Deep Dive into TBI Treatment: Medications, Symptoms, and Recovery Part 2

0:00:01 - Kiley Como
Hey everybody, welcome back to another episode of Mind Matters: Navigating Head Injuries and Concussions. This is part two of our deep dive into TBI. Again we're here with our friend and senior attorney in our head injury and concussion group, John Mobley. John, thanks again for being here. Let's dive back in to pick up our discussion where we left off, where we're talking about traumatic brain injuries. You went over some medications, some emergency procedures. Let's talk about kind of the long haul now. You've been in the emergency room, you've kind of gotten stabilized. Now you're back into living life. Let's go to rehab. Let's talk about that.

0:00:52 - John Mobley
Absolutely, Kiley. Thank you for that introduction. And just to update and remind the viewers, in part one, really our goal was to address what our TBI clients and victims do once they receive that diagnosis. So this is post-diagnosis life. So we went over some of the medications, some of the emergency care.

Really the longest portion of this treatment is going to be the rehabilitation and some of those various therapies. You know these therapies can help people with TBIs recover you know functions, relearn essential skills, find new ways to do things, to take you know their new health status into a full account. And rehabilitation can include all kinds of different kinds of therapy for you know emotional, cognitive difficulties, physical difficulties and for any sort of variety of just activities you and I would consider normal daily activities, right? That can be taking care of yourself, taking care of your home, keeping a clean home, driving, interacting with your spouse, your family members and others. All these things are changed in a dramatic way post-brain injury. So depending on the severity of that injury, you know those treatments that may be needed can vary in terms of how long the therapy lasts and how much of it you need. Really, the therapy for serious cases really begins in the hospital.
They're going to bring in someone immediately to begin the process, especially if it's a massive brain injury, severe, moderate, anything like that, you're likely going to need someone to help with walking, speech therapy, basic therapy, balance therapy right there at the hospital, just to even be functional enough to leave the hospital safely. Another thing that rehabilitation generally involves is, you know, a number of healthcare specialists are involved. Family, friends and a neurologist typically will manage and oversee this team and kind of be the quarterback of the case, we like to say. So they'll monitor if you need vestibular treatment.

You know, if you have a vestibular injury, you may not be able to maintain balance. You might be a fall risk. And you think, well, what's the big deal about that? Well, it's a huge deal. You know, especially if you're older, a fall can be the beginning of the end for some older people. You know, if you fall and break a hip, you think so, a fall risk. When, when we have clients that receive that label and then we ask these insurance companies for hundreds of thousands to, you know, sometimes millions of dollars in our settlement demands, it's because, you know, a fall risk, being dizzy for the rest of your life and and having a vestibular dysfunction.

It can involve huge, huge care in the future and financial stress and needing, you know, an in-home nurse, needing, you know, all these things that people don't think about that they're now gonna need when these injuries and the brain doesn't heal. These are all therapies that cost a lot of money. And insurance, you know, if you have, or are lucky to have, good enough insurance, it's great that it helps cover that. But, as anyone who has paid an insurance bill that has health insurance knows, there's usually stuff you have to pay for out of pocket. There's deductibles.

So you know, should our victims be responsible for this or should the, you know, defendant and the insurance company? So that's why we push so hard for big recoveries on some of these cases.

In terms of what rehabilitation therapy may include, just specifically, physical therapy, you know. So we sometimes have to build up the physical strength, the balance and the flexibility of these clients that have brain injuries so that they actually have the proper either range of motion or actual muscle stability to move. You know, if you have an issue with balance and constantly falling, you know, sometimes, and a lot of times, you have orthopedic injuries to boot. You know, problems with your knees or your neck or your back, and you're dizzy. It's just a fall risk waiting to happen. So if we can kind of knock out stuff one by one and strengthen the knees that were maybe injured in the accident, or the shoulder, then it maybe prevents you, when you're dizzy with a brain injury, from dropping things or tripping over your feet and injuring yourself more.

