Traumatic Brain Injury A Multidisciplinary Approach Oscar Guillamondegui, MD, MPH, FACS Trauma Medical Director Vanderbilt University Nashville, Tennessee.

Slides:



Advertisements
Similar presentations
Preventing the First Episode of Psychosis
Advertisements

Traumatic Brain Injury Presented by: David L Strauss, Ph.D. ReMed.
NHS Croydon Claire Godfrey AD Adult Strategic Commissioning.
Improving Psychological Care After Stroke
Supporting people in Dorset to lead healthier lives Commissioning the Dorset Community Persistent Pain Management Service Why is it so Painful to Commission.
Parvaneh Rabiee, Kate Baxter, Gillian Parker and Sylvia Bernard RNIB Research Day 2014: Rehabilitation and social care RNIB, 105 Judd Street, London 20.
The Long Term Impact of Brain Injury on Children & Families Martine Simons &Suzanne Benson Senior Social Worker Senior Clinical Psychologist and Clinical.
Department of Veterans Affairs Caregiver Support Program Update
Linking Actions for Unmet Needs in Children’s Health
Incorporating Behavioral Health in the EHR to Improve Care Insitute of Medicine | November 25, 2013 Brigid McCaw, MD, MS, MPH, FACP Medical Director, Family.
Kris Bakkum Kari Svihovec BrainU True or False? 1. Meningitis is caused by either a virus or a form of bacteria. 2. Viral meningitis causes.
Mayo Brain Injury Outpatient Program: Methods and Outcomes James F. Malec, PhD Professor, Professor, Mayo Clinic and Medical School Rochester, MN USA.
Unintentional Fall Injuries and Deaths Among MA Older Adults, Ages 65 Years and Over Carrie Huisingh, MPH, Epidemiologist Holly Hackman, MD, MPH, Epidemiologist.
Planning to Address the Complex Needs of Neuro-Rehabilitation in Kentucky Chell Austin, Executive Director Brain Injury Alliance of Kentucky 7321 New LaGrange.
Traumatic Brain Injury
National Polytrauma System of Care and VISN 19 Polytrauma System of Care Michael Craine, PhD Chief, Health Psychology Section, VA Eastern Colorado Health.
Cathryn Nelson Neuroscience Capstone  Affect between 1 and 1.5 million people in the United States each year. Often results in expensive hospitalization.
Health Care Providers Working with the Elderly Chapter 10.
Adult Short Term Assessment and Treatment (ASTAT) & Group Therapy Services (GTS)
Traumatic Brain Injury and Depression Prepared for: Agency for Healthcare Research and Quality (AHRQ)
Traumatic Brain Injury (TBI) Rehabilitation Programs for Younger Children and Adolescents Vanderbilt Bill Wilkerson Center: Pi Beta Phi Rehabilitation.
8/5/ Health Issues for Children in Foster Care Abraham Rice, M.D. Foster Care Clinic Medical Director Contra Costa Regional Medical Center Ab.
Albany VAMC Polytrauma Clinic February 25, 2009 Barbara Bates, MD, MBA.
Traumatic Brain Injury- TBI National Association of Special Education Teachers.
FIM+FAM – OUTCOME MEASURES Presented by Caroline Ray On behalf of Queen Elizabeth’s Foundation Brain Injury Centre, Banstead, Surrey.
TRAUMA SYSTEM Mazen S. Zenati, M.D, MPH, Ph.D. University of Pittsburgh Department of Surgery and Epidemiology.
Mary S. McCabe Survivorship Care Planning. National Directions Focus on recurrence Increasing expectations by patients and families Identification of.
Screening for Stroke and Cognitive Impairment Chapter 2: Background.
Assessment and Treatment of Traumatic Brain Injury within the ECHCS Polytrauma System of Care Estela Bogaert-Martinez, Ph.D. Director, Traumatic Brain.
Behavioral Health Issues and Pediatric Hospitalizations Stephen R. Gillaspy, PhD 11/05/09 Reaching Out To Oklahoma III Annual Pediatric Interdisciplinary.
© Copyright, The Joint Commission 1 Update on the Joint Commission’s Substance Use (SUB) Core Measure: SUB-1 Alcohol Use Screening Celeste Milton, MPH,
Traumatic Brain Injury Definition
