Neuro International

To the layperson, a Traumatic Brain Injury is a brain injury, but to the person with Mild Brain Injury as a diagnosis it can be a curse that remains forever and the person with the injury may never know what’s wrong.

“Fall” and “car accident” are the most common causes of brain injury in the country.  These causes of injury are also common work-related injuries.  However, workers’ compensation carriers can have a very difficult time understanding how a slip-and-fall could cause cognitive and behavioral deficits in an individual who is reported to have had no injury at all following release from a hospital or a walk-in clinic.  The severity of reported behaviors resulting from a mild brain injury can include aggression and anger as well as substance abuse where the person had none of these behaviors prior to the injury or accident and never used illegal substances.

Imagine if you were to slip and fall on a wet floor, through no fault of your own, in front of co-workers.  You’re not sure what happened or why you’re lying on your back for a few seconds, but as soon as you realize you fell, embarrassment is often the first thing you feel.  Your co-workers have immediate concern but you quickly laugh and tell them you’re okay.  Even if you have some discomfort, you get up and continue on your way, hoping everyone will forget that you looked silly when you fell.  No one even thinks you should go to the emergency room.  It never crosses your mind.

That night when you get home you’re not sure if you pulled something in your leg when you fell but it hurts.  Maybe it’s just a strain.  Over the next few days you notice a little soreness overall but you know it’s nothing serious.  Someone tells you at work that you have been writing the word Michigan instead of the word Florida and that they’ve answered your same question twice regarding lunch.  The soreness is gone in a few days but over the following weeks you feel increasingly “off” and can’t really describe the feeling.  You notice you’ve been unusually agitated and angry and what’s with those headaches.  Your co-workers seem to be very picky which is aggravating you, and your boss has corrected your work several times.  Your spouse is getting on your nerves much more than usual too.  The “fuzzy” feeling in your head is increasing but you don’t want to tell anyone as they will think you’re going crazy and losing it.  Maybe that is what’s happening but who do you talk with to find out?

These are some of the signs and symptoms of a mild brain injury which may not be detected or diagnosed for months or more.  Over time the symptoms can increase mildly or significantly and the person decompensates, can lose his or her job, and friends may fall away due to the personality change that can take place.  Diagnostic testing, including CT scans and MRI’s, cannot always detect when a Mild Brain Injury has occurred.  This is one of the reasons the diagnosis of Mild Brain Injury has been so controversial for many years.  A neuropsychological evaluation remains the best and most accurate method of testing individuals to determine their cognitive and behavioral status as well as observing and continuously evaluating and individual thought to have a Mild Brain Injury.

In some cases, individuals are referred to specialized residential post-acute neurological programs where professionals with expertise in mild to severe brain injury provide a comprehensive evaluation covering all areas of function over an extended period of time, typically up to one month.  Over a consistent period of time, these experts can observe, interact, and continuously evaluate individuals thought to have cognitive and/or behavioral deficits in normal everyday environments doing a variety of activities.  Combined with cognitive testing, and a behavioral analysis, a definitive diagnosis is possible.  This same process of evaluation holds true when determining an individual does not have a Mild Brain Injury and is suffering from some other diagnosis or cause of symptoms.

For the individual suffering a Mild Brain Injury, learning there is a diagnosis and that there are treatment and rehabilitation options available provides hope and relief.

March is “Brain Injury Awareness Month.”  Hopefully those living in Florida, New York, Michigan, New Jersey, Colorado, and California, as well as those in workers’ compensation and in the no-fault auto industry, are much more aware than the general public.  How much more does the public know now than 20 years ago?  It would be interesting to set up a table at the local supermarket for a day to ask people going in and coming out to share their knowledge or understand of traumatic brain injury.  Unless you are related to a person or living with a person who sustained a brain injury, or you work with individuals diagnosed with brain injury, it is likely the average person is unaware of the realities of brain injury.

Individuals living with traumatic brain injury who have behavioral issues, such as aggression, anger, and inappropriate social skills, are often mistaken by the public as being drunk or on drugs.  This is magnified when the individual has slurred or impaired speech as a residual of brain injury.  While we don’t want to believe this is still quite common, it is.  Even among seasoned police officers who arrive on the scene of a car accident and trained paramedics who respond when a person is injured in a fall, a mild brain injury and even a traumatic brain injury can be completely overlooked.

