WHAT IS THE TREATMENT FOR TRAUMATIC BRAIN INJURY?
In medical terms, there is no single treatment for traumatic brain injury. There is no single plan that is the same for all Traumatic Brain Injuries. In fact, there is no medication or surgery that can correct a Traumatic Brain Injury. However, the victim can “re-train” their brain and cognitive functions.
Every TBI is different. Children are different than adults. Women are different than men – women have a different bio-mechanical function than men. In fact, women mature faster than men. Therefore, each incident involving a brain injury requires a unique plan of recovery. In general, it takes about 30 days to recover from the first concussion, and about 45 days after the second concussion.
WHAT IS THE RECOVERY AND REHABILITATION PROCESS FOR A TRAUMATIC BRAIN INJURY?
Recovery from a TBI depends on both the severity of the brain injury and the individual himself. Every brain injury is different so recovery can take a few months to even years after the initial injury, and you may never see recovery for some injuries. Initially, recovery is aimed at saving cells and preventing further damage. Acute care is an option that can be very expensive.
Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. In medical terms, care for acute health conditions is the opposite from chronic care, or longer term care.
Outpatient therapy for traumatic brain injury patients can cost from $600.00 to $1,000.00 per day, and hospital-based rehabilitation can cost $8,000.00 a day or more. Those who suffer a traumatic brain injury leading to chronic care or permanent disability will require a substantial verdict or settlement to cover a lifetime of medical expenses and related costs. Costs associated with a traumatic brain injury can ultimately be several million dollars over a lifetime.
To facilitate rehab, a patient will see a neurologist or a rehabilitation physician known as a physiatrist. The neurologist will oversee the care for the patient, in terms of medication and neurological care. The neurologists will also oversee the rehabilitation process.
Patients may also see a rehabilitation physician who combines physical medicine and rehabilitation. Commonly referred to as a physiatrist, this care provider combines neurologists and orthopedics to focus on function and quality of life. Physiatrists can make recommendations that can be the basis for and included in a restorative life care plan.
Physical therapists may be employed if the brain injury is causing physical impairments in the individual. TBI patients may need to retrain their body to move or do something as simple as clenching a fist.
TBIs can impact the injured victim’s ability to speak and communicate. It common to undergo speech therapy. If the TBI hinders the victim’s ability to perform daily living functions, like grooming, the injured victim may see an occupational therapist. Brain injuries harm people in expansive ways, so it is important to know how this all affects the injured victim’s life in order to accurately assert a claim for damages.
WHAT MEDICAL PROVIDERS ARE NEEDED TO DETERMINE A TBI?
Following a TBI, an injured victim should see a neurologist for a neurological examination. A neurologist is a medical doctor trained in diagnosing disorders of the brain. The neurologist will evaluate and document the injured victim’s loss of consciousness, amnesia and confusion, and any other symptoms the victim may be experiencing. The neurologist will examine brain function and assess a person’s mental state to determine appropriate medical treatment. A neurologist may recommend a neuropsychological evaluation to assess cognitive status for a neuroradiological examination to quantify the resulting deficits in the victim’s brain function.
Neuropsychologists will evaluate the injured victim’s neurological dysfunction. While psychologists will look at the emotional disorder; neuropsychologists will look at the cognitive functions within the brain and conduct testing, which will usually take all day to complete. The test giver must take into all the factors of the testing into consideration when coming to a conclusion. The evaluation can cost thousands of dollars. It is important to to note that the extent of brain injuries are not picked up by an MRI. Neuropsychological testing picks up the nuances of the injury. The neuropsychologist will take an in-depth history, review all medical records, review neuroimaging studies, and conduct numerous standardized tests that measure memory, complex or sequenced tasks, I.Q., reasoning, emotional response, vision, and other brain functions. If possible, the neuropsychologist will compare pre-morbid levels (the victim’s condition preceding the occurrence of symptoms of a disease or disorder) to determine the reduction in brain function due to the TBI.
In the context of litigation, a neuropsychologist plays the role of establishing the presence of a neuropsychological disorder or injury, determining causality related to a specific event/accident, indicating probable prognosis, and advising as to the medical necessity of treatment and disability status.