Psychological care after stroke: A national update
Overseers Board Meeting December 7, When a Parent Returns with Visible or Invisible Wounds of War.
Educating Medical Students about the Care of Patients with Disabilities Kira Zwygart, MD Laurie Woodard, MD University of South Florida College of Medicine.
Data on Brain Injury in Massachusetts: A Snapshot Jean McGuire Executive Office of Health and Human Services Presentation to the Brain Injury Commission.
Disability Awareness Understanding and Caring For America’s Veteran’s.
Evidence-based and Ethical Practice in Rehabilitation for TBI and Polytrauma James F. Malec, PhD, ABPP-Cn,Rp Research Director Rehabilitation Hospital.
How can COPD Community Services reduce hospital admissions? Glenda Esmond Respiratory Nurse Consultant West Herts Community COPD Service.
Introduction: Medical Psychology and Border Areas
Low Incidence Disabilities. Prevalence Very low incidence disabilities include those with prevalence rates between 1/10 th and ½ of a percent Three very.
Sex Differences in Profiles and Outcomes of Patients with Traumatic Brain Injury in a National Rehabilitation Sample Dr. Angela Colantonio PhD, OT Reg.
Traumatic Brain Injury in the United States Emergency Department Visits, Hospitalizations, and Deaths 1995–2001 National Center for Injury Prevention and.
Traumatic Brain Injury in Florida: Statewide Needs Assessment Data & Implications for Broward County Deborah A Mulligan, MD FAAP FACEP Institute for Child.
The KU Wichita Center for Breast Cancer Survivorship Judy Johnston, MS, RD/LD Research Instructor Department of Preventive Medicine and Public Health,
Speech Language Pathologist By: Holly Christensen MAP 3A/4A.
Specialist Dementia Care in Lancashire An approved approach to dementia care in Lancashire February 2012.
CHILDREN & YOUNG PEOPLE’S DIRECTORATE Director of Children & Young People/Executive Director of Social Work Assistant Director Corporate Parenting Assistant.
In-Reach Hospital Program In-Reach Hospital Program Coordinating Multiple Service Providers Rare Presentation Partnership between: South Central Human.
CSD 2230 HUMAN COMMUNICATION DISORDERS Topic 6 Language Disorders Adult Disorders Traumatic Brain Injury Dementia.
Life After Brain Injury? Manifesto for children, young people and offending behaviour.
Non-pharmacological interventions to reduce psychological sequelae of mild traumatic brain injury: A systematic review Dr Nikola Creasey Paediatric Emergency.
Northumberland Head Injuries Service: Combined Health and Social Care Neil Brownlee Northumberland.
Health Related Quality of Life after serious occupational injuries and long term disability Presenter: Ibishi Nazmie MD,PhD University Clinical Center.
Traumatic Brain Injury: Epidemiology, Issues and Challenges Jean A. Langlois, ScD, MPH Centers for Disease Control and Prevention Institute of Medicine.
Status Epilepticus Presenting After Traumatic Brain Injury in Infants Kurz, J. E.1; Zelleke, T.1; Carpenter, J.1; Dean, N.2; Singh, J.1; Kadom, N.3; Gaillard,
Cognition Amy Waite, MA/CCC-SLP Speech Language Pathologist
The role of a neurosurgeon in caring for patients with traumatic brain injury Kevin Yoo M.D.
Depression and PTSD in Orthopedic Trauma
Cognitive Behaviour Therapy
Inclusive Community Choices
Mental Disorders.
Traumatic Brain Injury-TBI
A problem A lack of leaning aids for someone who has suffered a TBI (Traumatic Brain Injury) and is over the age of 18.
Traumatic Brain Injury (TBI)
Investigating the Impact of Traumatic Brain Injury on Caregiver Life Satisfaction: A Key Element of Successful Community Participation *Wheeler, S., **Motsch,
Co-PI: Ben Coopwood, MD, FACS
Peer Support for Post Intensive Care Syndrome (PS-PICS)
Indiana Traumatic Brain Injury State Plan 2018 – 2023
Presentation transcript:

