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Rehabilitation is an important part of the recovery process for a TBI patient.  The program should be customized to the person based on their strengths and capacities and modified over time to adapt to changing needs.  This usually involves a team of rehabilitation specialists in multi-specialties.  Individually tailored programs generally include physical therapy, occupational therapy, speech/language therapy, physiatry, psychology/psychiatry, and social support.  There are several options for rehabilitation:  home-based, hospital outpatient, hospital inpatient, comprehensive day programs, supportive living programs, independent living centers, club-house programs, school based programs for kids and others.

The overall goal is to improve the patient’s ability to function at home, work and in society.  This is done through helping the patient adapt to disabilities or to modify their environment to make every day activities easier.  Medications must be carefully prescribed because TBI patients are more susceptible to side effects and may react adversely to some pharmacological agents.  It is also important for family members to provide support for the TBI patient through involvement in their rehabilitation program. 

Here is an article that speaks to a personal experience one may have with TBI injured loved one:  https://www.brainline.org/article/introduction-rehabilitation-healing-brain

TBI recovery is slow, with a step-by-step course which progresses from coma, vegetative state, minimally conscious, conscious and then to a post-traumatic confusional state.  The severity of a TBI cannot be determined in the first few days after injury it may take weeks – or even months – to determine how or if a person will recover over time.  Many persons will eventually regain consciousness, but some will not.

Often improvement continues slowly over time.  There is much variation of how people move through each stage and how long each stage lasts.  Some people move quickly or skip stages while others may get stuck in a stage.  Every injury is different and follows its own timeline.  The longer a person remains in a coma or state of impaired consciousness, generally the more likely they will be severely disabled. 

One of the first meaningful behaviors a severely brain-injured person shows is the ability to follow an object with their eyes (visual tracking), is a definite sign of moving toward consciousness.  The earlier a person moves from a coma or vegetative state to a minimally conscious state, the better the long-term outcome.  Even if the disorder of consciousness lasts for several months, improvement can still be shown.  In this case specialized TBI rehabilitation may be beneficial.

Age plays a role in recovery outcome.  Younger people are more likely to return to a more independent, productive life.  Older persons don’t usually fair as well.  However, an accurate diagnosis of level of consciousness is imperative because it helps predict the short and long term outcomes.  This helps in making decisions concerning rehabilitation or whether to stop care altogether.

Throughout the recovery process TBI victims will undergo tests and procedures which will assist with diagnosis, prognosis, and treatment decisions.

Neurological monitoring/neuromonitoring:  Intracranial pressure monitors track the amount of pressure in the brain to help manage brain swelling. 

Neuroimaging studies:  Computed tomography (CT scans) or MRI is used to identify bleeding and injured parts of the brain, and to determine if surgery is necessary.

Electroencephalogram (EEG):  Measure electrical activity in the brain, show location/extent of injury and can be used to diagnose seizures.

Informal bedside neurological exam and formal behavior assessment scale:  Used to determine a person’s level of impaired consciousness.  Typically testing for basic reflexes, following a moving object with the eyes, performing basic commands and communication.

There are a few different systems that doctors use to diagnose the symptoms of TBI.  The Glasgo Coma Scale measures motor response, verbal response and eye opening response.  The Ranchos Los Amigos Scale measures levels of awareness, cognition, behavior and interaction with the environment.  These tests are often used to determine whether the TBI is mild, moderate or severe.

A Mild Traumatic Brain Injury is the most common type of TBI which is often missed at the time of initial injury.  15% of persons with mild TBI have symptoms that last one or more years.  It is classified as a loss of consciousness and/or confusion and disorientation is shorter than 30 minutes.  MRI and CAT scans are often normal even though the individual may have cognitive problems such as headaches, difficulty thinking, memory problems, attention deficits, mood swings and frustration. 

Other names for a mild TBI include:

  • Concussion
  • Minor TBI
  • Minor brain injury
  • Minor head trauma
  • Minor head injury

Moderate Traumatic Brain Injury is defined as a brain injury resulting in a loss of consciousness from 20 minutes to 6 hours and a Glago Coma Scale of 9 to 12.  The symptoms may be similar to a mild TBI but they do not go away or may even get worse.

Severe Traumatic Brain Injury describes a brain injury with a loss of consciousness of greater than 6 hours and a Glasgow Coma Scale of 3 to 8.

Traumatic Brain Injuries (TBIs) contribute to about 30% of all injury deaths; in fact 153 persons in the US die every day from injuries where TBI was a factor.  Depending upon the severity of injury, survivors can face effects of TBI for a few days or the rest of their lives.  TBI is an injury to the head that disrupts the normal function of the brain.  Interestingly, not all head injuries result in TBI. 

Males represent 78.8% and females 21.2% of all reported TBI accidents.  The leading causes of TBI are:  falls, being struck by an object, and intentional self-harm.  50-70% of all TBIs are the result of motor vehicle accidents.

