Traumatic Brain Injuries

Giffords' recovery renews focus on coverage gap for veterans

WASHINGTON — From the critical moments after she suffered a gunshot wound to the head in January to her triumphant return to Congress last week for a vote on the debt-limit deal, Rep. Gabrielle Giffords owes her recovery in no small part to veterans with similar injuries.

Doctors and rehabilitation specialists have learned a great deal from the treatment of traumatic brain injuries in combat veterans of Iraq and Afghanistan. One in five veterans of those wars has suffered some form of traumatic brain injury, most commonly concussions from roadside bombs.

Yet veterans' health care doesn't consistently cover cognitive rehabilitation therapy, the same therapy that's helped Giffords and other well-known figures — such as Sen. Tim Johnson of South Dakota and ABC News correspondent Bob Woodruff — get their lives back to normal after major brain traumas.

"If we fail to give people the tools they need to do that, then we've shut them out of society," said Susan Connors, the president of the Brain Injury Association of America.

While some veterans are getting very good treatment, advocates say, others are finding it difficult to get therapy or even the testing to determine whether they need it.

"It is a national disgrace," said Paul Rao, the president of the American Speech-Language Hearing Association and Johnson's speech therapist.

When people suffer traumatic brain injuries, they need more than just to learn how to walk and talk again.

Cognitive rehabilitation can include speech and communication therapies, and therapies to boost memory and social skills and relearn routine tasks such as getting dressed and shopping at the grocery store.

Connors compared it to elementary school.

Except that "You aren't learning it for the first time; you are relearning it," she said.

Pentagon spokeswoman Cynthia Smith said in an email that under the Tricare insurance plan, which covers members of the military, rehabilitation therapy "must be medically necessary and appropriate care keeping with accepted norms for medical practice in the U.S."

Brain-injury advocates say Tricare and civilian health-insurance providers deny payment for cognitive rehabilitation on the basis that it isn't proven effective, despite its wide embrace in the medical community and by the Department of Veterans Affairs.

Part of the problem is cost, typically $27,000 for one hour a day of treatment over six months.

Traumatic Brain Injury: Recognizing an Invisible Disability ...

In February 2011, Dave Duerson, a former NFL safety for the Chicago Bears and a two-time Super Bowl champion, ended his life because he feared that he had traumatic brain injury (TBI) stemming from the many concussions he suffered as a football player. Posthumous testing of Duerson’s brain, which he donated to research,  confirmed that he was suffering from life-altering injuries to his brain, injuries that were often invisible to others. But the effects of TBI can produce persistent behavioral challenges, including severe depression, lack of concentration, mood swings, and in Duerson’s case, suicide.

A brain injury may be sustained in a variety of situations. According to the Centers for Disease Control and Prevention (CDC),  over half of all brain injuries are caused by falls (35%)  and motor vehicle accidents (17.3%),  with over 1.7 million people sustaining TBIs every year. Fortunately, nearly 80% of patients seen in the ER are treated and released from the hospital. However, 52,000 people will die and 275,000 will be hospitalized as a result of a TBI.

Traumatic brain injury is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Most TBIs are concussions or other forms of mild TBI. Severe TBI may involve an extended period of unconsciousness or amnesia. A brain injury may affect the way the a person thinks, feels and acts and can change functions within the body, such as temperature, bladder and bowel control. For those with significant brain injury, special services may be required  including in-home care, neurological assessment and counseling, financial assitance as well as physical therapy.

What can you do to prevent concussions or other forms of TBI? There are a number of ways to reduce the risk of injury:

1. Wear a seat belt every time your drive/ride in a motor vehicle.

2. Use a child safety seat, booster seat or seat belt (according to your child’s weight, height and age) every time your child rides in a motor vehicle.

3. Wear a helmet, and make sure your children wear helmets when playing contact sports, skating, riding a bike, skateboarding or snowboarding.

4. Protect seniors from falls by removing trip hazards, installing grab bars in showers and bathrooms and improving lighting in the home.

5. To keep children from falling out of open windows, install window guards. Place safety gates at the tops and bottoms of staircases when youngsters are in the home.

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