Occupational therapy, on the other hand, is a way for our brain injury clients to learn or relearn how to perform daily tasks such as getting dressed, cooking, bathing. So while physical therapy is strengthening, occupational therapy is, it teaches you how to interact with the world again and around you. And that can be, you know, if you don't have range of motion or having trouble, you know, brushing your teeth teeth, maybe it's getting a longer toothbrush. Sometimes it's, it's things as simple as that. It sounds silly, but when you can't raise your shoulder, your arm high enough due to a shoulder injury, sometimes that's the difference between being able to complete a task or not.

So occupational therapists do an incredible job for our clients that are severely injured with brain injuries. If you were to injure the part of your brain that controls speech, you are going to potentially slur words, have the inability to find words, and a lot of times I have clients in our representation of those who have, you know, mild to moderate to severe brain injuries that say I literally know the word, I know the word I'm trying to say and it can't come out. You know, in some of the saddest cases we have clients where you know it's like the kids, their kids are completing their sentences or get spouses are getting frustrated like just just spit it out, spit it out, and they can't. It's, it's, it's heartbreaking. So one of the things that we try and get our clients to encourage them to do, if the doctors recommended it, is speech therapy. So that includes, you know, trying to improve the ability to form words, speak aloud, communicate properly and including, you know, instructions on any kind of
special communication devices or issues with swallowing, which can also affect speech as well. Because if you think about it, you know, especially if you work any job, communication is key. Sales, just interacting with people. If you can't communicate, then it really impacts your ability to do your job, make money, maintain employment or get those promotions that maybe you were on the track to get previously. So all important things.

Another type of therapy we see is psychological counseling. Just generally that can be, you know, learning to cope with your new condition. A lot of times these severe brain injury cases involve pretty scary impacts where you wouldn't recognize the car if we showed you the pictures. It's just twisted metal or maybe they were pulled out with the jaws of life. All that is super traumatic, right? So we have clients sometimes that either are afraid to get in the car, afraid to drive, or every time they do get in the car they're just constantly looking at that rear view mirror waiting to get hit again. It takes a huge toll on people when just going to the store to pick up a gallon of milk is now a traumatic experience. So these therapists and PTSD specialists do just life-changing work to give these people that are now afflicted with PTSD the proper skills to leave the door in the morning. You know you go out the front door of your house and face the world, because it can be that difficult for people with PTSD.

Another type of therapy that we see is vocational counseling, and that helps a patient and TBI victim actually return to work in the community by assessing their injuries and symptoms and saying, look, here's what you can probably do now. You may not be able to, if you were a roofer or a carpenter and you have balance issues, you can't be a roofer anymore. It's going to be, it's going to be too high to insure, you're going to be a risk to falling off that roof and dying.

So a vocational expert will actually look at what your symptoms are, what your now new permanent neurological deficits are, and they'll say, look, you had this skill, this skill, this skill. Why don't you try this instead? You know, maybe you can't be a roofer, but you could use some of those skills to be a carpenter doing, you know, not elevated, high risk work. When you now have balance and dizziness and vision issues due to your brain injury, let's keep you closer to the ground, but you can still do these things here. So it's really important so that someone can continue to pay those bills, pay the family and take care of the family with a new job.

So these are all just interesting things that really help people get their lives back. The last one would be cognitive therapy, and that is more intense therapy that helps improve memory, attention, learning. When you have a real severe injury, they help with the actual cognitive aspect of that.

0:09:35 - Kiley Como
It truly takes an army to take care of some of these folks. It sounds kind of similar to a stroke, right? Somebody who's had a stroke. So that's an obviously long and drawn out process. And I often think of the family and friends you mentioned up front that I think their jobs in all this is to encourage our clients to take hold of these resources that are going to be available, that they're going to need, right? So cognitive therapy. That is a fascinating area of work. It gets super complicated, very deep. Can you dive into that a little bit more?

0:10:06 - John Mobley
Sure. So just some of the specifics that a brain injury victim may address with a cognitive therapist is verbal fluency games, tasks and tools. They may prescribe you something as common as relaxation and actually scheduling time in your day to relax. Letting your brain battery recharge is how I've seen it explained by neurologists at, you know, some brain injury conferences, where it's like, look, your battery just isn't operating at 100 percent anymore, so if you do not take time to take care of yourself, your life is going to be a lot harder. You need to break up your day with smaller breaks, and that can include-- we previously spoke about the vocational rehab therapist. That can include, like, them sometimes giving a plan to present to your boss too. I've had clients say I'll work longer hours, but allow me to schedule in breaks during the day, right, because that's what my brain is going to need to be high functioning now and to do the same job that I did before. Cognitive therapy can also, you know,
include things like brain games, mnemonics, so sometimes it's actually your brain is viewed as these therapists as like a muscle and you have to exercise it and bring it back.

