bancroft traumatic brain injury in the military
Post on 02-Nov-2014
2.418 Views
Preview:
DESCRIPTION
TRANSCRIPT
© 2011 Bancroft | All rights reserved
2
By 2014 our distinct ability to deliver high quality individualized services in modern living, learning and working environments will exceed stakeholder expectations and secure Bancroft as the region’s elite provider of services to people with intellectual and developmental disabilities and brain injuries.
Our Core Value
Bancroft’s mission is to ensure that every person is given opportunities for lifelong learning and fulfillment.
We do this by altering perceptions, and by supporting those with intellectual and developmental challenges and acquired brain injuries in achieving their life goals as valued and respected members of our world.
Respect is our clearly defined core value that helps unify the organization and provide a framework for services, decision-making and working together.
Our Vision
Our Mission
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
3
TBI is a “signature injury” of the conflicts in Iraq and Afghanistan
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
4
DoD TBI Definition (Oct 07) Traumatically induced structural injury or physiological disruption of brain function as a result of external force to the head
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
5
DoD TBI Definition (Oct 07)
New or worsening of at least one of the following clinical signs • Loss of consciousness or decreased consciousness • Loss of memory immediately before or after injury • Alteration in mental status (confused, disoriented, slow
thinking) • Neurological deficits • Intracranial lesion
DoD definition parallels standard medical definition • CDC, WHO, AAN, ACRM
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
6
Blast Injury
Predominant cause of TBI in OIF/OEF A significant number of soldiers returning from the conflicts in Iraq and Afghanistan have this injury and will suffer long-term consequences
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
7
Blast Injuries
Primary-Explosion • Blast wave strikes and compresses body • Most serious damage sustained by air and
fluid filled organs • Causes brain injury without visible damage
to the head/skull • Causes significant damage to eyes, ears,
lungs
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
8
Blast Injuries
Secondary • Environmental material energized by
explosion strikes the body/brain Tertiary • Energy from explosion propels the body
into stationery objects
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
9
Multiple Neurological Injuries
• Skin breakdown • Penetrating Injury • Blast/concussive injury • Skull base injury • Facial fractures • Vasospasm* • Pseudoaneuryms* • Sagital sinus injuries
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
10
Blast Injuries Are Different
• Treated quickly and aggressively
• Occur under extreme stress
• Long term course is unknown
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
11
DoD Initiatives
• Prevention • Surveillance • Screening • Diagnosis • Case Management • Treatment • Rehabilitation • Reintegration
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
12
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
13
Baseline Testing Pre-Deployment
Neurocognitive Assessment Tool (ANAM)/Automated Neuropsychological Assessment Matrics (May 09) • Computerized • 20 min
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
14
Screening
• Military Acute Concussion Exam (MACE) (Aug 06)
• TBI screening for all medically evacuated at Landstahl Regional Medical Center (May 06)
• PostDeployment HealthScreening (Jan 08) • VA TBI Screening
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
15
MACE: Military Acute Concussion Evaluation • Developed by DVBIC and
released in Aug 2006
• Performed by medical personnel
• 3-Part Screening Tool – “CNS” • Cognition • Neurological Exam • Symptoms
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
16
MACE: Military Acute Concussion Evaluation • Alternate versions available
• Upcoming revision will include recurrent concussion questions
• Can be used during exertional testing to ensure that cognitive function remains intact
© 2011 Bancroft | All rights reserved
17
Post-Deployment Health Assessment/ Reassessment (January 08)
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
18
Diagnosis Potential Objective Indicators
• Pupillary response/visual tracking
• Biomarkers
• Imaging (DTI)
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
19
Mild TBI/Concussion • More difficult to identify
• Symptoms not unique to TBI
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
20
Possible Effects of TBI Acute
• Poor marksmanship • Slower reaction time • Decreased concentration
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
21
Possible Effects of TBI Chronic • Reduced work quality
• Behavioral Problems
• Emotional Problems
• “Unexplained” Problems
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
22
Treatment • Standardized Educational
Information
• New Protocol for 3 or more TBIs within 12 months
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
23
National Intrepid Center of Excellence (NICoE) • Located on Navy campus in
Bethesda, MD
• Dedicated 24 June 2010
• Serves Service Members (and their families) with complex TBI
• Primarily evaluative in nature
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
24
National Intrepid Center of Excellence (NICoE) • Generally to be used by those
who have refractory or difficult-to-diagnose/manage conditions
• Provides case management and referral capabilities to leading experts in the field
• Full Operating Capability: Oct 2011
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
25
Toolkit and Pocket Guide
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
26
Treatment Co-Morbid Conditions • Sleep Disorders
• Substance Abuse
• Psychiatric Illness
• Vestibular Disorders
• Visual Disorders
• Cognitive Disorders
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
27
Co-Morbidities Associated with mTBI
PTSD N=232 68.2%
2.9% 16.5%
42.1% 6.8%
5.3%
10.3%
12.6%
TBI N=227 66.8%
Chronic Pain N=277 81.5%
Sleep disorders
Substance abuse
Psychiatric illness
Vestibular disorders
Visual disorders
Cognitive disorders
Lew, et al: “Prevalence of Chronic Pain, Posttraumatic Stress Disorder, and Persistent Postconcussive Symptoms in OIF/OEF Veterans: Polytrauma Clinical Triad”, Dept. of Veterans Affairs, Journal of Rehabilitative Research and Development, Vol. 46, No. 6, 2009, pp. 697-702, Fig. 1
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
28
Treatment Research • Clinical Trials
• Cognitive Rehabilitation
• Neuroprotective Medications
• Longitudinal Study
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
29
Blast Physics/ Blast Dosimetry
Force Protection Testing & Fielding
Complementary Alternative Medicine
Field Epidemiological Studies (mTBI)
Rehabilitation & Reintegration: Long Term
Effects of TBI
Neuroprotection & Repair Strategies: Brain Injury
Prevention
Concussion: Rapid field Assessment
Treatment & Clinical Improvement
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
30
Challenges • Undetected MTBI
• Force readiness/cultural barriers
• Improved Collaboration
• Effective Treatment
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
31
Resources • www.brainline.org
• www.braintrauma.org
• www.maketheconnection.net
• www.dcoe.health.mil
• www.dvbic.org
• TBI Family Caregiver Guide
• www.Afterdeployment.org © 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
32
Resources • DCoE Facebook, Twitter, YouTube,
• Multiple Mobile Smartphone Applications
• DCoE Blog
• Yellow Ribbon Presentations
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
33
Questions?
© 2011 Bancroft | All rights reserved
Copyright – 2012, Boyer, Bancroft Brain Injury Services
34
Thank you for attending!
© 2011 Bancroft | All rights reserved
top related