News

News

Virtual Reality Therapy - 11/29/2022

Virtual reality (VR); a computer-generated, 3-dimensional, interactive environment, is increasingly used in medical settings as an adjunct (VR-augmented rehabilitation), or a replacement for conventional therapy (VR-based therapy), in a variety of conditions. Some simulations use a teach-by-example approach, some use an active, video game-style, and some are designed to expose the patient to a phobia or past traumatic event.

VR therapy can be administered in a distance-based, or telerehabilitation format and offers increased adaptability and variability compared to some forms of conventional therapy, as well as transparency in data storage and reduced medical cost.

 

PTSD

Cognitive behavioral therapy (CBT) along with exposure therapy, is effective and has been viewed as the standard of care for PTSD.  However, real-world exposure, as would be required in CBT can be difficult for PTSD patients, or even impractical for some patients, such as combat veterans. VR therapy provides a compromise that makes exposure therapy more tolerable and easier to access.

VR creates an immersive simulation of the patient’s initial trauma and virtually exposes the patient to visual, auditory, and proprioceptive stimuli they perceive as threatening of fear-inducing. The goal is for the patient to gradually generalize the virtual experience to their current, safe reality through repeated exposures in the virtual environment. This allows a treating physician to recondition the patient’s responses and reduce hyperarousal and reactivity, thus allowing trauma-associated memories and physiological reactions to be diminished or even potentially extinguished.

In an early study which used VR therapy for veterans that had both traumatic brain injury (TBI) and PTSD from blast exposure, participants reported modest symptom improvement and decreased avoidant behavior in everyday situations, i.e., restaurants, subways, movie theatres. A recent meta-analysis found significant improvement in depression across studies, however, there were mixed results for anxiety.

 

Pain Management

VR therapy has been found to reduce pain and anxiety in chronic pain patients and has received high patient satisfaction ratings. VR works, in part, by distracting the patient’s focus away from painful stimuli and is based on an inherent central nervous system pain-inhibiting mechanism. It reduces the need for sedatives and analgesics, resulting fewer adverse side effects and lower risk for addiction. VR used in the context of chronic pain also reduces costs and speeds recovery time by eliminating the need for expensive procedures. Additionally, VR can help build pain-management skills, such as regulating breathing to control pain and increasing a patient’s sense of control.

This year, the FDA approved VR for treating low back pain based on the results of a clinical trial in which 66% of participants (vs 30% of controls) reported > 41% pain reduction.  Similar results were obtained in another study in which patients with work-related injuries received home-based VR therapy and reported an average of 40% pain reduction as well as reduced depression and fatigue and improved sleep; and 69% reported reduction or cessation of opioid use.

 

A picture containing text, person, person, electronicsDescription automatically generatedPain Measurement

For many years the healthcare system has relied on subjective patient reports as the standard for pain measurement. However, pain is highly subjective and unique to each individual. It is difficult to objectively quantify and is both influenced and mediated by emotional and cognitive states.

Pain is known to cause movement to become slower and stiffer and VR technology has the potential to objectively measure pain levels by correlating pain with changes in movement patterns. In a 2019 study, VR was used to identify characteristics of movements that indicate pain effects and was able to quantify those effects. This creates an objective pain scale that can be used to guide treatment decisions and assess patient progress and treatment efficacy, which opens the possibilities for creating pain scale models which are specific to patient characteristics, such as age or sex, types of pain, and pain-response types.

 

Workplace Safety Training

A picture containing graphical user interfaceDescription automatically generatedThe development of VR for workplace safety and injury prevention is expected to dramatically alter the structure and administration of worker’s compensation. VR training addresses every level of the safety chain, including the individual (attitudinal), group (information exchange), and organizational (resource) levels. In a study of construction site safety, immersive VR training resulted in a significant safety advantage over conventional lecture-based methods. VR was more effective at maintaining trainees’ concentrated attention and was more effective over time than conventional training. The benefits occurred in task-related, but not general site safety. Another study found that immersive VR safety training improved safety-related knowledge base among workers with short-term work experience and civil engineering students, two groups at increased risk of injury on construction sites.