So you know we're thinking like Sudokus and brain games like that that actually work out your brain and get it firing on all cylinders. Again, we see these prescribed all the time across the board from various different neurologists saying like look, it's important that you focus on relaxation, your brain and concentration games, so that you can get some of that cognitive battery power back, which is crucial.

And when we're talking about the cost of this stuff, it's not cheap. It can be $500 to $1,500 per session and you can have 24 to 48 sessions on more serious brain injuries, sometimes less, and sometimes it just goes on and on and on. So when we have permanent injuries with these brain injury victims, we have to sometimes use life care planners to be like look, what is this gonna look like on an annual basis until this person lives, until the national estimated death age of 79.4 years, because they may need it every single year just to be baseline, normal. Scary thought. And it's expensive. And that's why these cases we take so seriously and ask for so much money, because if indeed the symptoms are permanent, then it's something this person now has to deal with for their entire life.

0:12:39 - Kiley Como
A grim but hopeful picture you paint there, right, there's a lot to it. I know a lot of times we see in clients that we have that are dealing with something so deep and potentially long standing as this, is that treatment fatigue right? It's so important to stay focused on your treatment. You mentioned it's like a muscle, right? When you build those muscles you're building new fiber, the brain's kind of similar, right? If you've got a damaged area of the brain you have to allow that to build new neural pathways almost sometimes. So sticking with it, not giving up, not getting tired of the treatment big part of that key. Is that not right?

0:13:15 - John Mobley
You really hit it right there, Kiley. And the thing is is that treatment fatigue is such a serious issue on these cases, and treatment compliance is another issue, because sometimes we have brain injury victims that forget appointments, they can't organize their calendar, they have trouble complying with the treatment, they miss three, four, five appointments just because they can't keep up with all or they seem overwhelmed. So it is truly a delicate balance and it's so helpful to have and I know we've discussed this prior numerous times on other podcasts, but it's important to have that support structure of family members. You know, fellow churchgoers, neighbors, co-workers, anyone who's willing to pitch in to help to allow these brain injury victims to succeed is absolutely crucial.

You know, in terms of some of just the one-off treatments that we see used and utilized by our brain injury victims is, we will sometimes see things like meditation, mindfulness, yoga, massage, reading, believe it or not. Alot of times we'll see, please limit your screen time, and that's a scary thought for anyone in this day and age you know, as we're now, all on our phones or computers all day, every day, and everyone's got a cell phone addiction, seemingly it's,it can be a hard pill to swallow, but one of the things that they'll recommend, both to relax the brain, allow that battery to recharge and if you have visual disturbances and visual issues from your brain injury, screens are not a good thing you know. So they'll say why don't you try alternative activities like reading, the yoga I mentioned.

0:14:47 - Kiley Como
Reading a real book.

0:14:48 - John Mobley
Yeah, a real book not the e-reader, I'm sorry. You got to, the Kindle has got to go back in the cabinet. You got to crack open the old book and that is these alternative you know activities are ways that you can not stress your brain further. You know, in terms of some of the other things that are used sometimes I mentioned trouble keeping up and organizing and remembering appointments. We'll see where some of our more successful brain injury clients will use like a calendar, even carry small notebooks with pen and paper, really to kind of avoid multitasking. You really need to learn how to write stuff down and log it somewhere, because your brain may not be able to do that for you anymore. So these are important things.

We've also seen our neurologists recommend rose tinted glasses and what that can do is filter certain light in wavelengths to prevent issues with whatever the brain injury is. If they have visual disturbances, it helps with that. And one of the big things is if you are hit so hard that you develop something called tinnitus, tinnitus, which is a fancy word for just the worst ringing in the ears you've ever had and this, unfortunately, we see sometimes that these tinnitus cases yield million dollar plus verdicts and you're thinking how, how would, why would any jury award a million plus dollars for ringing in the ear? Well, until you've had it, you know, you don't know and and and the level of impact, um, and what we have, what we, the feedback we've gotten from some of our clients, is look, I lay down to bed, it's completely silent and all I hear is the sound of cicadas in my ear.

