Maximizing Function & Return to Work Explored at 20th Annual Workers’ Compensation Insurance ExecuSummit

Hartford, CT (WorkersCompensation.com) -- The 20th Annual Workers' Compensation Insurance ExecuSummit in Hartford, CT, featured a session on interdisciplinary strategies for optimizing function and facilitating a return to work. Jerrold L. Kaplan, M.D. was the distinguished speaker; he is the Medical Director of Outpatient & Workers Compensation Services at Gaylord Specialty Healthcare, Assistant Clinical Professor at Yale Medical School, and Assistant Clinical Professor at UCONN Medical School. Dr. Kaplan delved into the complexities of spinal cord injuries (SCI) and traumatic brain injuries (TBI).

Dr. Kaplan had four primary objectives in his presentation. Firstly, he aimed to provide a comprehensive understanding of the demographics, mechanisms of injuries, and the critical role of interdisciplinary treatment in Spinal Cord Injury (SCI) and Traumatic Brain Injury (TBI) cases. Secondly, Dr. Kaplan discussed the cutting-edge rehabilitation technology available to enhance the lives of SCI and TBI patients. Thirdly, he addressed the pivotal question of when to utilize Work Conditioning versus Work Hardening to ensure the most effective approach to rehabilitation. Lastly, Dr. Kaplan illustrated the practical implementation of these strategies through a complex case study. He showcased how interdisciplinary approaches can maximize function and facilitate a triumphant return to work for individuals facing these challenging conditions.

Spinal Cord Injuries

Spinal cord injury is a critical concern in the United States, with an estimated 17,700 new injuries occurring each year. Currently, there are around 291,000 individuals living with spinal cord injuries. The demographic data from 2015 to 2022 reveals that the average age of those affected is 43, and 78% are men. The primary causes of injury include vehicular accidents (38.3%), falls (31.6%), violence (13.8%), sports-related incidents (8.2%), medical or surgical complications (4.6%), and others (3.5%). The distribution of injury levels shows that 47.2% have incomplete quadriplegia, 20.4% have incomplete paraplegia, 20.2% have complete paraplegia, 11.5% have complete quadriplegia, and 0.8% are classified as normal.

Timely treatment of spinal cord injuries resulting from trauma is crucial, requiring a range of medical interventions, neurological examinations, and surgical stabilization procedures if necessary. The continuum of care for patients includes long-term acute care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, home care, and outpatient therapy.

Rehabilitation is a comprehensive and coordinated approach that involves physiatric assessment, physical therapy, occupational therapy, speech therapy, psychology, nutrition, respiratory care, and other disciplines. The process aims to prevent and treat complications during recovery, such as respiratory problems, skin issues, spasticity, and pain. Overall, a systematic approach is necessary for a successful recovery.

Dr. Kaplan emphasized the importance of delivering consistent, optimistic, realistic messages to SCI patients. Providing education and empowerment to individuals regarding their diagnosis is crucial to their recovery journey.

Traumatic Brain Injuries

Traumatic Brain Injuries (TBI) are a significant concern and can result from falls (40.5%), motor vehicle accidents (14.3%), being struck by or against objects (15.5%), assaults (10.7%), or unknown/other factors (19%). The Glasgow Coma Scale is used to assess the severity of TBI, which categorizes injuries as mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS 3-8) based on the duration of the coma.

Traumatic Brain Injury (TBI) is a condition that can cause various impairments affecting cognition, physical function, and behavioral/emotional function. In addition, TBI can lead to complications such as dysphagia, malnutrition, skin breakdown, incontinence, endocrine dysfunction, seizures, and other injuries or processes. Therefore, following a comprehensive and interdisciplinary approach to TBI rehabilitation is crucial. Healthcare professionals, such as physiatrists, physical therapists, occupational therapists, speech therapists, and psychologists, work collaboratively to address these challenges. They design customized rehabilitation plans to target each TBI patient's specific impairments and complications, optimizing their function and quality of life.

Dr. Kaplan emphasized the importance of using specialized rehabilitation technology for patients suffering from spinal cord injuries (SCI) and traumatic brain injuries (TBI). Innovations like bionic exoskeleton technology, the ZeroG Gait & Balance System, the AlterG Anti-Gravity Treadmill, functional electrical stimulation (FES), KINESIQ, and the Bioness Integrated Therapy System (BITS) are crucial in improving patient outcomes.

Therapeutic recreation, adaptive sports, and adaptive equipment are essential in helping patients achieve success. Work conditioning and hardening programs prepare individuals for a successful return to work by tailoring the programs to the individual's job tasks, career aspirations, and employment goals. Rehabilitation professionals work closely with patients to set short and long-term objectives that align with their employment goals. These objectives encompass physical strength, cognitive function, and emotional well-being to ensure that patients are well-equipped to meet the demands of their jobs.

Concluding the session, Dr. Kaplan presented a case study about Eric, a young person who had to face various difficulties following a severe car accident. Eric, a firefighter at the time of the accident, managed to regain his strength and cognitive abilities by undergoing a comprehensive outpatient program, which included physical therapy, occupational therapy, and speech therapy. His successful return to work and normal activities highlighted the importance of interdisciplinary strategies and cutting-edge rehabilitation technology in maximizing function and promoting independence.

Dr. Kaplan's presentation provided valuable insights into the intricate world of SCI and TBI rehabilitation for healthcare professionals and stakeholders in workers' compensation insurance. He encouraged healthcare and insurance professionals to reconsider their approach to SCI and TBI rehabilitation and shift towards a positive transformation approach for those affected by these injuries. This paradigm shift would offer hope, support, and a brighter future for SCI and TBI patients on their recovery journey and their reintegration into the workforce.

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