Pain Management in Workers’ Comp - 10/7/2022

 

Pain management presents a clinical challenge that can often become heightened in the context of workers’ compensation. Research shows that chronic pain-related workers’ compensation claims lead to poorer outcomes and claimants tend to be more distressed compared to similar pain management cases not managed through workers’ compensation.

 

Some of the responsibility for the discrepancy lies in factors inherent to the workers’ compensation system, such as delays due to investigations, which lead to delays in diagnosis and treatment.  One underlying theme stemming from studies on ways to improve outcomes in workers’ compensation pain management cases, points to the advantages of a multidisciplinary approach.  Highly skilled nurse Case Managers that can coordinate these care plans have been proven to dramatically increase recovery outcomes, while simultaneously reducing costs associated with treatment.

 

 

Pain Management “Boot Camp” Improves Outcomes and Reduces Costs

 

Multi-disciplinary pain management programs drawing on a combination of psychological, physical, occupational, and medical approaches have been in use for some time and often demonstrate superior results to single-discipline treatments. These programs also improve return to work status, decrease the amount of medication needed, decrease healthcare utilization costs, and improve closure rates of disability claims. Additionally, the importance of including psychological support in pain management cannot be understated since psychosocial factors have been found to be a better predictor of return-to-work status than physical components of disability in patients with low back pain.

An interdisciplinary pain management program for workers compensation patients resulted in significant reductions in pain intensity and depression in those who completed the rigorous 4-week, 8-hour per day program[3]. Contrastingly, those who didn’t complete the program had higher pain scores at the time of their withdrawal compared to their baseline values at the start of the program.

 

Remote Patient Education Programs Foster Improved Pain Management and Faster Return to Work

 

Participation in a pain management program can improve pain management in worker’s compensation patients, according to a 2019 study. Participants have also reported less depression, anxiety, and disability and a reduction in their use of opioid medication after taking a course. The researchers concluded that including a pain management course as part of a patient’s care program can improve the potential for faster return to work and decrease patients’ resistance to rehabilitative care.

Two people looking at a computerDescription automatically generated with medium confidenceAlong with medical management, the program included pain psychology therapy, occupational therapy, and physical therapy, as well as relaxation training, biofeedback, aerobic condition, pool therapy, vocational counseling, and patient education.

Increasing Education on Pain Biology Is Beneficial and Effective at All Levels

 

Changing how all stakeholders, including workers, care providers, insurers, and legislators understand pain biology in the context of workplace injury is a key component to developing a comprehensive treatment model designed to improve clinical outcomes and shorten claims, according to a 2016 meta-review.

 

Dosing Guidelines Reduce Opioid Overprescribing by Imposing Maximum Dose Limits

Workers with chronic joint injuries and permanent partial disability are particularly vulnerable to developing chronic opioid use. Additionally, opioids are commonly prescribed for acute low back injuries, for which their usefulness is controversial.

DiagramDescription automatically generated with medium confidenceThe implementation of opioid dosing guidelines designed to curtail opioid prescribing for workers’ compensation patients successfully reduced morphine equivalent dose by 9.26 mg, as one study concluded. The reduction in prescribed dosage levels increased the longer the program was in effect. The target population, chronic non-cancer pain patients, experienced a larger decrease, as a result of the implementation of the guidelines, compared to other categories of pain patients.

The guidelines, known as Morphine Equivalent Daily Dose (MEDD), are based on a method for converting various opioid drugs into a standard unit of measurement so that they can be more easily compared. They were used to set a cap for the maximum recommended dose of opioids, though the capped amount varied from state to state.

