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Polytrauma Rehabilitation: A New Model of Care. Rose Collins, Ph.D. Minneapolis VA Medical Center VA Psychology Leadership Conference/ APA April 28, 2006. Objectives. Polytrauma: Definition and patterns Paradigm of Care Psychology in Polytrauma Care Treatment Issues and Considerations

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polytrauma rehabilitation a new model of care
Polytrauma Rehabilitation: A New Model of Care

Rose Collins, Ph.D.

Minneapolis VA Medical Center

VA Psychology Leadership Conference/ APA

April 28, 2006

objectives
Objectives
  • Polytrauma: Definition and patterns
  • Paradigm of Care
  • Psychology in Polytrauma Care
  • Treatment Issues and Considerations
  • Future Concerns and Directions
tbi blast injury polytrauma
TBI, Blast Injury & Polytrauma
  • TBI in peacetime: civilian vs. military
    • Mechanism: MVA, falls
    • Incidence
  • TBI in combat:
    • Mechanism: Blast
    • Incidence
  • Blast injury sequelae: Polytrauma
common sequelae of blast injury
Brain injury

Amputation

Fractures

Wounds

Psychological-PTSD

Crush injuries

Burns

Auditory/vestibular

Eye, orbit, face,

Dental

Renal

Respiratory

Cardiac and vascular

Gastrointestinal

Pain

Peripheral nerve

Common Sequelae of Blast Injury
polytrauma definition
Polytrauma: Definition
  • Trauma to several body areas or organ systems
  • Occur at the same time
  • One or more is life threatening
tbi in combat settings
TBI in Combat Settings
  • New mechanism of injury
  • New constellation of injuries
  • Challenges to TBI rehabilitation
  • New expertise and new model of care
polytrauma rehabilitation centers prc level i
Polytrauma Rehabilitation Centers (PRC) Level I
  • New patterns of injurynew paradigm of care
  • “Brain Injury Plus”
  • Brain injury drives the care process
  • Integrate care for complex polytrauma in single location—simultaneous tx of mult injuries
  • Higher level of medical acuity
  • Sequence and integrate treatment to meet patient need
  • Coordinated team effort with expanded team of consultants
extensive team of consultants
Anesthesiology

Audiology

Chaplin Services

Dentistry

Driver Rehabilitation

Gastroenterology

General Surgery

Infectious Disease

Medicine

Neurology

Neuro-ophthalmology

Neurosurgery

Nutritionist

Optometry

Oral and Maxillofacial Surgery

Orthopedics

Orthotics

Otolaryngology

Pharmacy

Plastic Surgery

Prosthetics

Psychiatry

Pulmonology

Radiology

Urology

Vocational Specialist

Extensive Team of Consultants
care across the continuum coma to community
Care Across the Continuum:Coma to Community
  • Multi-level national network of care
  • Delivery of specialized care close to home
  • Comprehensive interdisciplinary assessment of previously unidentified TBI patients
  • Proactive Case Management
  • Continued management of existing and emerging sequalae
  • Care for the patient who can’t return home
  • Telehealth
  • Identification of community resources
  • Collaboration with VBA
va polytrauma system of care

Seamless Transition

Department of Veterans Affairs

Department of Defense

VHA Continuum

of Rehab Care

DOD Healthcare Sys

VA Polytrauma System of Care

VHA

Polytrauma Rehab Centers (Level 1)

Polytrauma Network Sites (Level 2)

DVBIC

VBA

Polytrauma Teams (Level 3)

Local VA Polytrauma Case Mgrs (Level 4)

State & Community Resources

Specialized Rehabilitation Services

Informed, Empowered Patient & Family

Dynamic Links

The Right Care, At the Right Time, In the Right Place

Better Functional and Clinical Outcomes, Higher Satisfaction, Lower Costs

case management challenges
Family

DoD/VA Liaison

Military Treatment Facility

Military Transport

Military Command

TRICARE

Medical Holding Company

“Home” VA Medical Center (Level II, III)

Civilian Hospital

State/Local Services

Veterans Benefits

Case Management Challenges
psychology in polytrauma rehabilitation
Psychology in Polytrauma Rehabilitation
  • Integrated, active, interdisciplinary team member
  • Combat Stress and PTSD
  • Complex Pain syndromes
  • Behavioral management, adherence
  • Depression, Suicide
  • Intimacy
  • Provider stress
  • Education to mental health staff, nursing, and all hospital staff, Level II sites
family issues
Family Issues
  • Multiple stressors
    • Away from home, support systems
    • Care of other children, aging parents
    • Job loss, financial strain
  • Adjusting to VA and rehab environment
  • Duration, intensity & fluctuation of medical course
  • Expectations: Advocacy vs entitlement
family issues15
Family Issues
  • Role strain and change
  • Stress, trauma
  • Political context
  • Anger, grief and loss
  • Guilt
  • “Ambiguous loss” (Boss, 1999; 2006)
  • Depression, anxiety
  • Stress increases at transfer to Level 2
treatment considerations
Treatment Considerations
  • Pathologizing family vs family stress theory
  • Psychodynamic interpretations, motivated forgetting
  • Group size, duration
  • Directive, active, concrete, metaphor
  • Multi-modal education and treatment
  • Adjusting “to” and “with” cognitive impairments
  • Acceptance vs status quo
  • Assistance: increasing dependency vs support for  independence
future issues directions
Future Issues & Directions
  • (Complicated) Mild TBI
  • Vocational rehab & supports
  • Community reintegration
  • Increase substance abuse
  • Increase suicide
  • Life span, aging, secondary condidtions