Brain injury cognitive rehab not covered by many insurers

The Wall Street Journal on Monday examined how many brain injury patients who experience subsequent problems with memory, mental processing or behavior often do not receive cognitive rehabilitation because their health insurers do not cover the treatment.

According to the Journal, cognitive rehabilitation seeks to "reteach injured parts of the brain how to perform basic functions, like organizing the day or tuning out distractions," through the use of card games and computer programs, as well as memory aides, such as stickers, timers, notebooks and handheld recorders.

Preliminary studies indicate the effectiveness of cognitive rehabilitation, but research into the treatment remains limited because of a lack of funding by pharmaceutical companies.

A committee established by NIH in 1998 to evaluate cognitive rehabilitation concluded that the "evidence supports the use of certain cognitive and behavioral rehabilitation strategies" as part of a structured plan.

In addition, an analysis of 87 studies published in the Archives of Physical Medicine and Rehabilitation in 2006 found "substantial evidence to support cognitive rehabilitation for people with traumatic brain injury."

However, many health insurers maintain that research to support the effectiveness of cognitive rehabilitation remains insufficient.

In 2002, the BlueCross BlueShield Association Technology Evaluation Center said, "Available data are considered insufficient to make conclusions on whether cognitive rehabilitation results in beneficial health outcomes."

WellPoint covers cognitive rehabilitation for patients involved in accidents but not for those who experience strokes.

Thomas Watanabe, a professor of physical medicine and rehabilitation, said, "It's hard to demonstrate cognitive progress to the insurance company," adding, "If a patient starts out in a wheelchair and then starts walking with a cane, you can measure that progress" (Burton, Wall Street Journal, 1/8).