 

SCM Associates, Inc. Brings Darrell Prescott on as New Client Relationship Manager

SIGNAL HILL, CA, September 7th, 2022 - SCM ASSOCIATES is pleased to announce our recent addition of Darrell Prescott who will join the SCM team as Client Relationship Manager. Within his duties, Mr. Prescott will be leading the effort to develop both new and current clients for SCM Associates. 

Mr. Prescott comes to SCM with over thirty years of experience in the Healthcare Industry and specifically within the Workers Compensation Industry. Mr. Prescott earned his Bachelor’s degree from Indiana University and his Master’s degree from California State University Fullerton.

Mr. Prescott's background will be an asset as SCM Associates continues its new growth initiatives. SCM Associates will continue to be a leader for quality case management for catastrophic and injury case management for both the Workers Compensation and Commercial healthcare industries.

If you would like to contact SCM Associates for more information regarding our services, please contact Darrell Prescott at 949-350-6871 or by email at darrellp@scmassociates.org

Patient Centered Speech Therapy - 8/18/2022

Injuries that result in the need for speech therapy can be life changing for an individual. Proactive intervention, health education, and coordinated care plans can help to promote an environment for recovery.  A case management team can ensure that a patient has access to a high level of care, as well as can help to reduce associated costs for employers.

A picture containing person, tree, outdoor, peopleDescription automatically generatedWhat is a Speech Therapist?

Speech and Language Therapists, or SLTs, treat children and adults that have difficulties in speech, language, communication, and swallowing skills. SLTs seek to improve communication by working alongside the patient, as well as close family members and support teams. Communication difficulties can become frustrating for patients, as well as hinder independence, so SLTs are tasked with providing clients an efficient means of communication to enhance that client’s quality of life.

 

Injury on The Job Resulting in The Need for Speech Therapy

Injuries that result in the need for speech therapy that happen at the worksite can be life changing for an individual. Early diagnosis and rehabilitation after an injury resulting in the need for speech therapy is almost always necessary to help prevent additional damage. Case management services, in the instances of a worker becoming injured on the job, can help to facilitate these necessary medical services to help promote the patient’s recovery.

 

Disorders may develop due to a nerve injury, muscular paralysis, developmental delays, or structural issues. 

Speech Disorders Include:

 

  • Apraxia. Loss of muscle control in the muscles used to produce sound.
  • Disfluency. Interruption in the flow of speech, such as repetition.
  • Dysarthria. Weakness of speech muscles that affects clarity.
  • Speech sound disorders. Grouping of impairments hallmarked by the difficulty to produce sounds.

A group of people sitting in a roomDescription automatically generated with medium confidenceLanguage Difficulties Include:

 

  • Specific Language Impairment. Language impairment that is not related to hearing issues.
  • Word finding difficulties. Delayment in word retrieval or retrieving inaccurate words.
  • Expressive language difficulties. Difficulty expressing information verbally, as well as trouble with vocabulary and grammar.

Case Management and Rehabilitation That is Patient-Centered

Speech and language difficulties can greatly impact an individual’s life, leading to self-esteem, independence, idea comprehension, and school readiness difficulties. Personalized custom care plans and management can be tailored to fit the needs of an individual, promoting an environment that is patient centered. Bridging barriers to the healing process allows for a streamlined approach to reaching the highest possible level of care. Recognizing the need to incorporate solutions to make a difference in a patient’s recovery journey is one step towards improving their overall quality of life. Proper case management and rehabilitation can lead to more positive medical outcomes.

Speech Therapy with The Individual in Mind: SCM Associates

A group of people in a circleDescription automatically generated with low confidenceAt SCM Associates, we are more than just a case management company. Our team is dedicated to putting the well-being of every individual we work with at the forefront. We understand a client’s life has been disrupted, even sometimes permanently altered, due to an injury or health issue. We are dedicated to education, coordination, and facilitation of winning solutions for both providers and clients. Get in touch with our team to learn more about our custom individualized solutions and unique offerings that elevate care. 

