Conceptualization of brain injury as sickness rather than disease in early 1900's.
Treatment followed a medical model with professionals dictating treatment for acute
rehabilitation. Post-acute programs began to develop and pushed to differentiate
this care from acute care. Post-acute rehab was non-hospital based treatment with
an interdependent model of care. Individuals were no longer referred to as patients
but called clients. Care was provided by non-professionals under the direction of a
team of professional consultants. The individual and his/her family were considered
team members. Post- acute rehab separated itself from the medical model. The
science was not strong - outcomes were not adequately tracked, therapies were not
evidence-based. Funding sources did not consider care to be beneficial and
therefore did not cover costs.
TBI was seen as an "event" - a final outcome to an
insult in an isolated body system. Once it was fixed, there would be no other effect
on the body.(Association, 2009)
The Brain Injury Association published a position paper in March 2009.
The purpose of this paper was to encourage the classification of a TBI not as an event, not as the final outcome, but rather as the beginning of a disease process. The paper presents the scientific data supporting the fact that neither an acute TBI nor a chronic TBI is a static process--that a TBI impacts multiple organ systems, is disease causative and disease accelerative, and as such, should be paid for and managed on a par with other diseases.(Association, 2009)
Poor outcomes after TBI result from shortened length of stays in both inpatient and
outpatient medical treatment settings. Payers point to a lack of sufficient evidence-
based research as a primary reason for coverage denial of medically-necessary
treatment. This occurs particularly when behavioral health services and cognitive
rehabilitation are needed.(America, 2011)