# Presentation: 219455

## 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 

**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

## Slide 9

## TBI Treatment Considerations

- Treatment varies based upon:
- Severity of injury
- Time since injury
- Constellation of impairments

## Continuum of Care for TBI / Polytrauma

**Trauma Care**

**Long-Term Care**

**Subacute Rehab**

**Acute Rehab**

**Post-Acute Rehab**

**Community Rehab**

**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

-  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.

- TBI Rehabilitation Interventions to Support Reintegration to Family, Community and Work

## 		Follow-up Additional Specialized 		Assessments and Treatment

- 		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 

- + PTSD
**Re-experiencing**

**Avoidance**
**Social withdrawal **
**Memory gaps**
**Apathy**

- ? Mild
-    TBI
- Residual

**Difficulty with decisions**
**Mental slowness**
**Concentration**
**Headaches**
**Dizzy**
**Appetite changes**
**Fatigue**
**Sadness**

**Arousal**
**Sensitive to noise**
**  ****Concentration**
**Insomnia**
**Irritability**

- + Depression