Gray Matters: The Employer's Role in Brain Injury Recovery: Traumatic Brain Injury Is No Longer the Hopeless Condition That It Once Was. with Proper Care and Attention, Not Only from Medical Personnel and Family Members, but from Employers as Well, Patients Now Have a Greater Hope for Recovery

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A year ago this month, actress Natasha Richardson died after sustaining what was thought to be a mild brain injury after she slipped on a beginner's ski slope in Canada. By contrast, 43-year-old Thomas Eckel drove into a head-on collision in St. Lucie, Florida, in 2005, resulting in massive blood loss, multiple broken bones, cardiac arrest and a brain injury so severe that doctors feared he would not survive. Instead, he is mobile, energized and productive, and has returned to his job as a truck driver with his previous employer.

These cases not only underscore the unpredictability of brain injury but demonstrate that with proper medical care and ambitious recovery targets, cases that were once considered lost causes can turn into success stories. In the past, many adults with work-related traumatic brain injury were simply warehoused. But with advances in treatment and care strategies, including an employer that is ready and willing to help in gradual return to work, many survivors of severe brain injury can regain most of" their former way of life

Understanding the Problem

More than half of alt work fatalities result from transportation accidents and falls, many of which involve head trauma. The number of nonfatal brain work injuries cannot be reliably estimated, however, because brain injuries are often poorly documented or mild enough to be shrugged off by the injured person. Even an emergency room doctor or nurse may disregard a mild brain injury of an injured worker, especially if the patient has broken bones or bleeding that requires immediate care.

Brain injuries typically (but not always) involve a concussion, and even a minor concussion can have severe consequences, Internal damage increases pressure within the brain that builds over time and can ultimately cause severe debilitation and even death. Fortunately, the great majority of concussive injuries heat without treatment and even without doctors being aware that the worker incurred an injury.

A person who suffers a moderate or severe brain injury, on die other hand, typically has to spend weeks in an acute case hospital before transferring to an inpatient rehab hospital. Such cases can often cost more than $1 million to treat.

Even after treatment, a person's condition can change up to 10 years after his or her injury. Continued access to professional care and family support is important to prevent the deterioration of the patient's memory, cognition and physical condition.

Many case managers, including Marilyn Spivack, neurotrauma outreach coordinator at Boston's Spaulding Rehabilitation Hospital, praise the workers compensation insurer community for their efforts in brain injury treatment. "We had so many brain injury programs in the 1980s and 90s," said Spivack. "Then the HMOs came along and they lost their enthusiasm for treatment because they didn't see the return-to-work outcomes as quickly as they wanted--or at all."

Today, the situation has improved. Spivack believes that workers compensation insurers, in particular, now understand the importance of intensive, albeit expensive, rehabilitation. She appreciates that they take the long view and consider themselves financially responsible for the disabled worker throughout his or her lifetime.

Other catastrophic injury case managers have had similar experiences. "You have a workers compensation brain injured patient who is in the same hospital room as a nonworkers compensation patient, and the difference in resources is like night and day," said one worker.

But practices vary among insurers and between insurers and third party administrators that work with self-insured employers. The best insurers aggressively search out expert treatment of brain injury but may pay more in medical costs in the first year. This level of care reduces the risk of complications and puts the injured worker on track to a better recovery. …