Famous people who have sustained a brain injury could help tremendously in the area of brain injury awareness.  However, it appears when a famous person suffers a brain injury, what that person actually endures is often downplayed by the media and the word “recovered” or “recovery” is used very loosely.  The public sees how well the famous person looks and interacts on television.  Often there is no sound in the media coverage of the famous person, and the newscast is providing its own voice overlay.  It would be truly beneficial to see a recurring educational program on mainstream television filming a “regular” person going through the medical stages in the trauma center all the way through residential post-acute rehabilitation, an apartment program, receiving assisted living or supported living services, and, if able, going home if that is the true outcome.

Showing the positive outcome of an individual diagnosed with a traumatic brain injury going home with family and back to work is most often what we see in the media.  The person with the brain injury is surrounded by a loving family and everyone is happy and smiling.  What about the case of the “regular” person who does not have the benefit of being famous, having a “glamorous” story, a loving and close family, or being able to participate in the rehabilitation program he or she needs.

“Brain Injury Awareness” includes all examples of signs and symptoms of mild brain injury, how to assess if a brain injury may have occurred, how to prevent brain injury, and what individuals encounter following the diagnosis of traumatic or mild brain injury.  In all cases, information should be geared toward educating the public on the long-term aftereffects of brain injury, meaning years post-injury as that is the true reality.  More will follow in our blog.

Dear Friends,

It is with great appreciation that I accept The Brain Injury Association of Michigan’s Legacy Society Founders’ Award. I regret that I cannot be there in person, but i am most humbled that the BIAMI would bestow this award upon me. It is a great honor to know that no-fault benefits have assisted so many citizens in Michigan on their road to recovery after a devastating accident because of the legislation we created nearly four decades ago.

Allow me to take a moment to highlight some of the achievements of the legislation that we can be most proud of.

In 1973, Michigan faced multiple pressures to reform its automobile insurance system. We responded to these pressures by creating the Michigan’s Auto -No-Fault Insurance Act. The promise was to:
1) ensure that those injured in an automobile crash received all reasonably necessary medical care for their life time;
2) minimize the need for litigation as a result of automobile crashes;
3) ensure that a fair and equitable insurance premium would be paid for such coverage.

Many states have followed Michigan’s lead in creating similar auto no-fault insurance laws; however, Michigan’s Auto No-Fault Insurance Act has always been revered as the ultimate standard.

It is my opinion that this has truly been good public policy for Michigan residents. Seriously injured persons are provided optimal medical care that enables them to achieve maximum recovery, including the possibility of returning to work and becoming taxpayers again. Under this legislation, injured parties and families have the lifetime medical coverage needed so that they can avoid the threat of bankruptcy due to medical cost and/or the shifting of these costs to the states’ Medicaid program.

Additionally, a cutting edge brain injury rehabilitation industry has been created, providing thousands of new jobs and enhancing the communities where they operate. Michigan has become a brain injury rehabilitation center of excellence which has allowed our citizens to return to their communities. All of this is truly our legacy to share.

With Appreciation,

 
 
 

Governor William G Milliken

The following represent the state of the law as of January 1, 2006. Please note that worker’s compensation law can be complex and these laws and policies are subject to amendment at any time. If you need help with a worker’s compensation issue, please consult a licensed attorney.

Is Worker’s Compensation Compulsory? Yes

Are Waivers Permitted? Yes. However corporate officers may elect to be exempt. In the construction industry, no more than three corporate officers may be exempt, and each must demonstrate at least 10% ownership.

Numerical Exceptions: Real estate salespersons and brokers whose earnings are solely commissions are exempt from workers’ compensation coverage. Employers in the construction industry with one or more employees are required to carry workers’ compensation insurance. Florida statute excludes some individuals from the definition of “employee,” including, under certain circumstances, owner-operators of motor vehicles transporting property and passenger vehicle-for-hire drivers.

Choice of Physician: Employee selects a physician from list supplied by carrier or managed care organization when medical care is provided through an authorized managed care arrangement. Employee may petition for a one-time change of physician.

If medical care is provided outside an authorized managed care arrangement, the employer chooses the physician.

Waiting Period For Comp Benefits After Injury: 7 days

Compensation is retroactive if disability continues for what period of time from the date of injury? More than 21 days

Attorney Fees Permitted: 20% first $5,000; 15% second $5,000; 10% on amount received over first 10 years, 5% on balance, statute

You can read the Voice News article where they discuss our TBI program and how NeuroInternational specializes worker’s compensation and Michigan No Fault.

