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Work Comp Today

Providing biopsychosocial care in a therapeutic community for those who need it most.

Traumatic Brain Injury: Reversing the Silent Epidemic in Workers’ Compensation

A TBI injury occurs every 9 seconds

According to the Centers for Disease Control and Prevention (CDC), traumatic brain injuries (TBIs) are the leading cause of death and disability for children and young adults in the U.S., with 50,000 dying every year.

TBIs are often referred to as a “silent epidemic” because they frequently go undetected on MRI and CT scans, and medical providers usually don’t have a baseline of comparison for assessing cognitive function, particularly for mild TBIs where symptoms tend to emerge later in the recovery process.

The Brain Injury Association of America states that someone in the U.S. suffers a TBI, which includes concussions, every 9 seconds. An estimated five million Americans are living with disability related to TBI, with an unknown number going undiagnosed every day.

“Brain injuries can be missed during medical evaluations because they may lack physical symptoms like bruising, bleeding, or swelling, and imaging often doesn’t reveal mild TBI,” said Dr. Crystal Cobos, Director of the Head Injury & Concussion Clinic at Institutes of Health (IOH).

“Evaluation often relies on the subjective reporting of patients who typically have reduced insight into their neurological symptoms,” says Cobos. “Because so many cases are undiagnosed and symptoms are frequently linked to other conditions, particularly behavioral changes, a ‘silent epidemic’ has emerged.”

Brain injuries can result in a wide range of physical and cognitive symptoms, including headache, blurry vision, dizziness, fatigue, nausea, and problems with focus, memory, and reasoning.

Symptoms of delayed recovery from TBI can include depression, anxiety, sleep disorders, fear avoidance, and emotional dysregulation.

“Delayed recovery occurs when a person continues to experience high levels of symptoms and disability after the anticipated healing time has passed,” stated Dr. Gabriel Dawson, SVP of Systems, Analytics, and Compliance at Institutes of Health (IOH).

“When significant levels of symptoms continue beyond three months, their condition is considered chronic,” he added. At that time, a biopsychosocial evaluation should be performed to understand best all the factors impeding their recovery.

In the context of an evidence-based, biopsychosocial model, the rehabilitation team aims to comprehend the patient’s experience with their injury and the medical assessment to guide interventions more effectively. TBI can impact a wide range of functions, so a transdisciplinary approach to biopsychosocial treatment is preferred. This approach facilitates improved communication and integration across disciplines, leading to more comprehensive care.

“It is challenging to address one specific deficit in isolation when the whole system is impacted,” said IOH Speech Language Pathologist Jemelie Koda.

“The patient’s overall experience has a larger impact on functioning than the diagnosis
alone,” she continued. “If you consider a patient with light sensitivity and vision changes, for example, it is challenging to meaningfully address other important goals, like reading comprehension, visual attention, or screen tolerance.”

The CDC reports that TBIs cost the U.S. roughly $37.8 billion every year, which includes $4.5 billion in hospital care and other services. TBIs also account for $20.6 billion in injury-related work loss and disability and $12.7 billion in lost income from premature death.

TBIs remain among the most challenging and expensive injuries to treat within the workers’ compensation system. However, with the right approach, these conditions can be significantly improved, and disability can be reversed. Early intervention and specialized treatment are vital to achieving the best results. Selecting specialty healthcare providers, visiting their facilities, and making well-informed referrals to enhance clinical outcomes is crucial.

“When evidence-based treatment of TBI is delayed or inaccessible, outcomes suffer, and long-term disability rises significantly. A shift in cultural understanding is required to prevent unnecessary suffering. We have effective programs and services to address the many factors that influence brain injury and related disability, and we need to apply them through an integrated approach tailored to each patient,” explains Dawson.

Using a biopsychosocial model, a transdisciplinary team of specialty care professionals can effectively treat the various functional areas affected by an individual’s TBI. This approach leads to the best clinical outcomes and reduces long-term healthcare costs and utilization.

