traumatic brain injury in the defense department · 2019-03-14 · neha kumar do, mph ∎tbi...

Traumatic Brain Injury in the Defense Department

Neha Kumar, DO, MPHTBI Clinical Educator

March 2019

Defense and Veterans Brain Injury CenterRecovery Care Coordinator Training

“Medically Ready Force…Ready Medical Force” 1

Neha Kumar DO, MPH

∎ TBI clinical educator at the Defense and Veterans Brain Injury Center (DVBIC), Education division

∎Graduate of Nova Southeastern University- Doctor of Osteopathic Medicine and Master’s in Public Health

∎ Trained and Board Certified in Physical Medicine & Rehabilitation- New York Medical College


Disclosures

Neha Kumar has no relevant financial relationships to disclose.

The views expressed in this presentation are her own and do not reflect the official policy of the DoD or the U.S. government.

Commercial support was not received for this activity.



DVBIC Mission

As the Military Health System’s traumatic brain injury (TBI) Pathway of Care manager, the Defense and Veterans Brain Injury Center (DVBIC) promotes state-of-the-science care from point-of-injury to reintegration for service members, veterans, and their families to prevent and mitigate consequences of mild to severe TBI.

DVBIC fulfills this mission through ongoing collaboration with the Department of Defense (DoD), military services, Department of Veterans Affairs (VA), civilian health partners, local communities, families and individuals with TBI.

Objectives

Recognize the signs and symptoms of traumatic brain injury (TBI)

Apply targeted strategies to facilitate interactions with a service member or veteran with TBI and family members

Utilize Defense and Veterans Brain Injury center’s (DVBIC) educational products and other TBI resources for service members, veterans and family members


What is a Traumatic Brain Injury?

A blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.

Not all blows or jolts to the head lead to a TBI.

Source: DCoE


Two conditions must be met to suspect/diagnose a TBI 1. Injury event that affects the brain2. A new onset or worsening of any of the following immediately

after the event: Any loss of consciousness (LOC) Any alteration in consciousness (AOC): i.e., dazed, confused Posttraumatic amnesia (PTA)


Closed TBI Severity Classifications

Mild Moderate Severe

Normal imagingNormal or abnormal

imagingAbnormal imaging

LOC = 0-30 minLOC > 30 min, < 24

hours LOC > 24 hours

AOC = up to 24 hours AOC > 24 hours

PTA = 0-1 day PTA > 1, < 7 days PTA > 7 days

Causes of TBI in the Military

Common causes of concussion in military include: Falls Motor vehicle crashes Being struck by an object Assault Sports Guns or explosive devices Battle injuries


(DVBIC)

DoD Numbers for Military TBI incidence


Common Physical Signs and Symptoms Following TBI

Headaches: New or worsened Sleep disturbances Visual disturbances: Blurred or

double vision Fatigue: Feeling tired, irritable Dizziness: Feeling light-headed,

off-balance Sensitivity to light and/or noise Ringing in the ears Nausea or vomiting Disorders of taste and smell


TBI: Cognitive, Behavioral and Emotional Signs and SymptomsCognition and Memory

Poor concentration/working memory

Temporary gaps in memory Slow processing speed Decreased awareness of deficits Decreased problem solving Decreased judgment Difficulty finding words

Behavior Apathy and lacking motivation Agitation, aggression Personality changes Less empathy and concern Impulse control: Loss or

reduction of inhibition

Emotion and Affect Anxiety, depression, emotional

lability Irritability Mood swings Poor self-image

Courtesy photo: DVIDS


Potential Complications to Recovery

TBI with Co-occurring Conditions PTSD Alcohol or drug use/misuse A history of multiple concussions


TBI with lingering symptoms Headaches Pain Fatigue Sleep disturbances Poor concentration Memory problems Depression Anxiety Irritability

Communicating with Patients

• Create an environment that facilitates effective communication

• Quiet private room with minimal distractions

• Encourage a family member or buddy to accompany service member to appointments

Have extra pens and notebooks handy in case they would like to take notes

Email a list of items to be discussed prior to the meeting so the service member can begin to think about feedback and questions

Email a list of topics discussed and resources provided when appointment is complete


USMC photo by Staff Sgt. Jennifer Brofer


Communicating with Patients

• Encourage consistent use of memory aids (smartphone calendar, journal, etc.)