How to choose the best residential traumatic brain injury (TBI) NeuroRehab, NeuroBehavioral, and Supported Living Programs, Facilities, and Centers.

Choosing the best inpatient- residential Traumatic Brain Injury (TBI) Facility in Florida, Michigan, Texas and other states can be difficult and stressful for families and survivors. Making sure to avoid the bad or worst brain injury facilities and programs can be even more worrisome. In fact, choosing the highest quality brain injury neuro rehab center can be one of the most stressful decisions one has to make during the brain injury recovery process, especially if one is choosing a long-term care / supported living program.

Some suggestions for choosing the best ABI / TBI facility, and how to avoid the common mistakes people make when evaluating a traumatic brain injury program:

1. Never make your final choice for a particular program until you personally visit the facility, meet the staff, and speak to their current clients.
2. Ask yourself “Does this program offer reasonable family housing and travel to ensure families stay connected to clients?”
3. Make sure the staff are experienced in managing TBI programs. Pay close attention to the quality of the direct care staff as these folks will spend the most time with the TBI survivor. What is the average age of the staff? Ask about staff turnover rates and staff training.
4. Pick a staff during the tour and ask them questions. While touring, observe how the staff interacts with residents…do they treat them with dignity and respect? Do the residents seem happy and well cared for? Do you only get to meet designated clients?
5. Make sure the program does not have a punitive behavioral model. Ask the program administrator if residents are ever secluded or put in physical restraint. Ask what happens if the client exhibits maladaptive behavior.
6. Make sure the program offers comprehensive onsite services from all needed treatment team members. Make sure the program offers multidisciplinary treatment planning services. Inquire about how often the team members including doctors see the client.
7. Make sure the program is clean and offers healthy food and living accommodations. As an indicator, ask if the fruit is canned or fresh cut? Are the meals cooked from scratch? Do clients have food choices? If the food is bad and the program is dirty, this is a key indicator of the type of care you will receive in the program.
8. Make sure the surrounding community has plenty of medical, educational, vocational and recreational opportunities – having immediate access to community amenities is essential to quality living and to promote true independence. Make sure the community offers specialty doctors, labs, scans, dentist, and other services which TBI survivors often need on a routine basis  – you do not want to have to travel 2 hours round trip to do routine things like see clinical specialists, get an MRI, have a nice dinner,  see a movie, or walk around a mall.
9. If you are searching for a supported living program or long-term facility be sure the program has a true family-style environment. Family-centered programs create a warm and loving environment and are better able to offer more individualized care. Programs with a “house mother” who pays attention to detail is the ideal scenario. Is the owner onsite daily? How often does the owner interact with clients and staff?
10. While touring, look at the clients who are in the program… are they clean, groomed and well dressed?
11. Search the internet and make sure the program you are considering does not have a founded history of abuse or neglect (seclusion, restraint, physical abuse, deaths, etc).
12. Ask for client, family, and case manager references. When touring, pick out a client you see and ask if their family would be willing to speak to you (even the worst brain injury programs can pick a small handful of “satisfied” clients, but you want to ensure that you chose a program that has high customer satisfaction ratings, as well as low client attrition rates.
13. Ask the program administrator if the program has ever had a founded abuse claim, or if the State has ever placed the program under a moratorium for abuse and neglect. Search the facility online to ensure that there are not excessive claims of abuse. Remember, most neurobehavioral programs may have an occasional, unsubstantiated claim stemming from some clients who like attention or get upset when they do not get there own way. However, if the facility you are inspecting has excessive founded claims by external stakeholders such as families and State agencies, proceed with extreme caution.
14. You can also make an unscheduled tour of the facility; however, some key staff may be in the field working and may not be available to interview. Therefore, it is suggested to schedule your first tour in advance, then do an unscheduled follow up tour to see how things compare.
15. Ask if the program has had any dissatisfied customers in the past two years that have transferred to another program. Ask for details about why the client/family was displeased with the program, as well as which program he/she transferred to. Ask to speak to those client’s families. Remember, look for trends…
16. Lastly, recognize that just because a program is licensed or accredited that doesn’t mean that the care is good. Doing your homework with not only offer you peace of mind, but more importantly, will ensure that your loved one receives the quality of care and services which he/she requires.