 

Continuum of Care for TBIs - 7/1/2022

Continuum of Care Model Improves Outcomes for Traumatic Brain Injuries

According to 2015 data from the Centers for Disease Control and Prevention (CDC), traumatic brain injury accounted for over 2.2 million emergency department visits, 280,000 hospitalizations, and 50,000 deaths in one year[1]. Studies show that men have almost twice the risk of being hospitalized than women and are three times more likely to sustain fatal injuries[2]. However, the majority of TBIs – about 80% – are considered mild, with a Glasgow Coma Scale rating of 15 or less[3]. Of these, 85 to 90% of patients are able to resume normal function within six months and the remaining 10 to 15% experience persistent symptoms[3]. Though effective TBI clinical case management remains controversial, it is widely accepted that a multi-factorial approach is integral to facilitating optimal healing and full and successful return to work and that delayed, improper, or inconsistent clinical care negatively impacts outcomes.

Poor Clinical Management Leads to Increased Disability

Early and intensive care are thought to be key to obtaining successful outcomes in traumatic brain injury cases. A records review study conducted by the Washington State Department of Labor and Industries found that clinical case management diverged from expected outcomes for acute treatment, medical rehabilitation, and vocational rehabilitation for these types of injuries. Out of nearly 800 traumatic brain injury cases, 53.5% were determined to have temporary disability, 31.1% had permanent disability, and 9% had no disability[4]. Researchers concluded that this may be due, in part to the fact that most cases did not adhere to accepted clinical trajectory guidelines, including short intensive inpatient care, followed by intensive rehabilitation and referral for return-to-work support services. Poor Clinical Management Leads to Increased Disability

 

Return to Work Status Can be Impacted by a Combination of Worker and Workplace Factors

A review of published research on return-to-work after mild TBI concluded that mild TBI does not pose a significant risk for long-term work disability[5]. The study, titled Systematic Review of Return to Work After Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis, found that 75% of workers are able to return to work within 3 to 6 months after injury, while 5% to 20% experience persistent problems up to 2 years post-injury[5]. Factors that contribute to delayed return to work include <11 years of formal education, nausea or vomiting on hospital admission, co-occurrence of extracranial injuries, severe pain in the early stages post-injury, and limitations placed on patients’ job independence and decision-making input[5].
 

A Form of Patient Bias May Complicate Recovery from Mild TBI

Patient bias has been identified in a small percentage of mild TBI patients in which patients underestimate the severity of their past symptoms. Referred to as “good old days” bias, patients who experience this can develop unrealistic perceptions of their current symptom level and their degree of recovery[6]. These patients tend to underestimate their pre-injury symptom status and many place their pre-injury function at levels better than the average person. As a result, their perception of their current problems is heightened, and their perceived degree of recovery is diminished.

Financial Incentives Fuel a High Rate of Malingering

Financial Incentives Fuel a High Rate of Malingering

Malingering, driven by financial motivation, is a common occurrence following TBI and most instances of malingering occur in mild TBI cases [3]. Neuropsychological testing has revealed that mild TBI patients who are incentivized by the potential for financial gain tend to perform more poorly on neuropsychological tests than those with more severe injuries or those for whom monetary incentive is not a factor.[3] Some researchers estimate the rate of malingering at 30 to 40% in State-level cases and up to twice that rate in Federal-level cases[3].

Some jurisdictions have attempted to limit financial incentives for malingering. In Louisiana, workers compensation employees can collect up to two-thirds of lost wages plus medical expenses and vocational rehabilitation, but by doing so relinquish their right to sue for liability damages[3]. By contrast, Federal workers compensation laws, such as the Jones Act and Longshore Act, which provide for higher weekly compensation compared to many state laws, have been found to result in higher rates of overall recovery[3]. However, these laws also entitle workers to sue their employers for negligence and damages resulting from negligence, including pain and suffering and lost income or earning capacity[3].