• Encourage journaling of symptoms (date/frequency/severity) to make recall smoother when meeting with medical providers

• Repeat information as needed• Focus on one thing or task at a time• Discuss most important items first• Avoid information overload and distractions

Helpful Tips for Recovery Care Coordinators

Communicate with your colleagues (Lead coordinator, case manager, TBI recovery support specialists, others)

Set professional boundaries between you and the service member Provide clear expectations and positive feedback for desirable and

appropriate behavior Encourage a break when frustration is evident Recognize the person may use negative comments or refusal as a means of

control Discuss advantages and disadvantages of actions and decisions As patient transitions, talk about changes in the environment that may be

needed and connect with military, veteran, civilian and community resources that are available, as appropriate


Communicating with Family

Include family members in discussions. Service member may have difficulty understanding and following directions.

Evaluate family and caregiver support resources based on: Age Employment Home environment Other family obligations

Caregivers need support, information and resources, too: TBI education Caregiver coaching Peer support and counseling


Services Provided by DVBIC TBI Recovery Support Program

Focus: TBI expertise, resources and support facilitating connections across the continuum of recovery and spectrum of care.TBI recovery specialists establish ongoing relationship with client to ensure connection to both clinical and non-clinical care and resources.

Provide support, advice, advocacy and education Identify local resources and programs Track symptoms and monitor treatment compliance

and outcomes Conduct regular follow-up interviews


Eligibility: Service members (including National Guard and Reserves) who require transition assistance and veterans who have sustained a TBI, regardless of discharge status, where or when injuries occurred, or their family members or caregivers. For more information or to make a referral, email: [email protected] Fact sheet and client brochure available from TBI RSP website:

http://dvbic.dcoe.mil/tbi-recovery-support-program

DVBIC photo by Carlson Gray

mailto:[email protected]

http://dvbic.dcoe.mil/tbi-recovery-support-program

DVBIC Network Sites Map


DVBIC Resources: Tools for the RCC


https://dvbic.dcoe.mil


Service Member & Veteran Resources

Mild TBI Symptom Management fact sheets:∎ Managing Headaches∎ Help with Ongoing Symptoms∎ Management of Neck Pain∎ Head Injury and Dizziness∎ Changes in Behavior, Personality or

Mood∎ Ways to Improve Your Memory∎ Healthy Sleep

Service Member & Veteran Resources


Family Member & Caregiver Resources

Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans (2010)

Source of information and support for caregivers of service members and veterans who have sustained a moderate, severe or penetrating TBI dvbic.dcoe.mil/material/traumatic-brain-injury-guide-caregivers-service-members-and-veterans


Center of Excellence for Medical Multimedia (CEMM) – Traumatic Brain Injury Interactive education programs for patients, family members and caregivers

https://tbi.cemmlibrary.org

https://dvbic.dcoe.mil/material/traumatic-brain-injury-guide-caregivers-service-members-and-veterans

https://tbi.cemmlibrary.org/

Family Member & Caregiver Resources


References

Centers for Disease Control and Prevention (CDCP). (2015). Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA.

Defense and Veterans Brain Injury Center (DVBIC). (2019). Accessed at https://dvbic.dcoe.mil

Memorandum from the Assistant Secretary of Defense (Health Affairs). Traumatic Brain Injury: Updated Definition and Reporting, dated 6 April 2015. U.S. Department of Defense, Washington, DC.


https://dvbic.dcoe.mil/tbi-military

Contact Information

TBI Recovery Support Specialist

Elizabeth [email protected]


TBI Clinical Educator

Neha [email protected]

traumatic brain injury in the defense department · 2019-03-14 · neha kumar do, mph ∎tbi...

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