Treatment
Head injury is treated in the emergency room of the nearest trauma center.  The injured worker’s eye, verbal and motor responses are assessed using the Glasgow Coma Scale (GCS).  The GCS is a neurological scale utilized to provide a reliable, objective assessment of the conscious state of the injured worker.  A CT scan of the brain, possibly an MRI of the brain, EEG and cervical spine x-rays are ordered after the assessment.  Frequently, results of the diagnostics are read as normal by physicians in the acute stage of the injury.  It is important to understand normal diagnostics at the time of injury do not signify brain injury has not occurred.  Just as significant, a normal assessment of the injured worker in the emergency room by qualified personnel does not confirm brain injury has not occurred either.  Injured workers are frequently discharged from the hospital and provided with head injury precautions.  The reason head injury precautions are provided is because it is typical for the injured worker to develop symptoms or become more aware of their symptoms with time.  It is also possible for repeat CT or MRI scans of the brain several months after the injury to demonstrate subdural hematoma, subarachnoid hemorrhage or a number of other conditions that did not present at the time of the initial evaluation. 

Post Injury
Prior to discharge from the hospital, injured workers are told what to expect in terms of on-going symptoms and expectations for recovery.  Symptoms that frequently occur post head injury are poor concentration, memory difficulty, cognitive impairment, irritability, fatigue, headache, depression, anxiety, dizziness, blurred or impaired vision, light sensitivity, sound sensitivity, sleep difficulties, changes in personality, apathy or physical weakness.  The injured worker understands the symptoms that may occur as a result of their head injury.  However, they are reluctant to communicate to anyone about what they are experiencing once symptoms begin to surface.  Unfortunately, many injured workers discover their deficits after they return-to-work.  The injured worker recognizes they can not function at work because of difficulties with memory, concentration or other head injury symptoms.   

Recovery
Most head injury symptoms do subside after three months.  But if resolution does not occur in this timeframe evaluation is appropriate.  A specialized head injury program provides the most comprehensive and cost effective solution to the claims professional.  Head injury programs have access to audiologists, occupational therapists, physical therapists, speech and language pathologists, neuropsychologists and psychiatrists as well as other professionals necessary to assess and resolve traumatic brain injury (TBI).  A comprehensive approach to evaluation of head injury is more effective than referring to a number of specialists that are not working together as a team to appropriately evaluate your injured worker.  Head injury programs treat the whole person.  

Once diagnosed with TBI, injured workers have to correct deficits in language, communication, memory, problem solving, and attention problems as well as physical, emotional and behavioral impairments.  It is extremely hard work to relearn skills that come naturally to all of us.  The injured worker has to cope with some deficits that may never resolve and in fact may be lifelong challenges.  A profound impact on the entire family unit occurs as the reality that life will never be the same sets in. 

Resolution
There is no typical pattern of deficit associated with TBI.  Every patient is different because of the individual differences in our brains.  Recovery is gradual.  The typical timeframe for recovery from brain injury is eighteen to thirty-six months post injury for the brain to recover and regenerate.  The first six months are the most crucial.  This is why immediate referral to a head injury program is critical for any head injury no matter how insignificant it may appear to be at the time of injury.    

As a claims professional, it is important for you to recognize the symptoms of TBI.  Too many professionals are unfamiliar with TBI symptoms and treatment options.  Professionals involved in head injury claims do not recognize there are programs available to improve and resolve the deficits created by head injury.  Referring the injured worker to various specialists who are unfamiliar with the treatment of TBI is costly and will not resolve the problem.  A permanent disability will occur unless appropriate referral to a qualified head injury program takes place three months post injury.  Head injury programs are expensive but the cost of a permanent disability with future medical for a lifetime is far more costly for everyone.  The injured worker in particular must endure the greatest cost.  The injured worker must endure a lifetime of difficulty coping with unresolved head injury symptoms.

Maureen Kohl Bennington, M.S., CCM, CDMS, CPUR, CRC, is a managed care consultant.  Readers may write to Maureen at: mbennington@buildingpeopleinc.com