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VA Polytrauma System of Care

VA Polytrauma System of Care. Polytrauma Rehabilitation Centers. Tampa. Richmond. Minneapolis. Palo Alto. San Antonio (2012). Continuity of Care: From Battlefield to VA TBI/Polytrauma System of Care. Landstuhl Regional Medical Center. Minneapolis PRC. Walter Reed Army &.

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VA Polytrauma System of Care

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  1. VA Polytrauma System of Care Polytrauma Rehabilitation Centers Tampa Richmond Minneapolis Palo Alto San Antonio (2012)

  2. Continuity of Care: From Battlefieldto VA TBI/Polytrauma System of Care Landstuhl Regional Medical Center Minneapolis PRC Walter Reed Army & Bethesda National Naval Medical Centers Iraq Palo Alto PRC Richmond PRC Tampa PRC Balad, Iraq Bn Aid Station 2

  3. Learning Objectives • Talk 1 • Differentiate Acquired Brain Injury from Traumatic Brain Injury (TBI) • List types of TBI • List stages of recovery from severe TBI

  4. Acquired Brain Injury versus Traumatic Brain Injury • ABI: Impairment of brain function that is • not attributed to congenital, developmental, or degenerative conditions. • Examples include traumatic brain injury (aka closed head injury, open head injury, penetrating head injury), stroke (ischemic, hemorragic), brain tumors, anoxia, chemical exposure, etc.

  5. Traumatic Brain Injury • Damage caused by external, mechanical force • Closed Head Injury • Car accidents • Falls • Blunt assault • Open Head Injury • Penetrating • Gunshot wound • Stabbing wound

  6. Polytrauma Patient Characteristics

  7. Combat Polytrauma Patient Characteristics (FY03 – present)

  8. Mandatory TBI Screening Results14 April 2007 – 31 January 2009 270,022 Total OEF/OIF Veterans Screened Primary Screen 7,725 Veterans with Self Reported Prior TBI 53,953 Veterans Requiring Further Evaluation 50,068 Veterans Consenting to Further Evaluation 33,250 Veterans Completed Comprehensive Evaluation Follow-up Evaluation 21,292 5,184 TBI Confirmed 15,486 TBI Ruled Out Diagnosis Pending 12,580

  9. States of Severely Impaired Consciousness (SIC) • Coma • Vegetative State (VS) • Persistent /Permanent Vegetative State • Minimally Conscious State • Emerged From Minimally Conscious State • Post Traumatic Amnesia / Confusion / Delirium

  10. Severely Impaired Consciousness (SIC) Coma VS MCS SIC Confused Oriented

  11. Early Neurobehavioral Milestones • Duration of Unconsciousness • Duration of Consciousness (2 consecutive sessions/dates of observed command following) • Transition from VS to MCS • Tracking, Command Following, Verbalizations • Emergence from MCS • Accurate Yes/No Response, Object Use etc. • Duration or degree of impaired consciousness • Post-traumatic Amnesia ( 2 consecutive sessions/dates of target range scores indicating orientation) • Post-traumatic motor restlessness • Post-traumatic confusion

  12. Examples of Cognitive and Behavioral Changes After ABI / TBI • Fatigue • Executive Skills • Reasoning • Sequencing • Multi-tasking • Behavioral Control (start, stop, & resisting impulse) • Emotional Control (inappropriate or intensity change) • Orientation • Alertness • Focusing Attention • Speed of Processing • Remembering New Info • Remembering Past Info • Perception of Environment • Expressive language • Receptive language

  13. Outcome Trajectory for Disorders of Consciousness unpublished data

  14. Outcome Trajectory for Disorders of Consciousness unpublished data

  15. “To Care For Him Who Shall Have Borne the Battle, And For His Widow and Orphan” - Abraham Lincoln

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