The time following a catastrophic brain injury can be one of the most emotionally, financially, and physically difficult times in the lives of both the survivor and his or her loved ones. At the same time, the survivor and his or her family is trying to come to terms with the accident and what it means for the future, they also must deal with issues related to hospital care, rehabilitation, insurance, and finances. If you or a family member has been the victim of brain injury, chances are you have a lot of questions.
Brain Injury After Car Accident may become a permanent injury if left untreated.
Causes of Traumatic Brain Injury
Just like it sounds, traumatic brain injury is caused by trauma to the brain. This can result from a blow to the head, the head striking an object, an object penetrating the skull and entering brain tissue, or the shearing or tearing of brain tissue resulting from rapid deceleration or acceleration.
Accidents involving motor vehicles, ATVs, motorcycles, and bicycles are the leading cause of brain injury, causing 50 percent of all of them. SUV rollovers involving roof crush, seatbelt and seatback failures, airbag malfunction, tire blowouts, and driver error are some of the leading causes of accidents that cause brain injury in both passengers and drivers. In addition, ATVs and motorcycles that are not being operated safely, are being operated by underage or inexperienced drivers, or those that have been recalled by the manufacturer are also frequently involved in the types of accidents that cause a head injury. While some accidents are not possible to control, you can cut down on your risk of head injury by buying a car with a good “crashworthiness” rating, making sure that your car is always in good repair, replacing worn tires, and practicing good driver safety. In addition, ATVs should never be driven by children. Because some ATVs and motorcycles have a track record of poor safety, it’s important that you do your homework before you make your purchase.
So what accounts for the other 50 percent of traumatic brain injuries? Falls account for approximately 25 percent of all brain injuries, while violence accounts for another 20 percent. Sports-related injuries, especially those associated with contact sports like hockey, football, lacrosse, and rugby, account for the remaining cases of brain injury.
Prognosis of Traumatic Brain Injury
There are as many different outcomes to brain injury as there are brain injuries. Just like the people they affect, brain injuries are highly individual. However, while a long-term prognosis may take months or even years to determine, doctors can look at several factors—specifically the length of coma and the location and size of the injury—to come up with a hypothetical prognosis.
Brain Injury Symptoms
How do you know whether you or a loved one has sustained a brain injury and should be seen by a doctor?In some situations, it’s clear. There’s been an obvious accident or event that has caused the patient to lose consciousness, or to have visible and perceptible injuries. In these situations the patient is often rushed to the emergency room where, after the doctor has stabilized the patient, the brain will be assessed for injury.
The recent death of Natasha Richardson shows that even those with the mildest of symptoms should seek emergency care following trauma to the head. While those who are unconscious or who are experiencing severe symptoms will likely be immediately transported to the nearest facility qualified to handle brain injury, it’s up to those with less severe symptoms—symptoms such as dilated pupils, nausea, dizziness, lethargy, vomiting, and confusion—to make a judgment call on their own. As a general rule of thumb, if any of these symptoms are present medical care should be immediately sought. Those who are treated in a timely manner have a better long-term prognosis in general.
Acute Care Phase
What kinds of care can be expected immediately following a brain injury, during what is commonly called the “acute care phase?” That will depend upon the condition of the patient and the severity of the injury. Patients with very severe brain injuries may require life support, while those with minimal injuries may be sent home to recover with little more than instructions to take it easy for several weeks.
In general, the first action the medical team will take will be to ensure that the patient is stable. Any life-threatening injuries will be attended to, and respiration and circulation will be monitored. At this point, physicians will attempt to control or minimize intracranial pressure, as excessive swelling can cause further brain damage in addition to that already caused by the accident. In many cases, swelling can be controlled with medication, but in some cases surgery to reduce pressure is needed. A monitor to measure intracranial pressure is sometimes implanted under the survivor’s skull to continually monitor pressure.
Physicians will run tests such as X-rays, MRIs, and CT scans to assess the site and severity of the injury, as well as to look for bleeding or blood clots. These tests can also give physicians a better idea of the long-term prognosis of the survivor, as well as the types of issues he or she may face as a result of the injury.
Glasgow Coma Scale
Another tool that will be used to assess the severity of brain injury is the Glasgow Coma Scale. This tool is usually used immediately upon examination as well as throughout the acute care phase to measure the patient’s level of consciousness.
The scale, which ranges from “3” to “15,” assesses consciousness based on the patient’s visual ability, verbal responsiveness, and motor skills. The higher the score, the higher the level of consciousness. Scores from the Glasgow Coma Scale are frequently used as part of the formula that determines long-term prognosis.
Immediate Care is Important
Because timely care can minimize the long-term effects of brain injury, it’s important that even those exhibiting mild symptoms of brain injury are immediately seen. Fully conscious patients will be given a full neurological exam that assesses cognitive and physical function. While most head injuries that appear to be mild are exactly that, a comprehensive neurological exam is the only way to determine whether additional testing—and treatment—is necessary.