Institutes of Health logo (hor)
About the Author
Joe Toppe Author

Joe Toppe

Syndicated Business Journalist

Joe Toppe

Joe Toppe is a syndicated business journalist who graduated from Kent State University’s School of Journalism and is a Senior Business Reporter for Capital.com out of London. He has written and been featured on Fox Business, MSN (US), MSN Money Canada, the New York Post, Yahoo Finance, Green Entrepreneur, Innovation & Tech Today, and many more.
Gabriel Dawson bio

Dr. Gabriel Dawson

SVP Systems
Analytics and Compliance
Dr. Gabe Dawson is Senior V.P. of Systems, Analytics and Compliance at Institutes of Health, where he also oversees the IOH Academy, Research and Special Projects. Prior to entering healthcare, he served in the 82nd Airborne division as a paratrooper in the 325th AIR and served in Desert Shield/Storm. Dr. Dawson has competed as an Olympic weightlifter, power-lifter, and bodybuilder, as well as coaching Olympic athletes. On a very personal level, he is heavily vested in calling attention to the plight of first-responders injured in the line of duty.
Crystal Cobos bio

Dr. Crystal Cobos, DPT

CBIS Director, Head Injury & Concussion Clinic
Dr. Cobos oversees IOH’s Brain Injury & Concussion Clinic in addition to the diagnoses, treatment, and rehabilitation of orthopedic, neurological, cardiac cases, general surgery, and trauma care. Within the chronic pain and delayed recovery space, she leads the Specialty Rehabilitation Clinic for Complex Regional Pain Syndrome/Regional Sympathetic Dystrophy. Dr. Cobos is a Certified Brain Rehabilitation Specialist and the recipient of the Clinical Excellence Award, Academic Achievement Award, and Exception Clinical Research Award from Touro University. Her research in urinary incontinence is published in the Journal of Women’s Health Physical Therapy.
Jemelie Koda bio

Jemelie Koda, MS, CCC-SLP

Supervisor, Speech/Language Pathology
Jemelie Koda is a speech-language pathologist with clinical expertise working in a variety of settings, including outpatient, subacute, skilled nursing, and assisted living facilities. Ms. Koda is a Certified Brain Injury Specialist and is currently the lead SLP in the Brain Injury Intensive Outpatient Program at Institutes of Health. This program serves adults in the Worker's Compensation system who are experiencing functional changes related primarily to TBI and Covid-19.

According to the Centers for Disease Control and Prevention (CDC), traumatic brain injuries (TBIs) are the leading cause of death and disability for children and young adults in the U.S., with 50,000 dying every year.

TBIs are often referred to as a “silent epidemic” because they frequently go undetected on MRI and CT scans, and medical providers usually don’t have a baseline of comparison for assessing cognitive function, particularly for mild TBIs where symptoms tend to emerge later in the recovery process.

The Brain Injury Association of America states that someone in the U.S. suffers a TBI, which includes concussions, every 9 seconds. An estimated five million Americans are living with disability related to TBI, with an unknown number going undiagnosed every day.

“Brain injuries can be missed during medical evaluations because they may lack physical symptoms like bruising, bleeding, or swelling, and imaging often doesn’t reveal mild TBI,” said Dr. Crystal Cobos, Director of the Head Injury & Concussion Clinic at Institutes of Health (IOH).

“Evaluation often relies on the subjective reporting of patients who typically have reduced insight into their neurological symptoms,” says Cobos. “Because so many cases are undiagnosed and symptoms are frequently linked to other conditions, particularly behavioral changes, a ‘silent epidemic’ has emerged.”

Brain injuries can result in a wide range of physical and cognitive symptoms, including headache, blurry vision, dizziness, fatigue, nausea, and problems with focus, memory, and reasoning.

Symptoms of delayed recovery from TBI can include depression, anxiety, sleep disorders, fear avoidance, and emotional dysregulation.

“Delayed recovery occurs when a person continues to experience high levels of symptoms and disability after the anticipated healing time has passed,” stated Dr. Gabriel Dawson, SVP of Systems, Analytics, and Compliance at Institutes of Health (IOH).

“When significant levels of symptoms continue beyond three months, their condition is considered chronic,” he added. At that time, a biopsychosocial evaluation should be performed to understand best all the factors impeding their recovery.

In the context of an evidence-based, biopsychosocial model, the rehabilitation team aims to comprehend the patient’s experience with their injury and the medical assessment to guide interventions more effectively. TBI can impact a wide range of functions, so a transdisciplinary approach to biopsychosocial treatment is preferred. This approach facilitates improved communication and integration across disciplines, leading to more comprehensive care.

“It is challenging to address one specific deficit in isolation when the whole system is impacted,” said IOH Speech Language Pathologist Jemelie Koda.

“The patient’s overall experience has a larger impact on functioning than the diagnosis
alone,” she continued. “If you consider a patient with light sensitivity and vision changes, for example, it is challenging to meaningfully address other important goals, like reading comprehension, visual attention, or screen tolerance.”