Traumatic Brain Injury A Multidisciplinary Approach Oscar Guillamondegui, MD, MPH, FACS Trauma Medical Director Vanderbilt University Nashville, Tennessee

Conflicts of Interest None

Traumatic Brain Injury Why does a trauma surgeon care?

Traumatic Brain Injury Why does a trauma surgeon care? –Not a neurosurgeon

Traumatic Brain Injury Why does a trauma surgeon care? –Not a neurosurgeon –Don’t do cognitive evaluations

Traumatic Brain Injury Why does a trauma surgeon care? –Not a neurosurgeon –Don’t do cognitive evaluations –Have no long-term memory

Traumatic Brain Injury Why does a trauma surgeon care? –Managers of trauma –Contract with community –MAJOR problem with no major stakeholder

Traumatic Brain Injury Background 1.4 million people sustain TBI annually –Does not include non-diagnosed military sports-related –$56 billion direct/indirect costs 50,000 die annually Approximately 100,000 long-term disability CDC, Report to Congress TBI, 2003

Traumatic Brain Injury Background Langlois JHTR 2006

Traumatic Brain Injury Background Langlois JHTR 2006

Traumatic Brain Injury Background Langlois JHTR 2006

All Major Trauma

Yes TBI All Major Trauma

ISS >15 No TBI ISS >15 Yes TBI ISS< 15 Yes TBI All Major Trauma

ISS >15 No TBI ISS >15 Yes TBI ISS< 15 Yes TBI Ongoing Cognitive Issues Ongoing Mental Health Issues All Major Trauma

Traumatic Brain Injury Overview TBI affects all levels of society Majority (75 to 90%) recover quickly –“Mild” = 90% 10 to 25% have long-term deficit The ‘Hidden’ TBI patient –Emotional distress Iverson, Current Opinions Psych, 2005 Cicerone, JHTR, 2004 Gordon, JHTR, 1998

Traumatic Brain Injury Long-term Outcomes Wide range of functional issuesWide range of functional issues –Cognitive changes MemoryMemory ReasoningReasoning Language difficulties (communication/understanding)Language difficulties (communication/understanding) –Senses Loss of hearing, taste, smellLoss of hearing, taste, smell –Mental Health: DepressionDepression AnxietyAnxiety PTSDPTSD

Traumatic Brain Injury Long-term Outcomes

Traumatic Brain Injury Long-term Outcomes: Depression Community: 10% –8 - 10% Trauma Ctr: 20% –12- 20% Rehab Ctr: 30% –15 -50% Tertiary Care: 35% –16- 77% AHRQ 11-EHC017-EF Apr ‘11

Traumatic Brain Injury Long-term Outcomes: Associated Findings Anxiety: –31% v 77% PTSD: –11% v 37% Any concommitant: –8-93% AHRQ 11-EHC017-EF Apr ‘11

Traumatic Brain Injury Cognitive Therapy Minimal intervention improves outcome –Contact post-discharge 48 hrs –Follow-up at 5-7 days Cognitive assessment performed Coping strategies for common symptoms –Follow-up at 3 months Control Group had increased PCS complaints at follow-up Ponsford 2002

Traumatic Brain Injury Cognitive Therapy Increased intervention improves outcome –RCT (small: 24 cases/27 controls) –Intensive intervention led to more rapid progress –Those with progress discharged sooner –Intensity of therapy had no ‘ceiling effect’ –Cost-effectiveness remains an issue Shiel, Clin Rehab 2001

Multidisciplinary TBI Clinic Team –Trauma Surgeon –Nurse Practitioner –Social worker –Speech Pathologist –Brain Injury Association of Tennessee –Program Manager –Trauma Survivor Network Peer Visitor

Multidisciplinary TBI Clinic Program –Identify patients with Intracranial Hemorrhage Upon admission Consult with Speech-Pathologist –Cognitive Assessment prior to discharge Include RANCHO GOAT, Digit Span (see form) –Head injury literature at discharge Contact information

Multidisciplinary TBI Clinic Program- 3 month follow-up –No charge visit –Physical Exam Follow-up on any issues related to trauma –Cognitive Evaluation –QoLIBRI survey –Mental Health Screening HADS

Multidisciplinary TBI Clinic Program- 3 month follow-up –Peer group interaction TSN involvement Brain Injury Association of TN –Personalized information on referrals/resources Jean Doster-TBI Foundation of TN

The Team

Multidisciplinary TBI Clinic

Traumatic Brain Injury What Next? Radiologic Imaging –DTI –Others Genome analysis –‘At risk’ populations Improved prevention methods –Not hurt = no sequelae

Traumatic Brain Injury A Multidisciplinary Approach Oscar Guillamondegui, MD, MPH, FACS Trauma Medical Director Vanderbilt University Nashville, Tennessee