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Polytrauma Rehabilitation: A New Model of Care

Polytrauma Rehabilitation: A New Model of Care. Rose Collins, Ph.D. Minneapolis VA Medical Center VA Psychology Leadership Conference/ APA April 28, 2006. Objectives. Polytrauma: Definition and patterns Paradigm of Care Psychology in Polytrauma Care Treatment Issues and Considerations

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Polytrauma Rehabilitation: A New Model of Care

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  1. Polytrauma Rehabilitation: A New Model of Care Rose Collins, Ph.D. Minneapolis VA Medical Center VA Psychology Leadership Conference/ APA April 28, 2006

  2. Objectives • Polytrauma: Definition and patterns • Paradigm of Care • Psychology in Polytrauma Care • Treatment Issues and Considerations • Future Concerns and Directions

  3. TBI, Blast Injury & Polytrauma • TBI in peacetime: civilian vs. military • Mechanism: MVA, falls • Incidence • TBI in combat: • Mechanism: Blast • Incidence • Blast injury sequelae: Polytrauma

  4. Brain injury Amputation Fractures Wounds Psychological-PTSD Crush injuries Burns Auditory/vestibular Eye, orbit, face, Dental Renal Respiratory Cardiac and vascular Gastrointestinal Pain Peripheral nerve Common Sequelae of Blast Injury

  5. Polytrauma: Definition • Trauma to several body areas or organ systems • Occur at the same time • One or more is life threatening

  6. TBI in Combat Settings • New mechanism of injury • New constellation of injuries • Challenges to TBI rehabilitation • New expertise and new model of care

  7. Polytrauma Rehabilitation Centers (PRC) Level I • New patterns of injurynew paradigm of care • “Brain Injury Plus” • Brain injury drives the care process • Integrate care for complex polytrauma in single location—simultaneous tx of mult injuries • Higher level of medical acuity • Sequence and integrate treatment to meet patient need • Coordinated team effort with expanded team of consultants

  8. Anesthesiology Audiology Chaplin Services Dentistry Driver Rehabilitation Gastroenterology General Surgery Infectious Disease Medicine Neurology Neuro-ophthalmology Neurosurgery Nutritionist Optometry Oral and Maxillofacial Surgery Orthopedics Orthotics Otolaryngology Pharmacy Plastic Surgery Prosthetics Psychiatry Pulmonology Radiology Urology Vocational Specialist Extensive Team of Consultants

  9. Care Across the Continuum:Coma to Community • Multi-level national network of care • Delivery of specialized care close to home • Comprehensive interdisciplinary assessment of previously unidentified TBI patients • Proactive Case Management • Continued management of existing and emerging sequalae • Care for the patient who can’t return home • Telehealth • Identification of community resources • Collaboration with VBA

  10. Seamless Transition Department of Veterans Affairs Department of Defense VHA Continuum of Rehab Care DOD Healthcare Sys VA Polytrauma System of Care VHA Polytrauma Rehab Centers (Level 1) Polytrauma Network Sites (Level 2) DVBIC VBA Polytrauma Teams (Level 3) Local VA Polytrauma Case Mgrs (Level 4) State & Community Resources Specialized Rehabilitation Services Informed, Empowered Patient & Family Dynamic Links The Right Care, At the Right Time, In the Right Place Better Functional and Clinical Outcomes, Higher Satisfaction, Lower Costs

  11. Family DoD/VA Liaison Military Treatment Facility Military Transport Military Command TRICARE Medical Holding Company “Home” VA Medical Center (Level II, III) Civilian Hospital State/Local Services Veterans Benefits Case Management Challenges

  12. Psychology in Polytrauma Rehabilitation • Integrated, active, interdisciplinary team member • Combat Stress and PTSD • Complex Pain syndromes • Behavioral management, adherence • Depression, Suicide • Intimacy • Provider stress • Education to mental health staff, nursing, and all hospital staff, Level II sites

  13. Family Issues • Multiple stressors • Away from home, support systems • Care of other children, aging parents • Job loss, financial strain • Adjusting to VA and rehab environment • Duration, intensity & fluctuation of medical course • Expectations: Advocacy vs entitlement

  14. Family Issues • Role strain and change • Stress, trauma • Political context • Anger, grief and loss • Guilt • “Ambiguous loss” (Boss, 1999; 2006) • Depression, anxiety • Stress increases at transfer to Level 2

  15. Treatment Considerations • Pathologizing family vs family stress theory • Psychodynamic interpretations, motivated forgetting • Group size, duration • Directive, active, concrete, metaphor • Multi-modal education and treatment • Adjusting “to” and “with” cognitive impairments • Acceptance vs status quo • Assistance: increasing dependency vs support for  independence

  16. Future Issues & Directions • (Complicated) Mild TBI • Vocational rehab & supports • Community reintegration • Increase substance abuse • Increase suicide • Life span, aging, secondary condidtions

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