood flow in his eyes.
Earlier in the trial, an ophthalmologist and a child abuse specialist from Carle both said the retinal hemorrhages were the strongest evidence that Piersen was injured from shaking.
The hemorrhaging's extent and the fact that it was found in both of Piersen's eyes were the biggest factors in making that determination, the physicians both said.
During questioning by defense attorney Bryan Robbins Tuesday, Nichols said there's doubt in the medical community about shaken baby syndrome and whether shaking can cause retinal hemorrhaging is "hotly debated."
"I don't think it's valid at all," he said.
He also said children who are shaken usually have neck or spine injuries but Piersen did not.
During cross examination by Assistant State's Attorney Tom Bucher, Nichols said he couldn't determine if Piersen had been dropped, "hurled by an adult" or fell.
He also said it "extremely unusual" for there to be no neck or spine injuries if Piersen had been shaken but acknowledged that it was possible.
Also testifying Tuesday was Christopher Van Ee, a bio-mechanical engineer who said he specializes in the causes of injuries.
Van Ee said he conducted experiments that used models, similar to car crash test dummies, equipped with sensors.
He said he measured the acceleration of the models' heads by having them fall off the rail of a playpen, dropping them and shaking them.
The experiments took place during research he conducted before Piersen was injured but used a playpen the same height as Brant's, Van Ee said.
The models used were the nearest to Piersen's size that were available but actually somewhat smaller than Piersen was at the time of the incident, he also said.
Van Ee said the tests showed that shaking caused the least acceleration while falling and being dropped resulted in much more. He said it was "unclear" if shaking could have caused injuries such as Piersen received "but we do know a fall can."
During State's Attorney Brian Bower's questioning, Van Ee acknowledged that the test models weren't anatomically complete and didn't have any of soft tissues of other features of an actual human brain.
He maintained that he was "very confident" that the models were sufficient to reach the conclusion, however.
Van Ee also agreed with Bower that a child, unlike a test dummy, would be able to try to move and break a fall. But he added that such an attempt by a child of Piersen's age would probably be "very ineffective."
The defense rested its case after the two witnesses testified Tuesday, and the prosecution concluded its presentation of evidence on Monday.
Circuit Judge Teresa Righter told the juror that Wednesday's court session should begin with the attorneys' closing arguments, after which the jury would begin its deliberations.