Transcript Document

Our Returning Veterans, Are We
Ready?
Brant A. (Bud) Elkind, MS, CBIS-T
Director, Clinical Operations
Robin Hill Farm, Inc.
7/18/2015
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Traumatic Brain Injury
(TBI)
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TBI - “An insult to the brain, not of
a degenerative or congenital
nature but caused by an external
force, that may produce a
diminished or altered state of
consciousness, which results in an
impairment of cognitive abilities or
physical functioning” (AACBIS)
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Acquired Brain Injury
“An injury to the brain
occurring after birth that is
not hereditary, congenital or
degenerative; does not refer
to brain injuries induced by
birth trauma” i.e. Stroke/CVA,
Anoxia, Disease, Neuro-toxic
Poisoning, Metabolic
disorders (insulin shock, liver
and kidney disease, or trauma
(AACBIS)
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Brain Injury Range
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Mild characteristics include:
Loss of consciousness for les than
30 minutes or no loss
Glasgow Coma Scale of 13-15
Post-traumatic amnesia for less than
24 hours
Temporary or permanently altered
mental or neurological state with
pos-concussive symptoms
(AACBIS)
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Moderate Brain Injury
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Coma more than 20-30 minutes
but less than 24 hours
Glasgow Coma Scale or 9-12
Possible skull fractures with
bruising & bleeding
Signs on EEG, CAT or MRI Scans
Some long term problems in one or
more areas (AACBIS)
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Sever Brain Injury
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Coma longer that 24 hours, often
lasting day, weeks or longer
Coma scale of 8 or less
Bruising, bleeding in the brain,
signs on EEG, CAT or MRI scans
Long term impairment (AACBIS)
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TBI In The United States
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1.4 million sustain a TBI each year
50,000 die
235,000 are hospitalized
1.1 million ER visits
The number of people who sustain
a TBI and do not receive treatment
is unknown (BIAUSA)
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Leading Causes of TIB’s
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Falls 29%
Motor Vehicle Accidents 20%
(most are unrestrained)
Stuck by/against 19%
Assaults 11%
Other 13%
Unknown 9% (BIAA)
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Long Term
Consequences of TBI
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Direct and indirect costs of TBI in
the US as of 1995 was estimated
at $60 Billion
The CDC estimates 5.3 million
Americans currently have long
term, lifelong need to perform
activities of daily living as a result
of TBI (BIAA)
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Unmet Need for
Services One Year After
Injury
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Improving memory and problem
solving
Managing stress and emotions
Controlling one’s temper
Improving one’s job skills (CDC)
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The Wide Range of
Functional Change
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Thinking, language, learning,
emotions, behavior and or
sensation
TBI can also cause epilepsy,
increase the potential for
Alzheimer’s and Parkinson’s and
other brain disorders that become
more prevalent with age (CDC)
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OIF – OEF STATISTICS
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Approximately 1.6 million troops have to
date been deployed to Afghanistan and
Iraq
300,000 are estimated to have affected
by Traumatic Brain Injury (TBI) and or
Post Traumatic Stress Disorder (PTSD)
64% of all wounded are estimated to
have sustained “Blast Injuries”
47% of all blast injuries affect the head
(NABIS)
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Anatomy of a Blast
Injury
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Instantaneous pressure wave with a rise
and drop in pressure
Results in cavitation occurring at the
molecular level ((brain, inner ear, eyes,
gastrointestinal tract, lungs and spinal
fluid structures are liquefied)
Over-pressurization wave dissipates
instantaneously creating a vacuum
Impact may also energize shrapnel, may
exhaust gases and vapors that burn lung
tissue and flesh (Wikipedia)
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What We Expect to See
as Our Veterans Return
Home
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The most severely injured continue
to remain in Poly Trauma Hospitals
Those returning with mild brain
injuries pose a significant public
health concern
They will return with high
expectations to their homes,
families, jobs and communities
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Why there is Reason for
Concern
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Many will return healthy
Others will return, unaware of their
brain injury (Agnosia, an inability to
see their deficits) (D&VBIC)
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What we will see!
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Difficulty with:
Thinking
 Receptive - Expressive
 Short – Long-term memory
 Attention – Initiation
 Expressive – Receptive
 Multi-tasking
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What we will see
(Continued)
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Adverse Behavior (Impulsivity,
Disinhibition, Anger Control)
Seizure activity
ETOH – (Alcohol and Substance
Abuse)
High-risk behavior
Disorientation
Tinitus and feelings of Isolation
(EBIG)
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“Contrary to expectations, patients
with mild to moderate TBI are
actually much more affected by
their emotional difficulties than by
their physical disability” (Glasser)
Soldiers returning with mild to
moderate brain injuries are 3 times
more likely to incur a second brain
injury and 8 times more likely to
incur a third” (CDC)
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Systems of Care
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Poly-trauma Centers (4)
Poly-trauma Network Sites (21)
Poly-trauma Support Clinics –
VISN (Specialized teams)
Poly-trauma Point of Contact
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VA Poly-trauma Rehab
System of care
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Proactive Case Mgt
Telehealth Network
Long-term follow-up; proactive,
specialized
Care for those who cannot care for
themselves
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So, is the Community
Ready
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Probably not!
5 Professional Brain Injury
Programs in NH representing a
Continuum
Facility based
 Residential
 Home based
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Community
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To welcome our soldiers with mild brain
injury home we must be:
Inclusive not Integrative
Be involved at all levels
Social Service Agencies must
understand needs
Physicians and hospitals must be able to
appropriately diagnose, medicate and
care for people with mild brain injury
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Other Community Based
resources
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OT’s, PT’s, SLP’s and Psych
Professionals must be trained in
mild brain injury
The community must be
knowledgeable in the area of
disability rights.
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Partnerships
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The VA cannot do everything
Communities must be willing to
include
Support systems must be
educated and capable to working
with this specialized population
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References
American Academy for the Certification of Brain Injury Specialists (AACBIS) www.aacbis.net
Brain Injury/Professional vol. 4, issue 1, North American Brain Injury Society, “Reintegrating
Military Personnel after TBI, Community Integrated Rehabilitation Model in Practice, Trudel,
Davanzo, Mattingly, Nideffer & Barth
Brain Injury/Professional vol. 4, issue 1, North American Brain Injury Society, Current Trends in
Post Traumatic Stress Disorder & TBI among Military Personnel, Nideffer, Errico and Barth
The Essential Brain injury Guide, Edition 4.0, American Academy for the Certification of Brain
Injury Specialists
Blast Injuries, Wikipedia, the Free Encyclopedia, January 2008, NABIS, Blast Injury Institute,
Ziejewski, Inz, Karami, Akhatov
Defense Veterans Brain Injury Center
Brain Injury Association of America, www.biausa.org
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