Imagine, you know, noise warfare when you're trying to relax in your ear and it's just, you can't relax. You never have a moment of silence, a moment of peace. That's why jurors, once they hear the impact, you, you see these million-dollar plus verdicts because they have essentially, we're not-- people with tinnitus end up developing depression. They have social withdrawal because they can't, even if they're at a bar or a restaurant, they can't hear conversation because it messes up how you hear certain noise and process conversation. It's like a social death sentence, unfortunately in the most severe cases.

The medical device that is used to help that is called a tinnitus masker and it's basically a device that can help with that sound that causes so much grief for these people with this very, very unfortunate diagnosis. Another thing can be white noise machines, fans, listening to soft background music. It's like I said, this is life changing stuff and now this is just your life. So what does that mean? You got to travel with a fan whenever you want to go out of town somewhere. You have to drag music or have it present somewhere where you can receive some sort of peace instead of hearing that either that cicada sound or that underwater pressure sound that people with tinnitus have. Some huge impacts on life.

Another treatment that is a little newer and a lot of people don't realize is actually Botox injections, because Bot-- you know, we think it keeps us looking young and beautiful, well beyond our years but it actually has medical purposes too, and one of those is that it inhibits, you know, local neural, neurologic, neurologic inflammation, and it can inhibit some of these symptoms and relieve and improve sharp and shooting pains for people with neck and brain injuries. The studies are very promising, shows up to 88% of sufferers experience actual relief from these, so it's a true medical benefit. Now, if there's any leftover, you can always negotiate with your medical professional if they can put it in your face and make you look younger, but we don't know about that. So the cost for these Botox injections, of course, is going to sometimes be outside of insurance, and it can be $2,000 to $8,000 per treatment, and we see them done in huge series. So tens of thousands, tens of thousands of dollars over and over again. Especially if they provide relief, they may do a series of them.

So once again just goes to show. This is why lawyers like us ask for so much money on these brain injury cases because everything is very expensive and only getting more expensive. In this day and age, where the cost of goods is rising, well, medical goods rise with those costs too. They don't stay stagnant. So when we're doing life care plans, we have to project out not only the cost of goods, medical treatment today and medical medicine today but also what it's going to be in the future. Some other sorts of treatment that our clients receive is you know things like vitamins, riboflavin. These can help reduce issues with headaches as well as some symptoms from brain injury. We also see magnesium being used pretty heavily. It just does a lot of things for stimulating blood flow and it's great for sleep and sleep health. So big thing now a lot of people are taking magnesium for that, same goes for brain injury victims.

So, as you can see it's it's a lot of stuff, Kiley, and we've gotten through pretty much all of it, but it just goes to show exactly how much is at stake in what is being prescribed to these brain injury victims. And we met someone with a mild to moderate brain injury may see all of these that we've gone through recommended for 90 percent or 80 percent, but still it's a tremendous amount of treatment. It requires support from family and friends to get to this treatment and keep them complying with it and going to the appointments and reminding them that they have an appointment, helping them drive to the appointment if they can't drive themselves. So, like you mentioned, it takes a village it really does for successful brain injury rehabilitation and it's very expensive. And it remains very expensive into the future for these, for these injury victims, and that's where we come into play to help get them the recovery that they deserve, to even attempt to make them whole again.

0:21:13 - Kiley Como
John, that is amazing. What a deep well of information you are, man, and so glad that we have advocates like you out there that can help our clients not only understand, as we're doing in this podcast, but, as you're saying, to do the work with them, walk through the process with them and get them, you know, get them better and give them the compensation that they deserve. So, thank you, John, appreciate it. Alright everybody, that's going to do it for another episode of Mind Matters: Navigating Head Injuries and Concussions. Again, thank you, John Mobley, for joining us and sharing your knowledge with us. Everybody, if you wouldn't mind hitting that like and subscribe button, and always remember that if you're in pain, call Shane at 980-999-9999.