TBI TRAUMATIC BRAIN INJURY WITHIN THE MILITARY/VETERAN POPULATION

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1 TBI TRAUMATIC BRAIN INJURY WITHIN THE MILITARY/VETERAN POPULATION

2 What is TBI? An external force that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from mild, i.e., a brief change in mental status or consciousness to severe, i.e., an extended period of unconsciousness or amnesia after the injury. The majority of TBIs that occur each year are concussions or mild TBI.

3 Classification of TBI Severity Criteria Mild Moderate Severe Structural imaging Normal Normal or abnormal Normal or abnormal Loss of Consciousness (LOC) 0 30 min > 30 min and < 24 hrs > 24 hrs Alteration of consciousness/mental state (AOC) * a moment up to 24 hrs > 24 hours. Severity based on other criteria Post-traumatic amnesia (PTA) Glascow Coma Scale (best available score in first 24 hours) 0 1 day > 1 and < 7 days > 7 days < 9

4 Defense and Veterans Brain Injury Center: Recovering from Traumatic Brain Injury

5 Mild TBI/Concussion Most people with a concussion recover quickly and fully. In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past may find that it takes longer to recover if they have another concussion. Many service members and Vets suffer from a combo of mtbi and PTSD

6 mtbi- invisible injury o You don't have to be knocked out to have a mtbi. o You may be dazed, confused, or had your "bell rung. o Can t always see a brain injury o May have no other visible physical injuries o Compensate or hide deficits o Difficulty functioning in workplace, school, society o Significant Cognitive and Social deficits

7 Moderate A loss of consciousness lasts from a few minutes to a few hours Confusion lasts from days to weeks Physical, cognitive, and/or behavioral impairments last for months or are permanent. Persons with moderate traumatic brain injury generally can make a good recovery with treatment or successfully learn to compensate for their deficits. Department of Defense and Veteran's Head Injury Program & Brain Injury Association of America (1999).

8 Severe Injury Loss of consciousness longer than 6 hours Will require intensive rehabilitation after stable medically Will likely have lasting effects

9 Civilian mild TBI vs. Military mild TBI Civilian Mild single incident TBI Motor vehicle accident or assault, sports Immediate medical response, hospitalization, medical follow-up, rest Resolution of neuropsychological problems 3-6 months Many in litigation Military Multiple concussions Blast wave exposures, falls, motor vehicle accidents May/may not have medical attention, less hospitalization, increased chaos at time of event Co-occurring exposures Desire for redeployment

10 TBI: Signs & Symptoms Headaches Cognitive deficits-memory, concentration, decision making, problem solving, disorientation Slow processing, speaking, acting or reading Feeling tired all of the time, having no energy or motivation, initiation Mood changes--depression, Anxiety, personality changes, aggression, acting out and social inappropriateness Light-headedness, dizziness or loss of balance Nausea Increased sensitivity to lights, sounds or distractions Blurred vision or eyes that tire easily Loss of sense of smell or taste Ringing in the ears (Tinnitus) Changes in sleep patterns (sleeping a lot more or having a hard time sleeping)

11 mtbi & PTSD odifficult to differentiate ooverlap of symptoms otiming of events ochallenges in dx 42% of OIF/OEF veterans with a history of mtbi also had PTSD symptoms Lew et al., 2007; Journal of Rehabilitation Research & Development

12 TBI /PTSD Overlap Physical Headache, dizziness, fatigue, noise/light intolerance, insomnia, ringing in the ears (tinnitus), loss of sense of smell or taste Cognitive Slowed thinking, difficulty remembering, concentrating, or making decisions Emotional Depression, anxiety, irritability, affective lability

13 Associated symptoms/issues Depression PTSD Substance abuse Anger Physical injuries, chronic pain Feelings of guilt and shame Suicidal thoughts Employment/academic problems Financial problems Relationship problems

14 Physical Injuries PTSD Substance Use Disorder Mild TBI Anxiety Depression Pain

15 What does TBI treatment look like? Acute hospitalization Inpatient, Acute Rehab Out patient Rehab Community Reintegration Multi/interdisciplinary approach Regardless of where symptoms are coming from, treat them Education/expectations No quick fix Support system

16 TBI Step-Care Treatment Model COGNITIVE ISSUES IRRITABILITY / IMPULSIVITY SOMATIC COMPLAINTS SELF-CARE ROUTINES* BEHAVIORAL HEALTH ISSUES EDUCATION: Expectation of Recovery Begin each encounter at the bottom of the pyramid and progress upward * Includes SLEEP HYGIENE, diet, exercise, and avoiding further TBI Terrio 2009

17 Best practices when working with TBI population Medical history, (Visual problems, hearing issues, light sensitivity, pain, headaches) May need shorter session, meet more frequently (mental fatigue, slow processing) Time of appt (Morning vs. afternoon, Sleep cycle, Mental fatigue at end of day) Keep it simple Yes/no questions, close ended questions Few choices Few distractions (quiet, 1:1) Body language and tone of voice may differ with TBI

18 TBI Treatment & Services at the VA All OEF/OIF/OND Combat Veterans are screened for possible TBI If screening is positive, Vet is offered a comprehensive TBI evaluation with a specialist Polytrauma/TBI services and/or point of contact at every VAMC (Polytrauma Rehab Centers, Polytrauma Network Sites, Polytrauma Support Clinical Teams and Point of Contact) Injury does not have to be combat related in order to receive services from Polytrauma/TBI Interdisciplinary team approach-physiatry, Neurology, Optometry, Audiology, Speech/Cognitive therapy, Physical & Occupational therapy, Pain Management, Mental Health Involvement of support system

19 Questions? Lisa Estes Polytrauma/TBI Coordinator VA Medical Center Marion, IL ext

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