Depending on the severity of the brain injury, patients will either be sent home or will be sent to a rehabilitation center for recovery.
• A doctor who is available around the clock. Your loved one is dealing with an unpredictable injury that could require immediate medical attention and quick decisions from an experienced physician.
• Experienced nursing care 24 hours per day. While most rehabilitation facilities have 24-hour nursing care, it’s important that the staff on duty have experience with brain injury patients.
• Flexible, individual, multidisciplinary rehabilitation. Each survivor’s needs will be different, and so each survivor’s rehabilitation plan should be specifically geared toward him or her. The rehabilitation team should consist of doctors, nurses, physical therapists, occupational therapists, speech/language pathologists, recreational therapists, and counselors who can all work together to devise an effective rehabilitation program.
• Family participation. When it comes to helping the survivor get better, family and friends play a large role. The program should include family and other loved ones in the rehabilitation process.
• Services that help the survivor re-enter the community. Gaining maximum independence and re-entering the community—whether it’s home, work, or school—is a big part of any rehabilitation program. Good rehabilitation programs have services that ensure this re-entry goes as smoothly as possible.
• Plenty of recreational activities during down times. When the survivor is not actively participating in rehabilitation, he or she should have plenty of opportunities to engage in fun, social activities.
• Facilities that simulate real-life situations. In some situations, survivors of brain injury have disabilities that cause them to have to relearn everyday activities, such as cooking and doing laundry. Many rehabilitation facilities have areas that allow the survivor to relearn these things in a supportive, healing environment.
• Help with choosing adaptive equipment and technology. In situations in which adaptive equipment or technology is necessary, a staff member who can guide the survivor toward the right equipment can make a huge difference is that survivor’s independence and success.
All rehabilitation centers are not created equal. One of the most important decisions the family of the survivor will make is where their loved one will spend the rehabilitation phase of treatment. While proximity to the family and whether the center is covered by insurance will certainly factor into the decision, more important is whether the facility is equipped to deal with the survivor’s specific injuries.
Goals of Rehabilitation
A good rehabilitation center has the overall health of the survivor in mind and offers long-term medical care, physical therapy, occupational therapy, recreational therapy, counseling, family services, and educational services to both the survivor and his or her family. The staff comprises doctors, nurses, physical therapists, occupational therapists, recreational therapists, nutritionists, respiratory therapists, psychologists, case managers, and rehab engineering experts. In other words, there should be specialized staff members who have expertise in just about every issue the survivor will face.
To put it simply, the goal of rehabilitation is to ensure that the survivor is able to live as normal a life as possible. This means not only helping the survivor return to as much cognitive and physical function as possible, but also ensuring the survivor is well-equipped to deal with life after brain injury.
As independence is a goal of rehabilitation, most rehabilitation units have special facilities on-site designed to help the patient learn individual living skills. A good rehabilitation program will not only help survivors relearn the basic skills of everyday life, it will also help survivors cope with any complications of their condition that may require special care.
Standards of Care
Rehabilitation centers that are accredited meet a certain standard of care and are generally preferable to general rehabilitation programs. Look for programs that have been recognized by the Commission on Accreditation of Rehabilitation Facilities (CARF). These centers will have met a minimum standard of care and will offer a wide variety of services.
The Department of Health’s Joint Commission on Accreditation of Healthcare Organizations (JCAHO) also gives the designation of Brain and Spinal Cord Injury Program (BSCIP) to facilities that meet certain standards and criteria. Facilities with this designation must be accredited by CARF in brain injury and must admit a certain number of brain injury patients per year.
In addition to these designations, there are basic elements that every good rehabilitation center should have. These include:
- A staff that specializes in brain injury.
- Physician and nursing coverage seven days a week, 24 hours per day.
- Specialties offered such as family counseling, occupational and physical therapy, speech therapy, job training and community re-entry, life skills, and therapeutic recreation.
- Weekend and evening activities for residents.
- Programs that include family and loved ones in the care and rehabilitation of the survivor.
Curing Brain Injury
If the brain injury survivor is one of the 48 percent of Americans that are covered by private insurance at the time of the accident, then he or she will have some coverage for their medical care. How much coverage he or she has will depend upon the insurance policy that the survivor holds.
One of the most helpful things the survivor’s loved ones can do immediately following the accident is to get the survivor’s financial affairs in order. That means tracking down and reading insurance policies, talking to employers about benefits, locating pertinent financial and legal papers, and getting a ballpark estimate as to how much the care of the survivor will cost.
At this point, it’s important for the survivor and his or her loved ones to consider different sources of funding, in addition to health insurance. Additional funding sources might include automobile insurance, workman’s compensation, veteran benefits, legal settlements, social services, church or charity groups, scholarships, pensions, employment and disability benefits, social security benefits, and fundraisers.