Bully Pulpit: Specialized Rehab and TBI


Tim Gilmer

One year ago my nephew, Nick, sustained a traumatic brain injury from a freak accident. He began emerging from a coma two months later. Three months following his accident, Nick’s trach tube was removed, and he began standing with help and receiving initial speech and physical therapy. He looked like he was on his way to recovery. But his insurance, a very limited HMO, had no TBI treatment centers in their network. So they sent him to a general rehab facility where people go after they have had knee or hip surgery and other common conditions that require physical therapy.

The first week there, Nick’s brain became infected with meningitis and cerebritis, probably due to a fall from bed a few weeks earlier in the long term acute care facility the HMO had sent him to after being discharged from the acute care hospital. He was the youngest resident among older respiratory residents at the LTAC, many of whom would die there.

The brain infection was devastating, and after three surgeries, he remains bedridden in a nursing home, paralyzed, back on a trach and feeding tube, intermittently conscious. His wife, 22-year-old son, two teenage daughters and youngest son await the day he will regain full consciousness and, hopefully, return to them.

He is not without hope. He has shown signs of responding to loved ones, friends, and caregivers. But even if he regains full awareness, he may not be able to gain access to what he needs to function independently, or interdependently. I’m talking about the need for him to receive full services from a TBI treatment center — physical therapy, respiratory therapy, speech therapy, occupational therapy, neuropsychiatric therapy, counseling for him and his family, and more.

Just getting admitted to a rehab facility that specializes in TBI is difficult. And those who have the greatest need — the most severely injured — have the least chance of gaining admittance. Our health care system, made up of so many talented and dedicated doctors, nurses and therapists, is on a leash — controlled by outdated Medicare policy and private insurance companies whose fickle allegiance to patients is determined by cost more than medical need.

Those of us who have sustained spinal cord injuries know how important it is to get the benefits of specialized rehabilitation. But most of us don’t fully appreciate how much more rehab TBI survivors need, and how critically important it is for them to be stimulated in every way to re-awaken the brain and re-engage it with all organs, limbs, senses, bodily functions, surroundings — everything that makes us human.

If we had a law mandating that severe TBI survivors must receive the full services of a TBI treatment center instead of being given second- and third-class care from long term acute care hospitals and nursing homes, Nick and others like him — including many vets with war-related TBIs — would have a fighting chance to recover.

Those of us with SCI know just how critical specialized rehab can be. Our fellow TBI survivors deserve the best treatment possible — sooner rather than later.


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