By Jenny Quigley-Stickney, MSN, MA, MHA, CCM, ACM-RN, CMAC, CPHM, FCM 

Can you imagine having a fall in your classroom, injuring your head, and never regaining your ability to educate children? Can you imagine skiing down a hill, crashing into a tree, breaking your helmet, and never being able to walk a straight line again? Can you imagine being mugged on the way home from work and never fully recovering from the post-traumatic stress that followed the injury? Can you imagine diving into a pool and never being able to return to swimming—or even recall your love of the sport? Can you imagine surviving a car crash and waking up to find you are no longer the same person? 

These are the many faces of brain injury. No two injuries are the same. Each is a unique experience, influenced by the severity, location, and type of injury to the brain. 

Every March, we observe Brain Injury Awareness Month, providing survivors and families an opportunity to reflect on the complex, often invisible challenges faced by individuals living with brain injuries. For case managers, this month is a time to recognize the critical role we play in coordinating care, advocating for patients, and supporting recovery that extends far beyond discharge dates and clinical milestones. 

Navigating the healthcare system—from the critical care unit to acute rehabilitation, LTAC, home with services, outpatient rehabilitation, and supervised care—often means entering an entirely new world. Recovery can be lengthy and, in some cases, lifelong for the brain injury survivor. 

Understanding the Complexity of Brain Injury 

Brain injury care has evolved significantly since I began working in the field in 1987 on one of the first Commission on Accreditation of Rehabilitation Facilities (CARF) programs for brain injury. The definition of brain injury now encompasses both traumatic brain injury (TBI) and acquired brain injury (ABI). These injuries may result from falls, motor vehicle accidents, sports injuries, strokes, anoxic events, or illness. 

While the initial injury may be clearly documented, the long-term effects are often less visible and far more variable. 

Patients may experience cognitive changes, fatigue, impaired executive functioning, emotional dysregulation, sensory sensitivities, and sleep disturbances. Symptoms often fluctuate and evolve over time, making standardized pathways insufficient for many individuals. 

As case managers, our clinical insight is essential in recognizing these less obvious deficits and ensuring they are addressed through thoughtful care planning, appropriate referrals, and ongoing evaluation for both the patient and family. 

The Long Road After Acute Care 

For many brain injury survivors, the most difficult phase of recovery begins after acute treatment ends. Insurance limitations, fragmented services, and gaps between medical and community-based care can create barriers that significantly impact outcomes. 

Case managers serve as the bridge—coordinating rehabilitation services, facilitating interdisciplinary communication, and advocating for appropriate levels of care. Our ability to see the whole person, rather than a single diagnosis, is central to meaningful recovery for both the patient and their family. 

Psychosocial Factors and Family Impact 

Brain injury affects not only the patient but the entire family system. Role changes, caregiver stress, financial strain, and emotional fatigue are common—and frequently underrecognized. 

By assessing caregiver capacity, providing education, and connecting families with resources, case managers help reduce burnout and promote sustainable support systems. Early identification of psychosocial needs can prevent crises and rehospitalization later in the recovery process. 

Recognizing when a family support system is unable to sustain recovery is also a critical responsibility. Case managers identify unmet needs and connect patients to community-based resources when necessary, including 24/7 supervision, guardianship services, advocacy support, conservatorship, telehealth access, and national or local brain injury educational organizations and support groups.

Why Awareness Matters in Case Management 

Brain Injury Awareness Month reinforces key principles that guide effective case management: 

• Listening to patient-reported symptoms, even when they are not outwardly apparent 

• Advocating for individualized rehabilitation timelines 

• Promoting interdisciplinary collaboration 

• Supporting reasonable accommodations in return-to-work and community reintegration plans 

• Addressing mental health needs alongside physical recovery 

Awareness strengthens advocacy—and advocacy improves outcomes. 

Utilization Management and Workers’ Compensation Considerations 

Brain injury cases frequently intersect with utilization management (UM) and workers’ compensation frameworks, where timely decision-making and clear documentation are critical. Nurse case managers play a pivotal role in aligning medical necessity with payer requirements while keeping patient-centered outcomes at the forefront. 

Within UM, brain injury recovery rarely follows predictable timelines. Cognitive fatigue, delayed symptom presentation, and psychosocial barriers often complicate traditional length-of-stay benchmarks. Case managers are essential in: 

• Supporting medical necessity for continued rehabilitation services 

• Translating functional deficits into measurable, outcome-based documentation 

• Facilitating interdisciplinary communication to prevent fragmented care 

• Anticipating care transitions to reduce denials, delays, and readmissions 

In workers’ compensation cases, additional layers of complexity frequently exist, including return-to-work planning, employer communication, and regulatory requirements. Nurse case managers help balance recovery with vocational goals by: 

• Coordinating modified duty or graduated return-to-work plans 

• Advocating for appropriate cognitive and behavioral rehabilitation 

• Monitoring treatment adherence and functional progress 

• Addressing psychosocial and environmental factors that may impact recovery or claim resolution 

Effective case management in these settings requires both clinical expertise and high-level systems navigation skills—competencies nurse case managers bring to their work every day. 

A Shared Commitment 

In 2026 and beyond, continued education and awareness remain essential as we strive to improve outcomes for individuals with brain injury across medical, insurance, and occupational systems. Whether working in acute care, rehabilitation, utilization management, or workers’ compensation, nurse case managers are uniquely positioned to influence recovery trajectories through coordination, education, and advocacy. 

National and local brain injury associations continue to advocate for survivors and develop new resources to support recovery. Nationally, advocacy efforts focus on task forces and political action initiatives designed to establish sustainable funding and expand services for patients and families. 

In Massachusetts, advocacy efforts focus on advancing key legislative initiatives for the brain injury community, including: 

• Cognitive Rehabilitation Bill (S742/H1151) 

• Head Injury Treatment Services (HITS) Trust Fund Bill (S1072/H1687) 

• Primary Seat Belt Bill (S1699/H2688) 

• Acquired Brain Injury Advisory Board Bill (S134/H231) 

This Brain Injury Awareness Month, we recognize the critical role case managers play in making the invisible visible—ensuring that brain injury survivors receive timely, appropriate, and compassionate care while navigating complex healthcare systems. 

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Bio: Jenny has been active with CMSA/CMSNE for over 25 years serving currently as CMSA President Elect 2025-2026 and prior to this role, served as CMSA Treasure, Board of Director for CMSA from 2021-2023. Worked as CMSA National she served as the President of CMSNE & Chair for both CMSA and CMSNE Public Policy Committees. Jenny is active in the CMSNE New England states serving as co-chair for Public Policy promoting the advancement of the Nurse Licensure Compact, and Telehealth legislation for health care professionals. She has a passion for public policy and believes that legislation helps advance the field of professional case management. Jenny expanded her role, working on the National Board to becoming a member of CMSA Editorial Board 2021-current, CMSA Strategic planning committee for organizational development, Chair CMSA Finance Committee 2023-2026 and CMSA Sponsorship Committee 2022-current. Jenny has been employed at all levels of the transitions of care, working with traumatic brain Injury, stroke and spinal cord for over 25 years in acute rehabilitation hospitals, hospital at home program and Outpatient Program Director for traumatic brain injury. She recently has shifted her work in professional case management back to her first love, acute care, focusing on vascular and trauma care in ICU and step-down unit for Cape Cod Healthcare.