Excellent update to workers’ compensation TBI guidelines in New York
By Conor Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.
The New York State Workers’ Compensation Board has created new guidelines for Traumatic Brain Injury (TBI) that come into effect on May 2, 2022, according to an article submitted by the law firm Goldberg Segalla to JDSupra. The guidelines document, which includes mTBI (concussion), comprises 38 pages of recommendations, followed by 557 pages of evidence tables. While some areas could be updated to reflect a more current and nuanced understanding of brain injury, the guidelines include all best-practice treatment modalities and emphasize the case-by-case, highly patient-specific nature of the injury. While specific to New York State, it may be that this document will positively influence how TBI is handled by workers’ compensation and the legal system on a broader scale.
Critically, the guidelines specifically state that return to work constitutes “any work or duty that the patient is able to perform safely. It may not be the patient’s regular work.” TBI patients should not be asked to do any work that puts them at risk for a subsequent injury while still recovering, which is what the guidelines address with this stipulation about “not the patient’s regular work.
The diagnostic recommendations are comprehensive. Along with medical history and physical examination, imaging studies, and some diagnostic screens, the guidelines include neuropsychological and neurocognitive assessment, vision testing (including oculomotor testing for vision dysfunction), vestibular and audiological testing, and swallowing testing.
The guidelines section on rehabilitation is also fairly comprehensive. It includes occupational therapy, physical therapy, aerobic exercise, manipulation for chronic cervicogenic headache pain, aquatic therapy, biofeedback (for post-traumatic headache), vestibular rehabilitation, visual/ocular training, oculomotor training, neurocognitive behavioral therapies, memory rehabilitation, and acupuncture. The guidelines also include behavioral programs and an extensive section on medications.
These guidelines represent a significant step forward in recognizing the diverse and highly individualized needs of TBI patients and will hopefully contribute to a higher standard of care for workers in New York.