traumatic brain injury within the vha and dod systems of health care l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Traumatic Brain Injury within the VHA and DoD Systems of Health Care PowerPoint Presentation
Download Presentation
Traumatic Brain Injury within the VHA and DoD Systems of Health Care

Loading in 2 Seconds...

play fullscreen
1 / 39

Traumatic Brain Injury within the VHA and DoD Systems of Health Care - PowerPoint PPT Presentation


  • 357 Views
  • Uploaded on

Traumatic Brain Injury within the VHA and DoD Systems of Health Care. Rodney D. Vanderploeg, Ph.D. Tampa VAMC VA Psychology Leadership Conference/APA April 2006. Objectives. Describe the DoD/VHA system of specialized TBI care for active duty and veterans

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Traumatic Brain Injury within the VHA and DoD Systems of Health Care' - paul


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
traumatic brain injury within the vha and dod systems of health care

Traumatic Brain Injury within the VHA and DoD Systems of Health Care

Rodney D. Vanderploeg, Ph.D.

Tampa VAMC

VA Psychology Leadership Conference/APA

April 2006

objectives
Objectives
  • Describe the DoD/VHA system of specialized TBI care for active duty and veterans
  • Briefly describe TBI, and its incidence, severity, time course of recovery, and treatment stages
  • Describe the role of psychology and neuropsychology in TBI evaluation and care
defense veterans brain injury center
Defense & Veterans Brain Injury Center

Clinical Care

Research

Education

Prevention

Established in 1992

defense veterans brain injury center4
Defense & Veterans Brain Injury Center
  • Multi-site Center
  • Collaboration of Department of Defense & Department of Veterans Affairs
  • Established in 1992
  • Congressionally funded
  • Mission: Clinical Care, Clinical Research, and Education
slide5

Center HQ Support

Advisors

Research

Clinical Care

Education

Provider

Registry

VA

Concussion

VaNC

DoD

Rehabilitation

Pharm/Neurobehavior

Doctor/ Therapist

Family/ Caregiver

Patient

Defense & Veterans Brain Injury Center

(DVBIC)

Director

Deputy Dir

Consumer

Medic

defense veterans brain injury center6
Defense & Veterans Brain Injury Center
  • 3 Military Sites
  • 4 VA Sites
  • 1 Civilian Partner Program
defense veterans brain injury center7
Defense & Veterans Brain Injury Center
  • Military Sites
    • Walter Reed Army Medical Center (Head Quarters)
    • Naval Medical Center, San Diego
    • Wilford Hall US Air Force Med Ctr
defense veterans brain injury center8
Defense & Veterans Brain Injury Center
  • VA Sites
    • Minneapolis VA Medical Center
    • Palo Alto Health Care System
    • Richmond VA Medical Center
    • Tampa VA Medical Center
  • Civilian Partner Program
    • Virginia NeuroCare, Charlottesville
vha tbi network of care
VHA TBI Network of Care
  • 4 Lead TBI Centers
  • 16 Network Sites
  • 7 Associate Network Sites
slide10

*

Minneapolis

*

*

Richmond

Palo Alto

*

Tampa

VHA TBI Network of Care:

Four Lead TBI Rehabilitation Sites

interdisciplinary team and interdisciplinary rehab approach
Interdisciplinary Team and Interdisciplinary Rehab Approach
  • Rehab Medicine physician
  • Rehab nurses (primary nurse model)
  • Physical, Occupational, Recreational, and Vocational Therapists
  • Speech Therapists
  • Social Workers
  • Case Managers (including long-term)
  • Rehab or Counseling Psychologists
  • Neuropsychologists
inpatient acute rehabilitation
Inpatient Acute Rehabilitation
  • 3-5 hours of therapies per day (OT, PT, SP, Recreational, Psychology)
  • Average length of stay 1-3 months
  • Therapies include community outings planned and organized by the TBI patients together with the therapists
  • Case management begins before patients arrive and includes contacting families
  • Case management continues following discharge, may last for years
other lead tbi center programs
Other Lead TBI Center Programs
  • Low level or coma program: Only for those with acute coma, NOT long-term coma or vegetative state care
  • Short-stay admissions for:
    • Evaluation and treatment planning
    • Treatment trials
    • Re-evaluation
    • Vocational evaluations
  • Respite Care upon occasion
traumatic brain injury
Traumatic Brain Injury
  • Insult to the brain caused by an external physical force
  • Produces a diminished or altered state of consciousness
  • Results in impairments in physical, cognitive, behavioral, and/or emotional functioning
slide16

Coma

5

2

__1_

< 8

GCS

Mild TBI

= 13 - 15

Moderate TBI

= 9 – 12

Severe TBI

= 3 - 8

post traumatic amnesia
Post-traumatic Amnesia
  • The time interval from when the person regains consciousness until he or she is able to form memories for ongoing events
  • The individual is not fully oriented, typically confused, and unable to remember information after a period of distraction
slide19

Cogni t ive

Leve l

Preinjury Functioning

Mild TBI

Brief PTA

Moderate TBI

Ongoing Cognitive Problems

Severe TBI

INJURY

Ongoing Cognitive Problems

PTA

PTA

Coma

6

12

3

9

Retro-

Grade Amnesia

Months

traumatic brain injury20
Traumatic Brain Injury
  • Types of TBI
    • Open vs. Closed
  • Etiology
    • Motor vehicle accidents
    • Falls, assaults, gun shots to the head
    • Explosive Blasts (Iraqi conflict)
  • Demographics
    • Males > Females
    • Peak ages of incidence:

