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Assessment and Treatment of Traumatic Brain Injury

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Assessment and Treatment of Traumatic Brain Injury Powered By Docstoc
					  Assessment and Treatment of
 Traumatic Brain Injury within the
ECHCS Polytrauma System of Care

      Estela Bogaert-Martinez, Ph.D.
    Director, Traumatic Brain Injury Team
        Acknowledgement

Thanks to Rod Vanderploeg, PhD
Neuropsychologist, Polytrauma Center Tampa
VAMC , and to Michael Craine, Ph.D., Co-
Director, VISN19 Polytrauma Network Site, for
contributions to this material.
           Background
 Many   of those returning from current
  conflicts had experiences that put them at
  risk for TBI.
 Mild symptoms of TBI may be difficult to
  recognize, or confused with other
  conditions.
 Treatment of symptoms may be very
  different for TBI patients.
           War Injuries:
          Explosive Blasts
• Most common cause of injury
• 64% of war injuries caused by blasts
• 41% of blast injured at WRAMC had
  TBI (01/05 - 02/06)
Key Iraq wound: Brain trauma
By Gregg Zoroya, USA TODAY



“A growing number of U.S. troops whose body armor helped them
survive bomb and rocket attacks are suffering brain damage as a
result of the blasts. It's a type of injury some military doctors say has
become the signature wound of the Iraq war.”
            Traumatic Brain Injury
 Insultto the brain caused by an external
  physical force
 Produces a diminished or altered state of
  consciousness
     • Dazed and confused for several minutes or
     • Knocked out / Rendered unconscious and/or
     • With memory gaps for some or all of the
       immediate period after the event
 Resultsin impairments in physical, cognitive,
  behavioral, and/or emotional functioning
          Consequences of TBI
 Cognitive
 Memory deficits, poor concentration, thinking
 problems
 Emotional-Behavioral
  Depression, anxiety, irritability, mood swings
  Impulsivity, apathy, agitation, aggression
 Physical
 Headache, dizziness, fatigue, noise/light
 intolerance, insomnia/sleep disturbance
Levels of Severity

•   Mild
•   Complicated Mild
•   Moderate
•   Severe
C   Preinjury
o   Functioning                       Mild TBI
g                  Brief
n                  PTA
i                                                                       Moderate
                                         Ongoing Cognitive Problems
t                                                                         TBI
i
v                                                                     Severe TBI
e
                  I
                                                       Ongoing Cognitive Problems
L                 N
                           PTA
e                 J
v                 U
e                 R
l                 Y              PTA
                      Coma



             Retro-               3              6            9           12
         Grade Amnesia
                                                     Months
   TBI Treatment Considerations
 Treatment  varies based upon:
   Severity of injury

   Time since injury

   Constellation of impairments
Continuum of Care for TBI / Polytrauma

               Acute Rehab   Post-Acute
                               Rehab




 Trauma Care    Subacute     Community
                 Rehab         Rehab



                             Outpatient
                Long-Term    Specialty
                  Care         Care
Interdisciplinary Traumatic Brain Injury Team
- an Interdisciplinary Rehabilitation Approach
  •   Rehabilitation medicine physician
  •   Physical therapist
  •   Occupational therapist
  •   Speech Therapist
  •   Supported employment/Vocational rehabilitation
      specialist
  •   Social Worker
  •   Rehabilitation Psychology
  •   Neuropsychology
        TBI Rehabilitation Interventions to
         Support Reintegration to Family,
             Community and Work
• TBI Education & Support
• Cognitive Deficits:
       Compensatory Training/Cognitive Remediation
       Stimulant Medications; physical activation

•   Vocational Rehablitation/ Supported Employment
•   Stress Management Training
•   Social Skills Training
•   Specialty Treatment for Secondary Conditions:
    PTSD, Depression, Anxiety, Chronic Pain, HA, etc.
       Follow-up Additional Specialized
       Assessments and Treatment

   TBI: TBI Team

   PTSD: PTSD Program, Mental Health

   Chronic Pain: Pain Program, PM&RS

   Depression, Anxiety, Stress: Mental Health

   Seizures, Neurologic Conditions: Neurology
             What to Know:
          Relevant Background
 Mild   TBI Symptoms
     There is no symptom that is unique to or
      diagnostic of mild TBI
     Many postconcussion symptoms occur in
      normal healthy individuals
     All symptoms/problems overlap with one or
      more other conditions (PTSD, Depression,
      Anxiety, Chronic Pain, Somatoform Disorder,
      chronic health conditions)
                       + PTSD
                      Re-experiencing

                   Avoidance
                                            Arousal
                Social withdrawal
                  Memory gaps
                                       Sensitive to noise
                     Apathy
                                       Concentration
? Mild     Difficulty with decisions
                                          Insomnia
                                          Irritability
               Mental slowness
  TBI            Concentration
Residual          Headaches
                      Dizzy
               Appetite changes
                    Fatigue
                   Sadness
            + Depression

				
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