One Man’s Story
After a traumatic brain injury (TBI), tasks that were once easy may suddenly become next to impossible. Take the story of Matthew Drake, a 24 year old ex-soldier who sustained a TBI while serving in Iraq three years ago. The everyday tasks that most of us take for granted became a confusing nightmare for Drake after his injury. The simple act of cooking hot dogs for lunch was suddenly too complex for his injured brain to process.

About a year ago Drake moved into a privately run Cognitive Rehabilitation facility to improve those aspects of his life that could not be treated with standard medicine. He is now independent enough to live in an assisted living apartment, and yes, he can once again make hot dogs.

Cognitive Rehabilitation is a program that is individualized for each patient, addressing his or her specific needs and problems. Possible therapies may include speech therapy, occupational therapy, hand-eye coordination, and organizational exercises. The primary goal of treatment is to reverse as much as possible of the difficulties caused by the brain injury. The goal is not necessarily healing the injury, but learning to compensate for it. In Drake’s case, a list of steps was written down for making hot dogs. Drake was then assisted as he repeated these steps over and over. The caregiver stepped back as Drake began to catch on, until eventually he was able to do it on his own.

What the Insurance Companies Say
The majority of insurance companies refuse to accept Cognitive Rehabilitation as a primary course of treatment. They may pay for some treatment, but for long-term therapy many brain injury patients are on their own. Insurance companies point to a lack of substantial evidence of the effectiveness of this type of treatment.

The BIAA’s Position
In 2007 the Brain Injury Association of America released a paper fully endorsing Cognitive Rehabilitation and urging insurance companies and others to do the same. At the same time they acknowledged the fact that additional research needs to be done and clinical guidelines need to be better established. But the fact that questions remain, they say, should not be used as an excuse for insurance companies to deny paid support for treatment.

The effectiveness of these treatments is often hard to prove on paper as the brain itself is often not technically healed. Often times external tools such as calenders, diaries, notebooks, and wristwatch alarms may be necessary to help work around severe memory problems. Much of Cognitive Rehabilitation is about dealing with problems in new ways.

According to the BIAA, the real issue is that insurance companies don’t want to have to pay for long-term treatment, which is exactly what many brain injury patients need. From the paper: “Support for cognitive rehabilitation must extend beyond hospitalization and the immediate post-hospitalization period. Cost-effective care and support must be developed for persons with brain injury and their families who have longer-term needs.”

Sources:

http://news.medill.northwestern.edu/washington/news.aspx?id=83253

http://en.wikipedia.org/wiki/Rehabilitation_(neuropsychology)

Cognitive Rehabilitation: The Evidence, Funding and Case for Advocacy in Brain Injury, The Brain Injury Assocation of America, 2007