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LCDR Joann Shen , MS CCC-SLP & LTJG Megan Kelly, OTR/L MS, MSC, USN. The Patient Centered Team : How an Interdisciplinary Approach Can Be Used in Treatment of mTBI For Service M embers.

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slide2

DISCLAIMER We do not have any financial or nonfinancial relationships relevant to thecontent of the proposals to disclose.The views expressed in this presentation are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

slide3

Objective: This session will provide an overview of some of the cognitive and visual domains that can be addressed with service members with traumatic brain injury (TBI) in interdisciplinary therapy sessions with SLP and OT. We will discuss the process of clinical collaboration and how we treat cognition and visual symptoms in mTBI through an interdisciplinary approach.

slide4

At the end of the session, participants will be able to:1. Explain what is an interdisciplinary model for the rehabilitation of mTBI2. Describe how to treat cognition and visual symptoms through collaboration3. Summarize how an interdisciplinary approach can be used in treatment of mTBI

slide5

WHERE DID WE START- 5 staff members in TBI trailer- Multiple sites across base- Specialized care (multidisciplinary)- Traditional medical, including pharmacologic treatments, allied health therapy

holistic integrative patient and family centered
- Holistic- Integrative- Patient and family centered

WHERE ARE WE NOWServices available for concussion therapy:Traditional medical therapy, including pharmacologic treatments, allied health treatments with physical and occupational therapy, speech and language therapy. Complementary and alternative medicine (sleep hygiene, art therapy, acupuncture, mindfulness, yoga, etc.)

physical therapy
Physical Therapy
  • Vestibular Rehabilitation
  • Physical accommodation
  • Physical health management
occupational therapy
Occupational Therapy
  • Vision Therapy and Visual Perceptual Training
  • Stress Management
  • Anxiety Management
  • Sleep Hygiene Strategies
  • Skill integration for

holistic function

speech therapy
Speech Therapy
  • Cognitive Communication Rehabilitation
  • Group treatment to reinforce compensatory strategies and social communication
  • Assistive/accommodations technology training (CAP, smart phone, apps, etc.)
interdisciplinary
Interdisciplinary

WHERE ARE WE HEADED- Multiple pathways to recovery (Return to Duty vs. Return to Community)- Identify & participate in research to contribute to scientific TBI body of knowledge (outcome measures/ validate best practice models)

collaborative therapy outcomes
Collaborative Therapy Outcomes
  • Improved Preparation for Return to Community
  • Improved Preparation for Return to Duty
  • Goal setting and discharge as a team
  • Improved Goal Setting and Achievement for Providers and Service Members
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CHALLENGES:- Logistics (admin barrier, provider schedules, unstaffed teams)- Medical vs. Rehab model- Provider’s willingness to participate and collaborate- Redundancy of services

slide18

SOLUTIONS:Define the leadership roles, program parameters, hiring staff, and developing an interdisciplinary team approach.

references
References:
  • Parrish, C., Roth, C., Roberts, B., Davie, G. (2009). Assessment of cognitive-communicative disorders of mild traumatic brain injury sustained in combat. PerspectNeurophysiolNeurogenic Speech Language Disorders, 19(2), 47-57.
  • Leape, L., Berwick, D., Clancy., Gluck, P., Guest, J., Lawerence, D., Morath, J., et.al. (2009). Transforming healthcare: A safety imperative. Quality and Safety Healthcare, 18(6), 424-428.
  • Mashima, P. (2013). Rehabilitating post-deployment cognitive symptoms: Empowering change [PowerPoint slides]. TBI Grand Rounds, San Antonio Military Medical Center.
  • Radomski, M., Davidson, L., Voydetich, D., Erickson, M. (2009). Occupational therapy for service members with mild traumatic brain injury. American Journal of Occupational Therapy, 63(5), 646–655.
  • Riesthal, M. (2009). Treatment of cognitive-communicative disorders following blast injury. PerspectNeurophysiolNeurogenic Speech Language Disorders, 19(2), 58-64.
  • Scherer, M., Weightman, M., Radomski, M., Davidson, L., McCulloch, K. (2013). Returning service members to duty following mild traumatic brain injury: Exploring the use of dual-task and multitask assessment methods. Physical Therapy, 93, 1254-1267.
  • Schneider, S. , Haack, L., Owens, J., Herrington, D., Zelek, A.; An Interdisciplinary treatment approach for soldiers with TBI/PTSD: issues and outcomes. PerspectNeurophysiolNeurogenic Speech Language Disorders 2009; 19(2):36-46.
  • Solomon, P. (2010). Inter-professional collaboration: Passing fad or way of the future? Physiotherapy Canada, 62(1), 47-55.