As our industry is always evolving, our clinical experts create high-value papers to bring clarity to the most challenging areas of workers’ compensation.
The purpose of osseointegration (OI) technology is to offer greater comfort and control of the residual limb to people having severe difficulty utilizing and/or adapting to traditional prostheses. OI eliminates the conventional interface between the residual limb and the prosthesis by anchoring prosthetic components directly to the bone of the distal limb. The bone integrates with the OI implant through surgical techniques that enable a percutaneous connection to the external prosthetic device and obviate the need for sockets and other suspension systems.
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Depending on the catastrophic injury diagnosis, chronic pain may result in anywhere from 25–75% of cases. Disabling chronic pain can occur in 25% of cases. The past two decades have seen a steep rise in the number of pain injections performed, often with suboptimal results in workers’ compensation. In fact, chronic pain and suboptimal treatment can prolong disability and delay reaching an optimal functional outcome. A trial and error approach, polypharmacy, unrealistic expectations, and over-emphasis on the biomedical approach lead to iatrogenic disability. And yet, the interventional pain industry has grown despite lack of proven outcomes. In the past, treatments such as IDET (intradiscal electrothermal therapy), discogram, and even intrathecal pain pumps were heralded as pain solutions until demonstrated to be unreliable and even potentially harmful. This means that requests for certification of various procedures are likely. The Paradigm Management Team can take a judicious objective approach to determine whether a particular treatment, or treatment approach, is likely to help an injured worker improve function and improve overall quality of life.
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Over the past several decades, advances in the medical and surgical management of severe injuries have improved the survival of patients with traumatic brain injuries (TBI). As a result, there are a significant number of TBI survivors experiencing extended (greater than 21 days) states of disorders of consciousness (DoC) such as coma, vegetative state (VS), and minimally conscious state (MCS). It has been estimated that as many as 30–40% of severe TBI survivors will remain in prolonged states of severely impaired consciousness. As a result, there has been a growing interest in this population, both clinical and scientific, especially over the last 20 years. This has culminated in the recent release of national guidelines, which have significant implications for the clinical care of these patients.
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Medical marijuana or medical cannabis is a controversial and politically charged topic being debated in the United States. A growing number of anecdotal claims support the drug’s potential health benefits in treating everything from migraines to Alzheimer’s dementia and even autism. Most recently, discussions in the Workers’ Compensation industry are exploring whether to endorse marijuana/cannabis as a potential opioid substitute.
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Despite the FDA approval of two exoskeletons for home and community use, the true ROI profile of exoskeletons, both medically and technologically, is not yet known. The psychological benefit alone is not enough to justify the high cost of the device, training, and personnel support required to use it simply as a mobility device. Additional clinical studies validating the improved efficacy and comparative advantage in gait function, safety, functional independence, and associated secondary health benefit outcomes are needed.
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Laser therapy has clearly been helpful in treatment of clinical symptoms associated with hypertrophic scars such as refractory pruritus, pain, and erythematous discoloration. In addition, laser therapy is helpful in improving texture and pliability of pathologic scars that don’t respond to more conventional medical treatments. The success of laser treatments, while not absolute, certainly justifies its use for troublesome scar conditions.
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Hyperbaric Oxygen Therapy (HBOT) is approved by the Food and Drug Administration as a biologically-repairing and regenerative treatment modality for specific conditions. This position paper considers the efficacy and safety of HBOT as a treatment for brain trauma.
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Buprenorphine is a powerful semi-synthetic opioid medication used primarily to treat opioid dependence or narcotic addiction. This position paper evaluates the effectiveness of various uses in the context of the prescription opioid epidemic.
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Trauma-related acquired brain injury (ABI) is known to cause a number of secondary effects to the brain including neuroendocrine dysfunctions. This clinical position paper covers the recent developments and Paradigm’s stance in this area.
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FES bikes allow users to cycle by applying electrical stimulation to peripheral nerves. The process simulates active exercise for a disabled worker who would otherwise be unable to do so. This paper summarizes the conclusions from medical literature to date.
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Understanding that functional restoration is a comprehensive and quantifiable program can result in improved long term health and significant reduction in costs. This paper discusses the six steps for successful functional restoration.
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