Transcription
RULE 17 EXHIBIT 10Traumatic Brain InjuryMedical Treatment GuidelinesRevised: November 26, 2012Effective: January 14, 2013Revised: September 29, 2005Effective: January 1, 2006Revised: January 8, 1998Effective: March 15, 1998Revised: March 1, 2005Effective: May 1, 2005Presented by:State of ColoradoDepartment of Labor and EmploymentDIVISION OF WORKERS’ COMPENSATION
TABLE OF CONTENTSSECTIONDESCRIPTIONPAGEA.INTRODUCTION . 1B.GENERAL GUIDELINE PRINCIPLES . 21.2.3.4.5.6.7.8.9.10.11.12.C.APPLICATION OF GUIDELINES. 2EDUCATION . 2TREATMENT PARAMETER DURATION. 2ACTIVE INTERVENTIONS. 2ACTIVE THERAPEUTIC EXERCISE PROGRAM . 2POSITIVE PATIENT RESPONSE. 2RE-EVALUATE TREATMENT EVERY THREE TO FOUR WEEKS. 2SURGICAL INTERVENTIONS. 3RETURN TO WORK:. 3DELAYED RECOVERY . 3GUIDELINE RECOMMENDATIONS AND INCLUSION OF MEDICAL EVIDENCE. 3POST MAXIMUM MEDICAL IMPROVEMENT (MMI) CARE . 4INTRODUCTION TO TRAUMATIC BRAIN INJURY AND PHILOSOPHY OF CARE. 51.2.3.4.5.6.7.8.9.DEFINITIONS AND DIAGNOSIS OF TRAUMATIC BRAIN INJURY . 5a.Mild TBI (MTBI). 5b.Moderate/Severe TBI . 5c.Other Terminology . 6INTERVENTION. 6EDUCATION . 6RETURN TO WORK . 7DISABILITY. 7COURSE OF RECOVERY . 8a.MTBI. 8b.Moderate/Severe TBI . 8GUARDIANSHIP AND CONSERVATORSHIP . 8SYSTEMS OF CARE. 9a.Acute Care. 10b.Comprehensive Integrated Inpatient Rehabilitation Hospital or “AcuteRehabilitation”: . 11c.Long-Term Acute Care (LTAC) Programs. 11d.Sub-Acute Skilled Nursing Facility (SNF) Rehabilitation Programs. 11e.Post-Acute Rehabilitation . 12f.Long-Term Support Care . 12INTERDISCIPLINARY TREATMENT TEAM . 12a.Behavioral Psychologist . 13b.Behavioral Analyst . 13c.Case Manager . 13d.Chiropractor . 13e.Clinical Pharmacist . 14f.Clinical Psychologist . 14g.Driver Rehabilitation Specialist . 14h.Independent Life Skills Trainer . 14i.Music Therapist. 14j.Neurologist . 14k.Neuro-ophthalmologist . 14l.Neuro-otologist . 14m.Neuropsychologist . 14
10.D.INITIAL DIAGNOSTIC PROCEDURES. 191.2.3.4.5.6.7.E.Neuroscience Nurse. 14n.o.Neurosurgeon (Neurological Surgeon) . 14p.Nurse. 15q.Occupational Therapist . 15r.Occupational Medicine Physician . 15s.Optometrist . 15t.Ophthalmologist . 15u.Otolaryngologist . 15v.Physical Therapist. 15w.Physiatrist . 15x.Psychiatrist/Neuropsychiatrist . 15y.Rehabilitation Counselor . 15z.Rehabilitation Nurse. 16aa.Social Worker . 16bb.Speech-Language Pathologist . 16cc.Therapeutic Recreation Specialist . 16PREVENTION . 16a.Primary Prevention . 16b.Secondary Prevention . 17c.Tertiary Prevention. 18HISTORY OF INJURY. 19a.Identification Data . 19b.Precipitating Event . 19c.Neurological History . 19d.Review of Medical Records . 20e.Medical/Health History . 20f.Activities of Daily Living (ADLs): . 20g.Family History . 21h.Social History. 21i.Review of Systems . 21j.Pain Diagnosis . 21k.Psychiatric History . 21PHYSICAL EXAMINATION . 21NEUROLOGICAL EXAMINATION . 21INITIAL NEUROPSYCHOLOGICAL ASSESSMENT . 22a.Initial Neuropsychological Assessment – MTBI. 22b.Initial Neuropsychological Assessment – Moderate/Severe Traumatic Brain Injury. 23c.Post-Acute Testing. 24INITIAL IMAGING PROCEDURES . 25a.Skull X-Rays . 25b.Computed Axial Tomography (CT) . 25c.Magnetic Resonance Imaging (MRI) . 26VASCULAR IMAGING TESTS. 26a.CT Angiography (CTA):. 26b.Arteriography . 27c.Venography . 27d.Noninvasive Vascular Assessment (NIVA) . 27e.Magnetic Resonance Angiography (Magnetic Resonance Arteriography(MRA)/Magnetic Resonance Venography (MVA)). 27f.Brain Acoustic Monitor . 27LUMBAR PUNCTURE . 27FOLLOW-UP DIAGNOSTIC PROCEDURES. 28
