The Lifetime Financial Cost of Traumatic Brain Injury and Spinal Cord Injury

The lifetime annual costs for the treatment of either TBI or SCI are substantial. Of course, the specific cost of care will vary widely based on individual circumstances, the location of where the services are being provided, and the severity of the injuries. And while there is data on estimated costs for the individual injuries, there is little data regarding the cost for care for dual diagnosis.

Estimated Lifetime Costs Associated With TBI and SCI Diagnoses

When there is a dual diagnosis of TBI and SCI some costs can overlap but the overall costs increase due to the complexity of care. Dual diagnosis involves additional specialized rehabilitation, assistive devices, home modifications, and personal care assistance. For example, the lifetime treatment costs for a person with a severe TBI alone can range from $85,000 to $3 million,¹ and the National Spinal Cord Injury Statistical Center (NSCISC) estimates the cost associated with SCI for high quadriplegia (C1-C4) for the first year at $1.4 million, with substantial annual costs every year thereafter.²

These cost estimates for the treatment of the individual injuries do not take into consideration the additional damages such as lost wages, benefits, productivity, and related damage, such as pain, suffering, disability, and disfigurement.

What Causes Traumatic Spinal Cord Injuries?

According to the National Spinal Cord Injury Statistical Center (NSCISC), spinal cord injuries may result from medical conditions like inflammation, infection, cancer, or natural degeneration of the spine, but most are the result of a traumatic injury that fractures, dislocates, crushes, or severely compresses the spinal cord and vertebrae. “Vehicle crashes are the most recent leading cause of injury, closely followed by falls. Acts of violence (primarily gunshot wounds) and sports/recreation activities are also relatively common causes.”² SCI and TBI occur in the same type of incidents, and result in dual diagnosis.

Signs of Traumatic Spinal Cord Injury (SCI)

People who survive a significant SCI will have medical complications. SCI³ can damage all or part of the muscles and nerves below the injury site. For example, an injury to the chest (thoracic) or lower back (lumbar) can affect the chest, abdomen, and legs. In addition, bladder and bowel control, and sexual function can be negatively affected. A neck (cervical) injury can affect the movements of the arms and can affect the ability to breathe.

Medical Management of Dual Diagnosis

Physicians typically assign people with a dual diagnosis to hospital units that focus either on SCI or TBI based on individual needs and impairments. However, the treatment plan for people with a dual diagnosis needs to address unique challenges,⁴ such as:

• People with a dual diagnosis are more likely to manifest behavioral issues, exhibit mental disorders (psychopathology), and have more severe decline in cognitive functions such as memory, attention, language, and problem-solving abilities (neuropsychological impairments) than people with SCI or TBI alone.
• A TBI may affect the ability of people with a dual diagnosis to tolerate physical and cognitive therapy as well as other rehabilitation interventions required to treat the SCI.
• Dual diagnosis complications may overlap, such as seizures, headaches, problems with involuntary body functions like heart rate, blood pressure, and digestion (autonomic dysfunction), bladder and bowel dysfunction, spasticity, bone tissue formations (heterotopic ossification), and anxiety or depression.

Prognosis: What Recovery Looks Like by Injury Type

The prognosis for an SCI injury alone (without the dual diagnosis) varies greatly and is based on factors such as age, overall health prior to the injury, and the level of the spinal cord injury and the extent of the injury.²

Incomplete Quadriplegia

Incomplete quadriplegia is the most frequent injury experienced by 47.4 percent of people with SCI. Quadriplegia injuries, both complete and incomplete, occur when there is damage to the cervical (neck) region of the spinal cord — typically between the C1 and C8 vertebrae — resulting in varying degrees of paralysis and loss of sensation in all four limbs and the trunk, depending on the severity and exact location of the injury. An incomplete injury affects all four limbs, but the signals between the brain and the spinal cord are preserved and there may still be feeling below the location of the injury. The complications include muscle weakness or paralysis in all four limbs, loss of sensation, difficulty with bladder and bowel control, increased risk of infections, pressure sores, and challenges with breathing or circulation, depending on the severity and location of the SCI.

Complete Quadriplegia

Complete quadriplegia results in 12.3 percent of SCI cases. A complete injury is where all four limbs are weak or paralyzed. Complications of complete quadriplegia include total paralysis and loss of sensation in all four limbs and the trunk, respiratory dysfunction (such as difficulty breathing or risk of pneumonia), loss of bladder and bowel control, increased risk of pressure sores and infections, cardiovascular problems like dangerous spikes in blood pressure (autonomic dysreflexia) and sudden drops in blood pressure (orthostatic hypotension), and impaired sexual function.

Incomplete Paraplegia

Incomplete paraplegia is experienced in 20 percent of SCI. Paraplegia injuries, both complete and incomplete, occur when there is damage to the mid-back (thoracic), lower back (lumbar), or sacral (bottom) regions of the spinal cord — typically below the first thoracic vertebra (T1) — resulting in paralysis or weakness affecting both legs and lower body, while arm and upper body function remains intact. In an incomplete injury the signals between the brain and the spinal cord are preserved and there may be feeling and some movement below the location of the injury. Complications of incomplete paraplegia include partial paralysis or weakness in the legs and lower body, changes in sensation, loss of bladder or bowel control, muscle spasms, pressure sores, pain, and sexual dysfunction, with the severity depending on the extent and level of the spinal cord injury.

Complete Paraplegia

Complete paraplegia results in 19.7 percent of SCI cases. Complications of complete paraplegia include total loss of movement and sensation in the legs and lower body, loss of bladder and bowel control, increased risk of pressure sores and infections, muscle spasms, chronic pain, and sexual dysfunction.

Impact of TBI and SCI on Family and Financial Resources

The individual and dual injuries of TBI and SCI impose enormous emotional and financial strain on the person injured and their family. Families typically experience feelings of helplessness and grief as they witness the significant changes in the abilities and daily life of their loved one. This can often lead to stress, depression, and family conflicts.

The financial burden can exceed all available private health care insurance coverage. Many families find themselves forced to make difficult choices, potentially sacrificing their careers or depleting their savings to provide the necessary care and support. This financial strain, when combined with emotional challenges, can lead to a prolonged crisis for the entire family and affect their well-being and resilience.

If the dangerous or negligent actions of another person or care by a medical professional exacerbated or contributed to the extent of the injuries, you may wish to investigate this matter with an experienced attorney. An experienced attorney will be able to gather the information, access expert resources necessary to thoroughly investigate the matter, evaluate the possibility of finding additional financial resources, and answer your questions.