One workers compensation study on malingering in TBI patients categorized three levels of malingering: no incentive; limited incentive, as in Louisiana state laws; and high incentive, as provided by Federal law. The study found that potential for monetary gain is a major motivating factor leading to. Greater incentive is associated with a greater variety of patient-reported symptoms as well as exaggerated subjective reporting of the severity of symptoms and problems. Additionally, upon being released to return to work based on physical improvement some patients may amend their reporting to include continued or increasing psychological or cognitive issues.

 

A Continuum of Care Model May Improve TBI Workers’ Compensation Case Management

Worker’s compensation case management of mild TBI is complicated by several factors. One of the most significant of these is poor identification at the time of injury often due to the subtle nature of mild TBI along with the co-occurrence of more obvious or life-threatening injuries. Additional challenges associated with effective case management include a lack of evidence-based treatment guidelines and the prevalence of response bias due to the inherent subjectiveness of symptoms in mild TBI [7].

In Canada, the Workers’ Compensation Board of Alberta developed a continuum of care (CCM) model to resolve these issues and improve treatment outcomes [7]. The model is based on a similar approach to soft tissue injuries developed in 1994 that proved successful. Demonstrated benefits of the CCM model include: a guideline for consistent claims management, appropriate access to specialized services when indicated, collaborative multidisciplinary case management, earlier return to work, and the ability to develop a contingency plan if an injured worker does not recover within the anticipated timeframe[7].

The CCM approach outlines common recovery patterns and includes typical timeframes for when certain recovery milestones can be expected and when reassessment and revised treatment plans may be indicated. The model includes nine essential components[7]:

A Continuum of Care Model May Improve TBI Workers

  • Medical management for the first 6 months post-injury or longer, as indicated.
  • Stress management and counselling if the incident included a psychologically traumatic event.
  • Educational materials provided directly to patients by healthcare facilities at the time of emergency care.
  • Follow-up physical/neurological assessment at six weeks post-injury if symptoms persist.
  • Neuropsychological assessment if symptoms persist.
  • Counseling and/or physical therapy to assist with symptom resolution and to inform worksite reintegration.
  • Multidisciplinary collaboration in instances where the patient is unable to return to work in order to identify and devise a plan to resolve persisting barriers.
  • Claim identification and case management via appropriate screening questions to determine the potential presence of TBI and improve education of emergency medical personnel.

 

  1. CDC’s Report to Congress on Traumatic Brain Injury Epidemiology and Rehabilitation Recommendations for Addressing Critical Gaps 2015; Available from:
    https://www.cdc.gov/traumaticbraininjury/pdf/TBI_Report_to_Congress_Epi_and_Rehab_Snapshot-a.pdf.
  2. TBI Data | Concussion | Traumatic Brain Injury | CDC Injury Center. 2022
    https://www.cdc.gov/TraumaticBrainInjury/data/index.html
  3. Compensation and Malingering in Traumatic Brain Injury: A Dose-Response Relationship?
    http://dx.doi.org/10.1080/13854040600875203,
    2008
    https://www.tandfonline.com/doi/abs/10.1080/13854040600875203
  4. Disability and return to work outcomes after traumatic brain injury: Results from the Washington State Industrial Insurance Fund.
    https://doi.org/10.3109/09638280903186327,
    2010
    https://www.tandfonline.com/doi/abs/10.3109/09638280903186327
  5. Systematic review of return to work after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Archives of physical medicine and rehabilitation, 2014. 95(3 Suppl)
    https://www.ncbi.nlm.nih.gov/pubmed/24581906
  6. “Good Old Days” Bias Following Mild Traumatic Brain Injury.
    http://dx.doi.org/10.1080/13854040903190797,
    2009
    https://www.tandfonline.com/doi/abs/10.1080/13854040903190797
  7. Continuum of care model for managing mild traumatic brain injury in a workers’ compensation context: A description of the model and its development.
    http://dx.doi.org/10.1080/02699050310001617361,
    2009
    https://www.tandfonline.com/doi/abs/10.1080/02699050310001617361