1.2.3.4.5.6.7.8.9.10.11.12.F.ACUTE THERAPEUTIC PROCEDURES – NONOPERATIVE . 461.2.3.4.5.6.7.G.IMAGING . 28a.Structural Imaging . 28b.Dynamic Imaging . 28ADVANCED MRI TECHNIQUES . 29a.Magnetic Resonance (MR) Spectroscopy. 29b.Functional MRI (fMRI) . 29c.Diffusion Tensor Imaging, Susceptibility—Weighted Imaging and MagneticTransfer Imaging. 30NEUROPSYCHOLOGICAL ASSESSMENT. 30a.Mild Traumatic Brain Injury. 30b.Moderate/Severe TBI . 31PERSONALITY/PSYCHOLOGICAL/PSYCHOSOCIAL EVALUATIONS . 31a.Qualifications . 32b.Indications . 32c.Clinical Evaluation. 32ELECTROENCEPHALOGRAPHY . 34a.Electroencephalography (EEG) . 34b.Quantified Electroencephalography (QEEG) (Computerized EEG) . 35ELECTRODIAGNOSTIC STUDIES . 35a.EMG and Nerve Conduction Studies . 35b.Electroneuronography (EnoG). 35c.Dynamic Electromyographies . 35d.Evoked Potential Responses (EP). 35LABORATORY TESTING. 36NERVE BLOCKS – DIAGNOSTIC . 37VISION EVALUATION. 37a.Visual Field Testing. 38b.Ultrasonography. 38c.Fluorescein Angiography. 38d.Visual Perceptual Testing. 38e.Low Vision Evaluation . 38f.Electrodiagnostic Studies . 38g.Optical Coherence Tomography. 39OTOLOGY AND AUDIOMETRY . 39a.Audiometry . 39b.Tympanometry. 39c.Vestibular Function Tests. 39SWALLOWING EVALUATION. 41a.Clinical Assessment . 41b.Instrumental Evaluation. 41SPECIAL TESTS FOR RETURN-TO-WORK ASSESSMENT . 42a.Job Site Evaluations and Alterations . 43b.Functional Capacity Evaluation (FCE) . 44RESUSCITATION . 46INTRACRANIAL PRESSURE (ICP) AND CEREBRAL PERFUSION PRESSURE (CPP). 46HYPERVENTILATION. 46MEDICATIONS . 46HYPOTHERMIA . 47SURGERY . 47HYPERBARIC OXYGEN . 47NONOPERATIVE THERAPEUTIC PROCEDURES – INITIAL TREATMENT CONSIDERATIONS. 49
1.2.3.4.5.6.7.8.9.H.NONOPERATIVE THERAPEUTIC PROCEDURES – NEUROMEDICAL CONDITIONS INMODERATE/SEVERE BRAIN INJURY . 721.2.3.4.5.6.7.8.9.10.11.I.PATIENT/FAMILY/SUPPORT SYSTEM EDUCATION . 49a.MTBI. 49b.Moderate/Severe TBI . 49BEHAVIOR. 50COGNITION. 51a.MTBI. 52b.Moderate/Severe TBI . 52c.Computer-Based Treatment . 54d.Assistive Technology . 54PSYCHOLOGICAL/EDUCATIONAL INTERVENTIONS: . 54a.Acute Psychological/Educational Interventions in MTBI . 54b.Problem-Specific Referrals During the First Three Months Following MTBI. 55c.Referrals Three or More Months Post-MTBI . 55d.Functional Gains . 56PSYCHOLOGICAL INTERVENTIONS – MODERATE/SEVERE TBI. 56a.Acutely Symptomatic Phase. 56b.Early Recovery Phase. 56c.Stabilization Phase . 57d.Consultation in Regard to Usage of Medications . 57MEDICATION/PHARMACOLOGICAL REHABILITATION . 57a.Affective Disorders Medications . 59b.Behavior/ Aggression Medications. 60c.Cognitive Enhancers . 60HEADACHE: . 67a.Headache Treatment Algorithm. 69b.Botulinum Injections: . 70THERAPEUTIC EXERCISE . 70DISTURBANCES OF SLEEP: . 70NEUROLOGICAL COMPLICATIONS . 