Of all traumatic deaths, deaths from head injuries account for 34% of all traumatic deaths.  Beginning at age 30, mortality risk after head injury begins to increase.  Persons age 60 and older have the highest death rate after TBI, primarily because of falls.

 

Reference:  “Facts About Traumatic Brain Injury”  https://www.brainline.org/article/facts-about-traumatic-brain-injury.

Statistically speaking, TBI is an injury of young persons, since incidence rates peak between the ages of 16-25.  It is estimated that there are more than 5 million people in the US with TBI.  As a result of the young age of TBI onset and the sheer numbers of persons with TBI, the economic and personal cost is great. 

Studies conducted show that 50% of persons with severe TBI do not return to the vocational roles they had before the injury.  Additionally, 20% of those with what was categorized as mild-TBI were unemployed.  It is estimated that $56 billion dollars annually are spent as a result of failure to return to work after TBI. 

The challenge to return to work is great because the TBI person with more severe injury have emotional issues and problems with memory, sequencing and judgement.  They may experience fatigue, be dependent on others for activities of daily living as well as transportation. 

The following may aide in the return to work after TBI:

  • Vocational Rehabilitation services early in the rehabilitation process
    • On-the-job training
    • Counseling and guidance
    • Job placement services
    • Supportive work environment
    • Cognitive skills training
    • Provide training for and use of assistive technology

Unfortunately many people with TBI fail to return to work.  It is hard to determine why that is as studies are not well-defined, do not use universal definitions for terms, and often do not define a specific path (or pathways) of success with regard to return to work.

Reference:  “TBI Research Review:  Return to Work After Traumatic Brain Injury.”  https://www.brainline.org/article/tbi-research-review-return-work-after-traumatic-brain-injury

A skull fracture is defined as any break in the cranial bone.  There are many types of skull fractures, but they all result from one major cause and that is an impact or blow to the head that’s strong enough to break a bone.  The types include: 

  • Linear – a break resembling a thin line or crack

  • Depressed – a break in or crushing injury

  • Basilar – occurs at the base of the bran sometimes causing leakage of cerebral spinal fluid

Skull fractures are not always easily seen.  Following an impact or blow to the head some symptoms which may indicate fracture include:  swelling and/or tenderness around the area of impact, facial bruising, bleeding from the nostrils or ears. 

For mild fractures, pain medication may be the only necessary treatment, but neurosurgery may be required for more serious fractures.

Defined as an accumulation of blood within the brain or between the brain and skull.  They form when a head injury causes blood to accumulate in the brain or between the brain and the skull. 

Here are the different types of hematomas:

  • Epidural – a blood clot outside of the brain but under the skull

  • Subdural – located between the brain and the dura

  • Intracerebral – a ruptured blood vessel in the brain that causes bleeding

  • Subarachnoid Hemorrhage – bleeding under the arachnoid layer

  • Intraventricular Hemorrhage – bleeding into ventricles of the brain

Diagnosing intracranial hematoma can be difficult because sometimes people with head injury can seem fine.  And sometimes they are if the hematoma is small and produces no signs or symptoms.  However, symptoms can appear or worsen days or even weeks after the injury, which is why following a head injury the person should be watched for neurological changes, to have intracranial pressure monitored, and undergo repeated head CT scans. Sometimes surgery is required to drain the blood.

2/14/2019 in Medical Conditions

The Cerebrum is the largest part of the brain.  Divided into two hemispheres, the outermost layer, the cerebral cortex, has four lobes:

  • Occipital used for processing visual information

  • Temporal, one close to each ear, used for auditory processing, but may also be involved in emotion, learning and pronunciation/ learning a new language.

  • Frontal used for solutions to complex tasks, voluntary movements, forming complete sentences when talking and personality traits

  • Parietal for general sensation and feeling

 

The Cerebellum is located behind the top part of the brain stem where the spinal cord meets the brain and is made up of two hemispheres.  It receives information from the sensory systems, spinal cord and other parts of the brain and then regulates motor movement.  The cerebellum coordinates voluntary movement such as balance, coordination, posture, and speech, resulting in smooth and balanced muscular activity.

The Brainstem lies underneath and behind the cerebellum.  It controls the flow of messages between the brain and the rest of the body.  The brainstem also controls basic bodily functions such as breathing, swallowing, heart rate, blood pressure, consciousness, and state of sleepiness.

Surveillance can be a good way to move a case to closure.  The success of the investigation depends on both the adjuster and the investigator’s ability to gather accurate and reliable information.  Arm your investigator with as much information as you can provide.  Here are some tips to assure effective surveillance:

  • Select an investigation company that has experienced investigators with a proven success record.   
  • Before the investigation begins, conduct a Social Security trace, ANI trace and social media check.  Make sure these findings are communicated to the investigator.
  • Start off with two full days of surveillance starting at 6:30AM.  Based on the results after two days, decide whether further time is warranted.
  • Always have surveillance conducted on days when the claimant has a medical appointment.

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