The CDC reports that TBIs cost the U.S. roughly $37.8 billion every year, which includes $4.5 billion in hospital care and other services. TBIs also account for $20.6 billion in injury-related work loss and disability and $12.7 billion in lost income from premature death.

TBIs remain among the most challenging and expensive injuries to treat within the workers’ compensation system. However, with the right approach, these conditions can be significantly improved, and disability can be reversed. Early intervention and specialized treatment are vital to achieving the best results. Selecting specialty healthcare providers, visiting their facilities, and making well-informed referrals to enhance clinical outcomes is crucial.

“When evidence-based treatment of TBI is delayed or inaccessible, outcomes suffer, and long-term disability rises significantly. A shift in cultural understanding is required to prevent unnecessary suffering. We have effective programs and services to address the many factors that influence brain injury and related disability, and we need to apply them through an integrated approach tailored to each patient,” explains Dawson.

Using a biopsychosocial model, a transdisciplinary team of specialty care professionals can effectively treat the various functional areas affected by an individual’s TBI. This approach leads to the best clinical outcomes and reduces long-term healthcare costs and utilization.

Institutes of Health logo (hor)
About the Author
Joe Toppe Author

Joe Toppe

Syndicated Business Journalist

Joe Toppe

Joe Toppe is a syndicated business journalist who graduated from Kent State University’s School of Journalism and is a Senior Business Reporter for Capital.com out of London. He has written and been featured on Fox Business, MSN (US), MSN Money Canada, the New York Post, Yahoo Finance, Green Entrepreneur, Innovation & Tech Today, and many more.
Gabriel Dawson bio

Dr. Gabriel Dawson

SVP Systems
Analytics and Compliance
Dr. Gabe Dawson is Senior V.P. of Systems, Analytics and Compliance at Institutes of Health, where he also oversees the IOH Academy, Research and Special Projects. Prior to entering healthcare, he served in the 82nd Airborne division as a paratrooper in the 325th AIR and served in Desert Shield/Storm. Dr. Dawson has competed as an Olympic weightlifter, power-lifter, and bodybuilder, as well as coaching Olympic athletes. On a very personal level, he is heavily vested in calling attention to the plight of first-responders injured in the line of duty.
Crystal Cobos bio

Dr. Crystal Cobos, DPT

CBIS Director, Head Injury & Concussion Clinic
Dr. Cobos oversees IOH’s Brain Injury & Concussion Clinic in addition to the diagnoses, treatment, and rehabilitation of orthopedic, neurological, cardiac cases, general surgery, and trauma care. Within the chronic pain and delayed recovery space, she leads the Specialty Rehabilitation Clinic for Complex Regional Pain Syndrome/Regional Sympathetic Dystrophy. Dr. Cobos is a Certified Brain Rehabilitation Specialist and the recipient of the Clinical Excellence Award, Academic Achievement Award, and Exception Clinical Research Award from Touro University. Her research in urinary incontinence is published in the Journal of Women’s Health Physical Therapy.
Jemelie Koda bio

Jemelie Koda, MS, CCC-SLP

Supervisor, Speech/Language Pathology
Jemelie Koda is a speech-language pathologist with clinical expertise working in a variety of settings, including outpatient, subacute, skilled nursing, and assisted living facilities. Ms. Koda is a Certified Brain Injury Specialist and is currently the lead SLP in the Brain Injury Intensive Outpatient Program at Institutes of Health. This program serves adults in the Worker's Compensation system who are experiencing functional changes related primarily to TBI and Covid-19.

Hummus Recipe

This month, we highlight a basic hummus recipe. Hummus is a delicious and healthy dip, popular in Middle Eastern cuisine. Making it at home is simple and offers numerous health benefits, thanks to its primary ingredients: chickpeas and tahini. Tahini, a sesame seed paste, is rich in unsaturated fatty acids, while chickpeas belong to the pulse family, which includes lentils, beans, and various peas. Chickpeas are high in soluble fiber – good for gut health and digestion.

Why not whip up this nutrient-packed dip for your next snack? It only takes a few minutes. Hummus is tasty and versatile and an even healthier option when paired with your favorite fresh vegetables for dipping. Feel free to experiment by adding different herbs and seasonings to tailor it to your taste. Read More

Chef Denise Roa on a recent outing with IOH patients at a local farmer’s market, explaining the benefits of fresh, locally grown food.