72POST-TRAUMATIC SEIZURES/POST-TRAUMATIC EPILEPSY (PTE). 72CARDIOPULMONARY COMPLICATIONS . 72a.Cardiac System. 72b.Pulmonary System . 72SLEEP COMPLICATIONS. 73MUSCULOSKELETAL COMPLICATIONS . 73a.Long-Bone Fractures . 73b.Heterotopic Ossification (HO) . 73GASTROINTESTINAL COMPLICATIONS . 74GENITOURINARY COMPLICATIONS. 74NEUROENDOCRINE COMPLICATIONS . 74FLUID AND ELECTROLYTE COMPLICATIONS . 74IMMOBILIZATION AND DISUSE COMPLICATIONS . 75VASCULAR COMPLICATIONS . 75NONOPERATIVE THERAPEUTIC PROCEDURES – REHABILITATION . 761.INTERDISCIPLINARY REHABILITATION PROGRAMS . 76a.Behavioral Programs. 78b.Comprehensive Integrated Inpatient Interdisciplinary Rehabilitation Programs. 78c.Home and Community-Based Rehabilitation . 79d.Nursing Care Facilities . 80e.Occupational Rehabilitation. 80f.Opioid/Chemical Treatment Programs. 80g.Outpatient Rehabilitation Services. 80
2.3.4.5.6.7.8.J.NONOPERATIVE THERAPEUTIC PROCEDURES – VISION, SPEECH, SWALLOWING,BALANCE, & HEARING. 921.2.3.4.K.Residential Rehabilitation . 81h.i.Supported Living Programs (SLP) or Long-Term Care Residential Services . 81ACTIVITES OF DAILY LIVING (ADLS) . 82a.Basic ADLs . 82b.Instrumental ADLs (IADLs). 82MOBILITY . 83a.Therapy . 83b.Adaptive Devices . 84ATAXIA . 85NEUROMUSCULAR RE-EDUCATION . 86a.Motor Control . 86b.Motor Learning. 86WORK CONDITIONING . 87WORK SIMULATION. 87MUSCLE TONE AND JOINT RESTRICTION MANAGEMENT, INCLUDING SPASTICITY. 87a.Orthotics and Casting. 88b.Postural Control . 88c.Functional and Therapeutic Activities . 88d.Therapeutic Nerve and Motor Point Blocks. 88e.Botulinum Toxin (Botox) Injections . 88f.Pharmaceutical Agents . 89g.Intrathecal Baclofen Drug Delivery . 90VISUAL TREATMENT . 92a.Visual Acuity and Visual Field Function . 92b.Disorders Involving Ocular Motor Control and Ocular Alignment: . 93c.Visual Perception . 93d.Visual Inattention . 93e.Total Time Frames for all Vision Therapy (Orthoptic Therapy) . 94NEURO-OTOLOGIC TREATMENTS . 94a.Treatment of Fixed Lesions . 94b.Treatment of Recurrent, Non-Progressive Otologic Disorders. 95c.Treatment of Progressive Otologic Disorders. 95d.In-Office Treatment Procedures . 96e.Tympanostomy . 96f.Vestibular Rehabilitation. 96SWALLOWING IMPAIRMENTS (DYSPHAGIA) . 99a.Compensatory Treatment. 100b.Therapy Techniques . 100COMMUNICATION . 101a.Motor Speech Disorders. 101b.Voice Disorders. 101c.Language Disorders. 101d.Cognitive-Communicative Disorders. 101NONOPERATIVE THERAPEUTIC PROCEDURES – RETURN TO WORK, DRIVING, & OTHER. 1051.2.DRIVING . 105RETURN TO WORK . 106a.Return to Work – MTBI. 106b.Return to Work – Moderate/Severe TBI. 108c.The Following Should be Considered when Attempting to Return an InjuredWorker with Moderate/Severe TBI to Work. 108
3.4.5.L.OPERATIVE THERAPEUTIC PROCEDURES. 1111.2.3.4.5.6.7.8.9.10.11.12.13.M.VOCATIONAL REHABILITATION. 109COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) . 109OTHER TREATMENTS . 110a.Hyperbaric Oxygen . 110b.Deep Thalamic Stimulation.
RULE 17 EXHIBIT 10 Traumatic Brain Injury Medical Treatment Guidelines Revised: November 26, 2012 Effective: January 14, 2013 Revised: September 29, 2005 Effective: January 1, 2006
