Timing and Frequency of Rehab for TBI Highly Individualized

It is often difficult for insurance companies — and the families, themselves — to understand why one person with a TBI may recover fully while another person with a seemingly identical injury needs life-long care.

See more videos with Dr. Malec.

I think the optimum timing of rehabilitation-- and the frequency--is highly individualized. That does make it difficult to be prescriptive. From the payer's point of view, I can see why they have difficulty with it. Why does Patient A-- who looks like they have pretty much the same injury as Patient B-- need so much more therapy? But in fact, there's a great deal of diversity in outcomes after brain injury, and some people with moderately-severe brain injuries walk out of the hospital and seem to be just fine. That's rare, but it happens. Whereas, more typically, people need a good deal of intervention and rehabilitation over the course of their lifetime. There is a number of factors that go into the timing of this. Perhaps one of the most important is the person's awareness of their disabilities. After a severe brain injury, people may not feel like they need any help even though it's very obvious to their family that they're in a lot of trouble. The first job may be simply getting them on-board in terms of recognizing their disabilities. That kind of an intervention can be very intensive, or it may simply be keeping them engaged in some small way until they start to wrap their minds around what's happened to them. So again, it's a tricky business in knowing what's right for a person at what time, and I think it's really hard to make generalities that go across a large number of patients.
Posted on BrainLine November 1, 2012.

Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.