1-5 yrs; 15-24 yrs; >75 yrs

civilian incidence of tbi
Civilian Incidence of TBI
  • General Population
    • 1.5 Million Americans per year
    • 91 per 100,000
    • > Stroke, Spinal Cord Injury, MS
    • Prevalence: 5.3 million with TBI disability
military incidence of tbi
Military Incidence of TBI
  • Military and Veterans
    • 7,000 peacetime admissions annually
    • Active Duty males: 225 per 100,000
    • Active Duty females: 150 per 100,000
blast induced brain injury
Blast Induced Brain Injury
  • Rats exposed to whole body blasts (overpressurization waves) & to focal blasts to torso while head protected had cognitive dysfunction (Cernak et al. 2001)
  • Clinical characteristics of blast TBI in humans not well described in literature
war injuries explosive blasts
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)
  • 85% closed head injury
slide26

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.”

Shaun Radhay , a Marine, suffered brain damage and other injuries in a mortar blast.

By H. Darr Beiser, USA TODAY

consequences of tbi
Consequences of TBI
  • Cognitive
    • Attention
    • Information processing (speed & efficiency)
    • Memory and Learning
    • Abstract Reasoning
    • Executive Functions
      • Problem solving, planning, insight/awareness, set shifting, sequencing
consequences of tbi28
Consequences of TBI
  • Behavioral-emotional
    • Irritability
    • Impulsivity
    • Affect Regulation: apathy, agitation, aggression
    • Depression, Anxiety
    • Social Pragmatics

Cognitive and behavioral impairments are the most disabling long-term, more so than physical injuries

psychology related assessment issues
Psychology-Related Assessment Issues
  • Determining original severity of injury
  • Identifying past and present treatment, and the success or lack thereof
  • Neuropsychological evaluation of current functioning
  • Psychological functioning: Axis I & II, and coping resources
  • Identifying and assessing family and systems issues
neuropsychological assessment
Neuropsychological Assessment
  • Focus on Memory and Executive problems
  • Core (Brief) DVBIC Battery
    • WTAR (Wechsler Test of Adult Reading)
    • CVLT-II
    • Brief Visuospatial Learning Test – Revised
    • Letter-Number Sequencing (working memory)
    • D-KEFS Verbal Fluency (letters and semantic)
    • Design Fluency
    • Trails A and B
    • WCST-64
    • Grooved Pegboard Test
treatment considerations
Treatment Considerations
  • Treatment varies based upon:
    • Severity of injury
    • Time since injury
    • Constellation of impairments
mild tbi overlapping symptoms across conditions
Mild TBI: Overlapping Symptoms across Conditions
  • Postconcussion Syndrome (PCS)
    • Insomnia
    • Impaired memory
    • Poor concentration
    • Depression
    • Anxiety
    • Irritability
    • Headache
    • Dizziness
    • Fatigue
    • Noise/light intolerance
  • PTSD
    • Insomnia
    • Memory problems
    • Poor concentration
    • Depression
    • Anxiety
    • Irritability
    • Stress symptoms
    • Emotional numbing
    • Avoidance
slide33

Predisposing Factors Causative Factors Perpetuating and Mitigating Factors

Medical Iatrogenesis

Psychiatric Conditions

Psychiatric Conditions

Litigation Iatrogenesis

Personality Traits

Personality Traits

Medical Conditions

Medical Conditions

Self-Expectation

Acute Symptoms

Chronic Symptoms

Intelligence Level

Intelligence Level

mTBI

Demographic Characteristics

Coping Abilities

Social Support

Coping Abilities

slide36

Cogni t ive

Leve l

Preinjury Functioning

Mild TBI

Brief PTA

Ongoing Cognitive Problems

Moderate TBI

INJURY

Severe TBI

PTA

Ongoing Cognitive Problems

PTA

Coma

Months

6

12

3

9

Retro-

Grade Amnesia

Mild TBI Interventions

Psychological Support, Psychotherapy, Existential Issues, Family Issues

slide37

Cogni t ive

Leve l

Preinjury Functioning

Mild TBI

Brief PTA

Ongoing Cognitive Problems

Moderate TBI

INJURY

Severe TBI

PTA

Ongoing Cognitive Problems

PTA

Coma

Months

6

12

3

9

Retro-

Grade Amnesia

Psychological Support, Psychotherapy, Existential Issues, Family Issues

Acute Specialized Brain Injury Rehabilitation

For those with Moderate to Severe Injuries

slide38

Cogni t ive

Leve l

Preinjury Functioning

Mild TBI

Brief PTA

Ongoing Cognitive Problems

Moderate TBI

INJURY

Severe TBI

PTA

Ongoing Cognitive Problems

PTA

Coma

Months

6

12

3

9

Retro-

Grade Amnesia

Psychological Support, Psychotherapy, Existential Issues, Family Issues

Subacute Rehab, Outpatient Therapies, Day Treatment, or Community Re-Entry Programs

slide39

Cogni t ive

Leve l

Preinjury Functioning

Mild TBI

Brief PTA

Ongoing Cognitive Problems

Moderate TBI

INJURY

Severe TBI

PTA

Ongoing Cognitive Problems

PTA

Coma

Months

6

12

3

9

Retro-

Grade Amnesia

Psychological Support, Psychotherapy, Existential Issues, Family Issues

Vocational Rehabilitation and/or Ongoing Case Management