Assessment and Treatment of Traumatic Brain Injury[1]

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., CoDirector, 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  Insult to 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  Results in 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 o g n i t i v e L e v e l Preinjury Functioning Brief PTA Mild TBI Ongoing Cognitive Problems Moderate TBI Severe TBI I N J U R Y Ongoing Cognitive Problems PTA PTA Coma RetroGrade Amnesia 3 6 9 12 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 Rehab Community Rehab Long-Term Care Outpatient Specialty 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 Social withdrawal Memory gaps Apathy Arousal Sensitive to noise Concentration Insomnia Irritability ? Mild TBI Residual Difficulty with decisions Mental slowness Concentration Headaches Dizzy Appetite changes Fatigue Sadness + Depression