TBI Therapy and Rehabilitation or the Lack Thereof

TBI Therapy: Helena Part Three

In part three we talk about the TBI therapy that Helena received in the hospital and as can be expected the lack of TBI therapy she received because of her insurance.

There is always sadness secondary to any serious injury or surgery, more so for someone with little family. Helena’s hospitalization was over the Christmas holidays. She explains:

First of all this happened, because, because it happened before Christmas, I spent Christmas in the hospital, and the rehab part, you had to, I had to interact with other people; we ate our meals in a commons room, and that’s when I started some physical therapy and some evaluations for occupational therapy, to see what my cognitive deficits might be.

(The physical therapy was for) my left clavicle and vertebrae high up in my neck. So I was in a collar, and they didn’t do much in terms of neck and back stuff, but I had very poor balance. At first I couldn’t walk and then eventually I could walk very wobbly with a walker.

Her problems with walking were due to the balance problems, not from a movement disorder, per se. With respect to her other TBI therapy, she said:

In occupational therapy I had to put blocks together and look at different colors of things and, and see if I could organize things and shapes, and I just wanted to throw up. I finally had to say to them I can’t do this anymore, and I didn’t understand why. It’s just that it made me feel so nauseated.

Though she has been diagnosed with a vestibular disorder, her insurance wouldn’t pay for any vestibular therapy as part of her TBI therapy. She explains the insurance rationale, as best she can:

Well I think (because the balance problem) occurs periodically, my insurance wouldn’t pay for any vestibular rehabilitation. (They said the TBI therapy was) not necessary. The therapist that I was with said why don’t you come back when you’re on Medicare, because that may cover, when you turn 65 come back and try it again, because it, it hasn’t really gone away.

Even though you’d had brain surgery and were in ICU for four days, and had severe damage to your brain, they came in and claimed that restoring your balance wasn’t medically necessary as part of  your TBI therapy?

Well I had the vestibular (problems) that happened probably a year out from my hospitalization and, and then the, my balance got so bad that I went to the doctor and then that’s when I was evaluated. So a year out they wouldn’t pay for that.

It was, at that point I was with HIRSP, that state program for people who are basically uninsurable by anybody else.

Both the insurance company and the therapist were unconscionably wrong in denying/putting off this TBI therapy. As Helena explained, she had severe nausea and balance problems from the very beginning of her recovery. Nausea is often caused by vestibular problems, or by related eye movement problems. Her balance was so off that she couldn’t walk after her surgery. Further, a periodic recurrence of balance problems is a normal consequence of TBI, especially if related to a condition called benign paroxysmal positional vertigo or BPPV. See http://vestibulardisorder.com To deny her needed treatment because the symptoms recur one year post makes as little sense as denying a severe TBI survivor seizure medication for a seizure that occurs one year post injury.

What other visual problems did you have:

I had double vision in my left eye, which was very disorienting, and contributed and exacerbated the balance problems, as soon as they took the, the bandages off.

Most of my PT, was going up stairs, and my left side was not paralyzed but it was severely weakened, so I had to learn how to balance again, make sure that I was going up the stairs properly, and I wasn’t very successful at it. I had to go very slowly and mostly do two steps my right and left foot, I couldn’t do the steps one at a time, and so I used a walker for probably close to a month after I’d started rehab.

Also the theory of postponing treatment and TBI therapy for up to two years is particularly troublesome with a person who already has a history of TBI, because of the risk of a second TBI from a fall. See for example the severe consequences to our TBI Voices participant, Elizabeth, as a result of her second fall.

The final problem with the wait for Medicare theory is that it vividly demonstrates what is wrong with current proposals in the Republican controlled Congress to privatize Medicare. If Medicare is replaced by a voucher system to buy private insurance, the same kind of administrators that are denying Helena absolutely critical care for her balance problems, would be concocting the excuses why such care wouldn’t be provided to seniors – no ounce of prevention to keep Helena upright and brain healthy. Rather just the risk of added costs and disability from a secondary fall.

Next in Part Four – Helena Discharge Into Uncertainty