Likewise, the Defense will also retain a forensic neuropsychologist to determine whether the deficits found are the result of brain impairment from this accident, as opposed to psychological trauma, physical (peripheral) injury, malingering, a pre-existing condition, or some combination of these causes.
The injured victim will need to undergo various neuroimaging studies. Certain studies will reveal the injured victim’s neuroanatomical abnormalities, as well as cellular and metabolic dysfunction on the microscopic level.
WHAT DIAGNOSTIC TOOLS ARE USED TO VERIFY A TRAUMATIC BRAIN INJURY?
Scientific advances in neuroimaging have enabled objective verification of many of the injuries. However, it is important to note that even so called “mild” traumatic brain injuries may go undetected during emergent care of the acute injury and can still have lifelong debilitating effects.
Computed Tomography is capable of detecting skull fracture and subarachnoid hemorrhage, and can differentiate acute hemorrhage of the parenchyma from edema or swelling. However, a CT Scan is not reliable to show specific deficits related to regional damage to the brain. CT Scans and MRIs are great tools if looking for structure – not for functioning. Many times the CT Scan will come back negative.
Magnetic Resonance Imaging is the preferred imaging technique for detecting sub-acute and chronic TBI. However, just like a CT Scan, traditional MRI is not reliable to detect mild TBI microscopic shear injury or metabolic dysfunction on the microscopic level. MRI uses magnetic and radio waves to look at the brain. For brain injuries, one should use a 3.0 Tesla MRI.
Fluid Attenuated Inversion Recovery uses a pulse to selectively reduce signal from cerebrospinal fluid (CSF). FLAIR imaging increases the detection of contusions, white matter injuries, and subarachnoid hemorrhages. It also improves the detection of diffuse axonal injuries.
Diffusion Tensor Imaging measures the random motion of water molecules in brain tissue. The white matter tracts are clearly shown by DTI. It also shows disruption in those tracts and is an excellent technique for showing diffuse axonal injury. DTI can reveal pathology where a conventional MRI is negative or normal in appearance.
Single Photon Emission Tomography measures cerebral blood flow in the brain tissue. Measuring blood flow is an indirect measurement of brain metabolism. SPECT is highly sensitive for detecting regional blood flow disturbances in patients with TBI. SPECT is more effective than CT or an MRI when dealing with mild TBI. SPECT also analyzes brain functioning by creating 3-D pictures to look at blood flow to the brain.
Positron Emission Tomography evaluates the glucose metabolism in various regions of the brain. Slowed glucose metabolism indicates neuronal dysfunction in that region of the brain. PET is good for illustrating regional brain dysfunction. Essentially, a PET Scan examines the glucose consumption to analyze the brain functioning. This evaluation can determine if the brain is processing its fuel.
NeuroQuant is an FDA-approved method of analyzing MRI data in measuring brain volume of a patient and comparing it to normal controls. Brain atrophy or shrinkage is associated with damage to the brain. NeuroQuant measures atrophy to various areas of the patient’s brain which can then be correlated to the patient’s TBI symptoms.
Electroencephalogram detects electrical activity in the brain using electrodes attached to the scalp. Brain cells communicate using electrical impulses at all times, even during sleep, so an EEG can be used to record the impulses.
Electronystagmography is a diagnostic test to record involuntary movement of the eyes. The test is performed by attaching electrodes around the nose. ENG can also be used to diagnose dizziness by testing the vestibular system.
Videonystagmography testing is designed to document a person’s ability to follow visual objects with their eyes and see how well their eyes respond to information from the vestibular system. The test also checks the functionality of each ear and if a vestibular deficit is causing dizziness.
When considering the results of a neuropsychological evaluation to look at brain functioning, it is important to take into account the environment of the test taker. Was it noisy? Were there distractions? Is this on par with the day to day environment where there may be distractions and things occurring?
In addition to diagnostic testing, a Neuro Psychiatrist is good to obtain for assessment of any potential injuries. It is important to obtain an expert’s opinion to prove the existence of injuries.