Here are some health benefits of hummus:

  • It has a low glycemic index, helping to stabilize blood sugar levels
  • It’s a good source of protein, supporting muscle growth and repair
  • Rich in antioxidants, it offers anti-inflammatory properties
  • High in fiber, it helps you feel full longer, aiding in weight management
  • It boosts gut health, thanks to its fiber content
  • It protects against chronic diseases such as heart disease, type 2 diabetes, and certain types of cancer

Chickpeas and hummus are staples of the Mediterranean diet, renowned for reducing the risk of several chronic conditions. Enjoy this delicious, health-boosting dip any time as part of a balanced diet!

Please consult your doctor if you have food allergies or other health-related concerns regarding your diet.

Did you know?

Science has proven that chronic, low-grade inflammation can turn into a silent killer that contributes to cardiovas­cular disease, cancer, type 2 diabetes, and other conditions. The culinary team at IOH provides simple tips to patients to fight inflammation, reduce chronic pain, and stay healthy. Click the link below to review more delicious, healthy & easy recipes for everyday life.

An integral part of IOH is focused on nutrition. We teach patients the benefits of anti-inflammatory nutrition to lessen the effects of chronic pain. Patients learn how to prepare and cook nutritious meals together and how to shop and prep so they can make the same meals at home.

Lake Perris Outing

Recently, patients at our IOH Riverside clinic enjoyed a fun kayak outing at Lake Perris. Some patients mentioned they were nervous about trying the new activity, but eventually, they worked up to it and enjoyed themselves as you can see in the photos.

As with many outdoor activities, kayaking offers a holistic approach to fitness, providing a low-impact, full-body workout that strengthens muscles and improves cardiovascular health. Beyond physical benefits, it promotes mental well-being through stress reduction and a connection with nature. 

Botanical Gardens Outing

IOH Riverside patients recently visited the nearby botanical gardens and enjoyed the spring blooms with a gentle walk, nature bingo, and paced respiration.

Walking outdoors in nature offers many health benefits, from reducing stress and improving mood to improving cardiovascular health and boosting vitamin D levels.

Did you know?

Incorporating movement into our daily lives profoundly benefits our physical and mental well-being. From enhancing flexibility and strength to boosting mood and cognitive function, increasing activity and staying active offers countless advantages. Creative approaches to movement, such as stretching to improve flexibility, walking to clear the mind, dancing for a fun cardiovascular workout, or engaging in aquatic exercises for low-impact resistance training, all ensure that staying active never becomes monotonous. Hiking in nature provides a scenic backdrop for exercise and connects us with the environment, enhancing our sense of peace and well-being. Activities can be tailored to individual preferences and fitness levels, making the journey toward health a personalized and enjoyable experience.

Exploring Creative Ways To Move More​

IOH clinicians and technicians offer a variety of creative ways to help patients increase activity and mobility by exploring ways to move that are both enjoyable and beneficial.

Art and Creative Therapy

Watercolor Mural Project

We are happy to share this art project currently underway at our San Diego clinic.

As a Certified Art Healer at Institutes of Health, Natasha Rashid Le Bars champions the profound impact of art healing with IOH patients. Through various art projects, she addresses the misconception that art is only for the artistically inclined, emphasizing its therapeutic potential for everyone. Natasha’s approach involves helping patients recognize how trauma manifests in the body and mind, and how creative activities can facilitate release and healing.

At IOH, Natasha helps cultivate an environment of community, trust, and vulnerability, where patients feel supported in their artistic exploration. Music accompanies their sessions, aiding relaxation and stimulating conversation. Natasha reports that patient feedback often reveals surprise at their artistic abilities and a sense of relief from intrusive or negative thoughts.

During art therapy sessions, Natasha prioritizes the therapeutic process over artistic skill, encouraging patients to focus on the positive emotions evoked by art creation. As she advocates, “Focus LESS on being ‘good at art’ and MORE on how ‘creating art makes me feel good,’ no matter the result.” Through her work, Natasha empowers individuals to harness the healing power of art for their overall well-being.

We are proud to share this awesome 5-star review from one of our patients at IOH Riverside!

These words fuel our passion for providing the most advanced healthcare services for the Workers’ Compensation community. At Institutes Of Health, we strive to create a warm and welcoming environment from the very first step and deliver compassionate care to the patients we serve. Thank you for recognizing our commitment to excellence!

Community Engagement

Institutes Of Health proudly participated in the 2024 Survive HEADSTRONG Walk & Health Fair in San Diego, on March 23, hosted by the San Diego Brain Injury Foundation. It was a celebration of resilience and achievement for brain injury survivors, where we walked and rolled together to raise awareness for the needs of this incredible community. IOH staff and patients united as one voice for brain injury recovery. Way to go IOH team!

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