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The industry's top independent medical evaluation service provider offers timely information on a wide range of medical news and claims management topics - all in the name of helping you manage injury claims in the most efficient and cost effective manner.   

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5/30/2019

There are only so many hours in a day and giving each file the attention it deserves takes time.  So, how do you squeeze more hours out of every day?  That’s easy – increase efficiency, and you will increase productivity!  Here are a few tips to help you effectively manage your time:

  1. Get Organized – Keep a neat work area.  Get rid of what you don’t need on your desk.  Place important documents in labeled folders and group the folders by claim number in easily accessible, secure file drawers.  Keep your emails organized by creating a folder for each file and putting all email correspondence in the appropriate file.
  2. Create a Plan –  Create a master task plan (or checklist) for each file you are working on.  Each task should be in priority order with deadlines clearly visible.   There are many types of project management software designed to help you keep track of tasks and deadlines.
  3. Use a To Do List – Every morning, review the master task plan for each file (observing any deadlines) and make a list of tasks that need to be completed that day.     

Adding these simple steps to your daily routine can help you stay on task and on schedule and improve productivity so you can identify and resolve problems more quickly.  Good project management skills improve work-quality, increasing customer satisfaction and giving you the competitive advantage needed to boost your bottom line.

The thoracic spine (located between the cervical and lumbar spines) is your middle back, beginning right below your neck and ending at your low back.  The main function of the thoracic spine is to anchor the rib cage and protect the spinal cord, heart and lungs.  It is the longest and most complex region of the spine; made up of 12 vertebral bodies that hold disks (T1-T12).  T1 connects with the cervical spine above at C7 and T12 with the lumbar spine below at L1.

Interestingly, the space between disks (intervertebral opening) is much larger in the thoracic spine as compared to both the cervical and lumbar spines.  A bigger intervertebral opening and smaller nerve root allows more room for spinal nerves and reduces the chance of the nerve becoming pinched or inflamed.  Recent research suggests this might be the reason disk degeneration of the thoracic spine is much less likely to cause pain or other symptoms, unless of course the degeneration causes a disk to push on a nerve.  There are several other causes of thoracic spine pain.

Myofascial pain (muscular in nature) can be caused by poor posture, or any irritation of the large back or shoulder muscles, which would include strains or spasms. Joint dysfunction, thoracic herniated disk, compression fracture, kyphosis, scoliosis, arthritis or osteoporosis can also cause pain.

Symptoms of nerve damage in the thoracic spine include: 

  • Stooped posture
  • Muscle weakness/spasms
  • Pain that is referred to the ribs, shoulder, arm, fingers, neck or legs
  • Limited range of motion
  • Tingling, numbness, burning or pins-and-needles sensation

Whiplash is not really a medical condition.  It is a term used to describe the sudden acceleration-deceleration mechanism of injury to the neck.  A whiplash injury can range from a muscle sprain to spinal cord contusions to fractured vertebra.  Spinal cord contusions and fractured vertebra can be easily detected, but a muscle sprain cannot.  This means there is no way to prove or disprove most claims of whiplash injury where a muscle sprain is involved.

While a car accident victim can experience neck, head, and back pain following the accident, but can such an energy transfer cause chronic, long-lasting pain, and if so, how?

There is no proven physical reason why a whiplash injury would cause chronic pain.  But, in fact, about 25% of whiplash injury patients suffer chronic pain.  Additionally, whiplash injuries in the United States come with a price tag of about 2.7 billion dollars a year1.  So, what we know about whiplash is important to lowering claim costs.  

1 http://www.theatlantic.com/health/archive/2016/03/chronic-whiplash-is-a-medical-mystery/476052/

A concussion is the most common and least serious type of traumatic brain injury.  The brain is the consistency of gelatin and is cushioned by cerebrospinal fluid inside the skull.  A violent bump, blow or jolt to the head, neck or upper body can cause the brain to slide back and forth forcefully against the inner walls of the skull, or twist in the skull which can create a bruise on the brain.  A concussion can sometimes create chemical changes in the brain, even stretching or damaging brain cells.  A concussion is a traumatic brain injury that affects brain function and should be taken seriously. 

Typically, a concussion is diagnosed through a physical exam and interview.  The doctor will begin with questions about how the injury happened and its symptoms.  A physical examination may follow to determine what symptoms.  Some doctors use a special eye test to look for concussions.  It assesses if any visual changes are related to concussion such as changes in pupil size, eye movements and light sensitivities.  If there is a question of bruising or bleeding in the brain, an MRI or CT may be ordered.  If there are seizures, an electroencephalogram (which monitors brain waves) may be performed.

Most concussions don’t require surgery or any major medical treatment; they are symptomatically treated.  For example, over-the-counter pain relievers may be recommended for headaches.  Rest, avoiding sports and other strenuous activities is also recommended.  Driving a motor vehicle or bike should be avoided for 24 hours or longer.  Consuming alcohol may slow recovery.

Concussions are usually not life-threatening but can cause serious symptoms requiring medical treatment.  Symptoms include some or all of the following:

  • Headache or feeling of pressure in the head
  • Temporary loss of consciousness
  • Dizziness or “seeing stars”
  • Ringing in ears
  • Nausea
  • Confusion or feeling “in a fog”
  • Amnesia with regard to the traumatic event
  • Slurred speech
  • Appearing dazed
  • Vomiting
  • Fatigue
  • Delayed response to questions
  • Sleep disturbances
  • Disorders of taste and smell
  • Psychological adjustment problems and depression
  • Concentration and memory complaints
  • Irritability and other personality changes
  • Sensitivity to light and noise
  • Loss of consciousness lasting longer than 30 seconds
  • Headache worsening over time
  • Changes in physical coordination, such as stumbling or clumsiness
  • Confusion or disorientation, such as difficulty recognizing people or places
  • Seizures
  • Vision or eye disturbances

With more severe concussions, these symptoms may be more severe or worsen with time.  Repeated concussions can cause problems such as lasting cognitive issues.

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

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