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

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

2
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.
3
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.

4
War InjuriesExplosive 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)

5
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.
6
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

7
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

8
Levels of Severity

• Mild
• Complicated Mild
• Moderate
• Severe

9
(No Transcript)
10
TBI Treatment Considerations

• Treatment varies based upon
• Severity of injury
• Time since injury
• Constellation of impairments

11
Continuum of Care for TBI / Polytrauma
Post-Acute Rehab
Acute Rehab
Subacute Rehab
Community Rehab
Trauma Care
Outpatient Specialty Care
Long-Term Care
12
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

13
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.

14

• Follow-up Additional Specialized Assessments
  and Treatment
• TBI TBI Team
• PTSD PTSD Program, Mental Health
• Chronic Pain Pain Program, PMRS
• Depression, Anxiety, Stress Mental Health
• Seizures, Neurologic Conditions Neurology

15
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)

16
PTSD Re-experiencing
Avoidance Social withdrawal Memory gaps Apathy
Arousal Sensitive to noise Concentration Insom
nia Irritability
? Mild TBI Residual
Difficulty with decisions Mental
slowness Concentration Headaches Dizzy Appetite
changes Fatigue Sadness
Depression