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A Collection of Medical & Legal Information About Brain Injury

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Things You Must Know While in the Hospital for TBI

Immediate application for disability:

In some hospitals, the patient's advocate will help the family apply for SSI and/or SSD for you, knowing that the hospital will be paid quicker if the application is done immediately. However, most hospitals will no longer help the family do this. It needs to be done immediately if there are serious symptoms. Please see how to make such applications on our website under the title "Important Information > Social Security Disability Benefits."

Step down treatment:

Sadly, the quality of a patient's insurance, will often determine how long they will be kep in the hospital following a serious TBI. Your job as a family member is to maximize the rehabilitation available to the patient. If your loved one is unresponsive but not diagnosed as "brain dead" (see more below) then there will come a time when subacute treatment needs to be considered. This is where possible differences over the real Rancho scale come into play. The hospital will also make the determination as to whether or not it appears there has been any noticeable recovery on the part of the patient. Again, that is capable of being distorted as well. If there is any question of that, the family needs to contact a rehabilitation facility, who will send out an expert to do an assessment on the patient for free. Some of these include:

NeuroRestorative - locations across the United States. 1-800-743-6802 Shepherd Center - (located in Atlanta, GA but world renown) 1-800 743-7437 or 404-350-7345 Kessler Institute for Rehabilitation - (located throughout New Jersey) 973-243-6950 CNS Center for Neuro Skills - (locations throughout California) 1-800-922-4994

Unfortunately, hospital staffs do not always put a lot of trust in the observations of friends or family members regarding the patient's capabilities. This is because they are hopeful and wanting to see improvement at all costs. An example would be occasional observations of eye tracking towards where a loud sound in the room might be, which may or may not be random. However, bringing in someone for an examination can cut through all of these problems.

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Brain Death/End of Life Decisions:

In cases of severe life threatening TBI and coma, the issue will inevitably arise as to whether or not the patient can ever recover and lead a meaningful life. If a Glasgow Coma Scale is 3 or 4 or the Ranchos is Level I or II, these discussions will necessarily need to take place.

In many states, a finding of "brain death" must necessarily rely upon the results of an EEG, which detects the electrical signals given off by the brain. If there is little or no "signal" then the neurologist will make a determination of brain death.

There is a difference between a coma and brain death. In a coma, the brain stem responses such as breathing, can be either present or absent. If they are absent, the patient will be on a ventilator. Therefore, "brain death" is really a patient who is no longer able to live without the intervention of mechanical help. It is an irreversible end of all activities both in the brain and the brain stem.

With coma on the other hand, we have a patient who is alive, but their eyes may be closed and they cannot be aroused. However, they are breathing on their own and have some purposeful motor responses. These individuals will progress to brain death, recover a level of consciousness, or evolve into a vegetative state.

"Vegetative state" is when individuals are alive but have severely impaired consciousness. Their eyes may open spontaneously, but there is no awareness of the environment. They do not track objects which are presented to them and they do not speak.

Another term, called "minimally conscious state", involves a patient who is alive, but has a severely depressed level of consciousness, with only inconsistent behaviors suggesting awareness. They may occasionally track with their eyes or even speak, but then lapse into a lower state of consciousness.

If there are any questions about the above, contact the family lawyer or feel free to call us on our toll-free 800 number.

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