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Congresswoman’s recovery won’t be as simple as Lisbeth Salander’s

Consumer Reports News: January 14, 2011 10:44 AM

The Girl Who Kicked the Hornet's Nest—the third book in the Stieg Larsson trilogy, The Girl with the Dragon Tattoo—left many readers believing that you can survive a bullet wound to the head without any residual neurological damage.

According to the story, a small-caliber bullet entered Lisbeth Salander’s brain at the temple, and then stopped about 4 centimeters into the brain. In addition to bleeding, there were all sorts of bone fragments near the heroine’s entry wound and some were embedded in brain tissue. Her physical and cognitive recovery, subsequent to surgery, and near-immediate ability to go out and fight bad guys, was nothing short of, well, fictional.  

That depiction is pure rubbish, but it left the public with a glib impression of neurologic recovery, one that has been reflected in the media in the aftermath of the shooting of U.S. Rep. Gabrielle Giffords (D-Arizona). In real life, traumatic brain injury (TBI) patients have a long and arduous road to recovery.

It typically entails years of physical therapy, speech therapy, and occupational therapy, according to Gregory J. O'Shanick, M.D., chairman of the board of directors of the Brain Injury Association of America, who has seen plenty of penetrating head injuries. “Although we’ve come a long way from 1848 when a rod pierced the brain of Phineas Gage,  and the railroad worker became no-longer-Gage due to a severe personality change, even with 2011 resources, it is unrealistic to expect anyone to return entirely to baseline,”  O’Shanick says.

Although rehabilitation services can make a substantial difference, many current health-insurance policies impose severe limitations on the amount and duration of therapies. This adds insult to injury for families who try to advocate for their injured relatives and have to deal with insurance denials and treatment obstacles.

Fortunately, a new clause in the health-reform bill includes, under essential benefits, both rehabilitative and habilitative services and devices. Not only will that cover adults who have sustained brain injury and strokes, but also pediatric populations. “A lot of insurance  companies have skirted responsibility for children with such deficits by labeling them as developmental disabilities and punting the services to the school system,”  O’Shanick says. The new health-reform bill now provides a platform for future enforcement of these types of treatments. 

That’s good news for all of us, because studies show that with rehab, rapid improvement can occur in the first six months following an injury. Although the rate of recovery slows between 6 and 24 months, there is still often progress between 24 months and five years, O’Shanick says. Although we all pray for a happy ending much like Lisbeth’s, it’s near certain that Giffords will require a great deal of rehabilitation. Fortunately, for  the 1.1 million survivors of TBI each year, those services should be easier to get when health-reform changes take effect in 2014.

 Orly Avitzur, M.D., Consumer Reports medical adviser

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