The Steep Cost of Brain Injury Recovery

This article originally appeared on Next Avenue on December 28, 2015.

By Chandi Edmonds

Of course, you don’t have to be famous to get a brain injury. But the steep costs of recovery may hinder or prohibit the best outcomes for anyone with a traumatic brain injury who does not have the resources of celebrity patients.

The November news that the late Frank Gifford, a legend in football and sports broadcasting history, suffered from CTE (chronic traumatic encephalopathy) due to a legacy of concussions and brain injuries, helps many understand the issue.

But while Gifford managed a stellar career on and off the football field, many of the nation’s 1.7 million people who are estimated to sustain a traumatic brain injury annually are not nearly as fortunate. Families can be greatly affected by physical, financial and emotional stressors because of an injury.

Certainly increased media attention on head injuries and concussion in athletes participating in youth, college and professional sports has sparked new initiatives and research. And Concussion, the much-awaited movie starring Will Smith, adds to the public conversation about traumatic brain injury and its consequences.

But is it enough to have only an intermittent spotlight on this pervasive problem?

More Attention Is Needed

As a physical therapist, I see scores of patients during the rehabilitation phase. Many will succeed and be able to walk out of the hospital doors on their own. But many others have a permanent disability and find it difficult to feed or bathe themselves or even communicate.

For those who regain their physical and language capacity, life after injury can still be challenging. More than 5.3 million children and adults in the U.S. — including many older adults — live with a lifelong disability as a result.

As therapists and family promote the goal of quality of life, each diagnosis has variable factors that affect cognition, behavioral, emotional, social and occupational skills. While all people with brain injuries want to return to life as normal, it is impossible for so many of them. Remarkably, even with repeated head trauma, Gifford, who died Aug. 9 at 84, was still able to have a long career.

The opportunities are present for some NFL athletes to find a second career, such as sports broadcasting, after injury or retirement. But that is not possible for the typical person with a brain injury.

And of course, brain injuries can occur in any environment to anyone — from a child to an octogenarian who is hit by a car or falls at home.

The Costs

Research shows that a failure to achieve a self-perceived productive role in society after a brain injury comes at an economic cost to the injured, their families and society. The opposite is also true; those who return to work showed positive outcomes and self-reported satisfaction.

For the average adult with brain injury, the unemployment rate two years after diagnosis is 60 percent, compared to the national unemployment average of 5.1 percent. Complicating matters is the high cost of treatment. The lifetime costs of a patient’s treatment for a traumatic brain injury are estimated to run from $85,000 to $3 million.

Still, receiving appropriate care and support can minimize the cycle of unemployment, dependence on federal and state public programs, supplemental security income and even homelessness.  Estimates show that up to 53 percent of people who are homeless are affected with a brain injury.

A recent survey by the Kessler Foundation found that employers who hired people with disabilities such as brain injury had less job turnover and the same amount of absenteeism compared to non-disabled employees. Employers might consider it a great opportunity to hire those with disabilities and brain injuries to meet their employment needs.

Some May Get Help, Others Not

For veterans, the Wounded Warrior Project  estimates that 320,000 military personnel have been affected by a brain injury since 2001. According to the project, 33,149 veterans were diagnosed with a traumatic brain injury in 2011. The project offers resources for employers, provides information about injuries, reasonable employer accommodations and onboarding processes.

Comedian Tracy Morgan’s settlement payout from Walmart in a July 2014 lawsuit over a fatal crash last year that left him with a traumatic brain injury amplifies the financial effects felt by all such victims. But few are as lucky. Morgan settled last May with Walmart for an undisclosed sum.

With an estimated net worth of $18 million, Morgan presumably was never in financial peril following the crash that rendered him out of work for 16 months. His return earlier this year as host of Saturday Night Live earned him accolades and kickstarted his career, which had been on hold. His applauded appearance there was a reminder that recovery is possible.

Yet millions of other Americans who are not legendary athletes or celebrities also need assistance in their physical, fiscal and emotional recovery. It is time to focus on them as well.

- Chandi Edmonds is an assistant professor and director of clinical education in the Physical Therapy and Human Movement Science department at Northwestern University's Feinberg School of Medicine.