Traumatic brain injuries (TBIs) are among the most catastrophic outcomes of personal injury accidents. Pedestrians, bicyclists, and motorcycle riders are particularly vulnerable to TBIs caused by traffic accidents. Other kinds of accidents, including falls from a height or impacts from falling objects, can also produce the kind of head injuries that cause permanent brain damage.
Any significant concussion can cause bleeding or swelling of brain tissue. Recovery is more likely when brain tissue has not been damaged. Brains are particularly likely to sustain permanent damage when they experience a second violent impact before a previous injury heals. Even a single impact, however, can cause a brain injury that has serious lasting consequences.
Long-term effects of TBIs can include paralysis, impaired motor control, poor balance, loss of coordination, sleep disturbances, problems with vision and speech, difficulty thinking and concentrating, memory loss, diminished problem-solving skills, and personality changes. A TBI can make it impossible to return to former employment and may prevent the victim from engaging in any gainful employment. A TBI victim might have difficulty learning new skills and retaining new information.
Brain injuries that cause personality changes can impair the victim’s ability to socialize and to form personal or professional relationships. Victims of TBIs are often unable to participate in activities that were once a source of joy, including participation in sports, socializing, and reading.
Brain Injury Rehabilitation
Brain tissue that has been destroyed because of a violent impact does not heal. Depending on the location and nature of the brain damage, other parts of the brain might take over functions that were controlled by the damaged area. Brain injury victims often need extensive and ongoing rehabilitation to maximize their recoveries, even when neurologists do not anticipate a full recovery. The extent of a recovery can never be predicted with certainty, although the passage of time will provide evidence of the permanent limitations that a TBI victim is likely to experience.
Neurological testing provides information about the location and observable extent of a brain injury. Rehabilitation usually begins with psychological testing to measure the impact that the injury has had on the victim’s reasoning, perception, memory, and personality. Functional testing will also identify the impact a TBI has had on balance, muscle strength, fine motor skills, and other physical abilities.
After the TBI victim’s challenges are identified, an appropriate rehabilitation team can make a plan to help the victim address those challenges. Neurologists, psychologists, physical and occupational therapists, speech therapists, vocational rehabilitation experts, and other professionals typically help the victim engage in physical and mental exercises, learn coping skills, and deal with anger or depression.
Cognitive rehabilitation tends to be a slow, ongoing process that requires one-on-one treatment by a variety of specialists. The needs of TBI victims often change over time. Life care planners must be alert to observable changes that have already occurred and must consider the need for a flexible care plan that will respond to changes in the victim’s condition as they occur.
Role of the Life Care Planner
Life care planners assess the current and future needs of TBI victims. Their comprehensive assessment culminates in the preparation of a report that itemizes the victim’s current and future needs, as well as services and products that the victim will need to approximate the life the victim would have lived in the absence of a TBI. The goal is to develop a plan that will make the victim whole. While no plan can heal the victim’s injuries, a life care plan addresses the ways in which the victim can engage in the activities of daily living, pursue employment, and attain independence to the extent that the victim’s condition allows.
Life care planners work with the rehabilitation team and other sources to develop a life care plan. Life care planners understand that there is no “one size fits all” plan that will meet the needs of each TBI patient. Brain injuries can result in diverse impairments. Some victims are impaired in multiple ways while others face fewer limitations. Severe injuries may require a lifetime of care in an assisted living facility while other injuries may permit the victim to live a degree of independence, often with the assistance of visiting professionals. Victims who live independently may still need outside assistance to prepare their meals, clean their homes, and arrange their transportation.
Preparation of a Life Care Plan
A life care planner works with the victim’s attorney to gain access to all relevant medical records. Life care planners are familiar with medical terminology. Based on medical records, they assess the victim’s condition and functionality. If additional testing might help the life care planner make recommendations, the planner will advise the attorney of the testing that should be pursued.
A life care planner then interviews the TBI victim, preferably at the victim’s residence. The planner will want to meet with family members who are in close contact with the victim and any other collateral sources who can provide quality information about the victim’s life before and after the injury.
A life care planner consults with professionals who have evaluated or treated the TBI victim to obtain information that is not covered by medical records. A life care planner might also review relevant research literature and clinical practice guidelines to develop a full understanding of future treatment needs.
The life care planner will then identify appropriate services (including various forms of therapy and counseling and personal housekeeping services) that the victim will need to maximize a return to the lifestyle the victim enjoyed prior to the brain injury. The life care planner will also identify any products (such as wheelchairs or exercise equipment) and environmental modifications (such as wheelchair ramps) the victim might need to cope with the injury.
Having identified the victim’s current and future needs, the life care planner will document the charges associated with each recommended service or product, taking into account the need for replacement products over the course of the TBI victim’s life. The life care planner will use standardized tables and medical information to assess the victim’s anticipated lifespan.
Finally, the life care planner will review the life care plan with relevant medical personnel, supportive family members, and the victim’s attorney to assure that the plan is both practical and complete. At that point, the victim’s attorney will typically present the plan to an economist to determine the present value of the future expenses.