February 20, 2022
February 20, 2022
Traumatic brain injury (TBI) is a leading cause of death and disability. In 2013, there were approximately 2.5 million emergency department (ED) visits, 282,000 hospitalizations, and 56,000 deaths related to TBI in the United States. Many survivors live with significant disabilities, resulting in major socioeconomic burden as well. In 2010, the economic impact of TBI in the United States was estimated to be $76.5 billion in direct and indirect costs. More severe TBI carries a disproportionately greater economic toll (Rajajee, 2022).
According to the Centers for Disease Control and Prevention, incidents of traumatic brain injury (TBI) have grown exponentially in the last several years, creating physical and emotional trauma for those affected. Aftereffects of a brain injury can last a lifetime. A life care plan can provide health and UCR costs for future care following a traumatic brain injury.
In this blog post, we will define what is a traumatic brain injury, elements of a life care plan for traumatic brain injury, and why a life care plans are important in this setting.
Brain injuries are classified by methods and generally acquired brain injuries (ABI) are classified as traumatic, anoxic/hypoxic, vascular, or other (Weed & Berens, 2018). A traumatic brain injury is the broadest category of ABI and can be subdivided to closed or open. Open injuries involve disruption of skull/scalp and closed injuries involve impact of brain against inner part of skull. A traumatic brain injury is a result of physical impact on the brain.
The National Library of Medicine defines a traumatic brain injury as a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head.
The recovery process for most patients presents ongoing challenges and can result in reduced productivity at work, decreased job stability, and often lessened job responsibilities.
Life care planning can be an essential component of outlining future care and cost that will aid in the recovery process from TBI. Convalescence involves a coordinated team of professionals to assist in relearning physical and mental functions and the length of recovery can depend on the severity of injury sustained.
It should be noted that TBI evaluation depends on the severity of the injury.
The first severity measurements involve two parameters:
Each parameter is measured with standard tests such as the Glasgow Coma Scale (GCS), which measures three areas of functionality.
Each area or component is assigned a score and when added together, determine the severity of brain injury. The GCS is scored between 3 and 15, 3 being the worst and 15 the best. A score of 13 or higher correlates with mild brain injury, a score of 9 to 12 correlates with moderate injury, and a score of 8 or less represents severe brain injury. A brain injury can impact neural and physical responses, as well as the ability to understand and speak.
Because of the interactive relationships following a TBI onset, evaluation and contextually based treatment can follow — sometimes for life. A life care plan created by a certified life care planner professional provides direction and quantifies future cost of care so that a person with TBI can attain or maintain a level of functional capacity and quality of life.
It should be noted TBI is a chronic, life-long disease process and may affect pre-existing conditions and alter previous management protocols. Additionally, not all impairments may be evident at time of onset of TBI and secondary complications can take time to manifest.
An array of elements comprises a life care plan for a person suffering from a traumatic brain injury. The elements below are not all inclusive but are important items to be considered.
Medical Treatment – Treatments can include medication, surgery, nerve blocks, physical therapy, occupational therapy, speech therapy, recreational therapy, hippotherapy, music therapy, aquatherapy and other modalities (Archer, 2012; Nudo & Dancause, 2013).
Cognitive Capacity – Reduced cognitive capacity can result in short- and long-term memory impairment, abstract thought and reasoning, disorientation, initiation, sequencing, and other cognitive impairments.
Psychological/Behavioral Symptoms – Psychological symptoms can be complex and lead to misinterpreted behavior. From lack of inhibition and hoarding to depression, anger, dysfunctional sexual activity, and hyperactivity, the symptoms run a gamut of problems dealing with people and real-world situations.
Other items to consider include routine medical care (Physician encounters, Radiographic imaging, & Laboratories etc.), evaluations by non-physicians (Physical therapy, speech therapy, occupational therapy), therapeutic modalities (physical/occupational/speech therapy sessions), wheeled mobility needs and accessories, home furnishings, orthotics/prosthetics, orthopedic equipment, medication, supplies, home/facility care, transportation, health and strength maintenance including leisure time activity, vocational/educational plan, and architectural considerations.
With all the complexities of analysis and treatment, creating an appropriate life care plan for an individual with ABI or TBI can be a challenge. Problems in essentially every organ of the body and cognitive along with behavior problems must be considered. A carefully constructed life care plan by a certified life care planner can be vital at documenting future needs of the patient.
Archer T. Inﬂuence of physical exercise on traumatic brain injury deﬁcits: scaffolding effect. Neu-rotoxicity Research, 21(4):418-434, 2012.
Jacobs, Harvey & Katz, Howard & Berens, Debra. (2017). Life Care Planning for the Adult with Traumatic Brain injury. Brain Injury Professional. 14. 8-12.
Nudo, RJ, Dancause, N. Neuroscientiﬁc basis for occupational and physical therapy interventions. In: Brain Injury Medicine Second Edition, ND Zasler, DI Katz & RD Zafonte, (Eds.) Demos Medical, New York, NY. Pages 1134-1148, 2013
Rajajee, V. (2022, January). Management of acute moderate and severe traumatic brain injury. Uptodate. Retrieved from https://www.uptodate.com/contents/management-of-acute-moderate-and-severe-traumatic-brain-injury
Weed, R. O., & Berens, D. E. (2018). Life Care Planning and Case Management Handbook (4th ed.). Routledge.
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