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Transcript
Primary Care for
Patients with
Brain Injury
Courage Center
Physicians Clinic
Teresa Kiresuk, DNP
Michelle Ullery, FNP
Korinne Novak, ANP
Brain Injury Incidence
• MN TBI: 154,933
–
Estimated that 10,00 progress to long term disability (MN,
Department of health, 2010)
• Nationwide TBI: 1.4 million annually
–
100,000 develop long term sequale (CDC, 2010)
• Currently estimates of 5.3 million individuals have
disability due to TBI (CDC, 2009)
cdc.gov/traumaticbraininjury/tbi_report_to_congress.html#6
health.state.mn.us/injury/midas/ub92/index.cfm
2
Post Brain Injury Problems
Physical Symptoms
Psychological Symptoms
Social Symptoms
3
Physical Symptoms
Headache
Dizziness
Tinnitus
Visual Disturbances
Insomnia
Fatigue
Chronic Pain
Impaired Cognition
Neurogenic Bladder
Neurogenic Bowel
Spasticity and Dystonias
4
Psychological Symptoms
Personality Changes
Mood Disorders
• Depression
• Mania
• Anxiety
• Substance Abuse
5
Social Symptoms
Relationship Difficulties
Vocational Concerns
Sexuality Issues
Driving Safety
6
Health Maintenance Needs
USPSTF Preventive healthcare and health
maintenance
General recommendations based on age and gender
for
-Screening,
-Immunization
- Counseling
-Chemoprophylaxis
7
Health Maintenance Needs
Following TBI
Screening: Headache, fatigue, dizziness, visual changes,
bowel and bladder management, spasticity, mood disorders,
personality changes, vocational concerns and status,
relationship concerns, and substance use
Counseling: injury prevention, family planning, health
concerns
Immunization: pneumovax, influenza, hep b, TD,
Chemoprophylaxis: asa, vit d, calcium, bisphosphonates
Secondary Prevention Measures: injury, skin integrity,
8
Health Maintenance Challenges
Inadequate comprehensive primary care and
preventive health services
• Appointment time limitations
• Physical access to clinic and exam techniques
• Provider knowledge regarding Post TBI needs
• Provider knowledge regarding Health Maintenance
Needs
• Focus on a Few Chronic Problems
9
Interdisciplinary Approach
Primary Care, Psychiatry and PM&R in same clinic
HCH Model
Co-Visits, Back to Back Visits
Specialty Services within Clinic Organization
Rehabilitative Services in Organization
Specialty Referrals Available
Adaptive Clinic Equipment
10
References
Bockenek, W., Currie, D. (1994). Physical medicine and rehabilitation as a primary care
specialty, Commentary. American Journal of Physical Medicine and Rehabilitation. 73(1)
58-60.
Bushnik, T., Englander, J., & Wright, J. (2008). The experience of fatigue in the first 2
years after moderate-to-severe traumatic brain injury: a preliminary report. Journal of
Head Trauma Rehabilitation. 23(1)17-2
Castriotta, R,& Murthy, J. (2011). Sleep disorders in patients with traumatic brain injury:
a review. CNS Drugs 25(3): 175-85.
Hoffman, J., Lucan, S., Dikmen, S., Braden, C., Brown, A., Brunner, R., Diaz-Arrastia, R.,
Walker, W., Watanabe, T., and Bell, K. (2011). Natural history of headache after traumatic
brain injury. Journal of Neurotrauma, 28(9) 1719-1725.
Iverson, G., Zasler, N., & Lange, R. (2007). Post-concussive disorder. In Zasler, N., Katz,
D., & Zafonte, R. (Eds.), Brain Injury Medicine (pp373-406). New York: Demos Medical
Publishing
Klein, M., (2011). Sexuality and Dysfunction. Medscape Reference: Drugs, Diseases, and
Procedures. Retrieved from http://emedicine.medscape.com/article/319119overview#a30.
Kroll, T., Jones, G., Kehn, M., and Neri, M. (2006). Barriers and strategies affecting the
utilization of primary preventive services for people with physical disabilities: a qualitative
inquiry. Health and Social Care in the Community, 144284-293.
11
References
Morrison, E., George, V., & Mosqueda, L., (2008). Primary care for adults with physical
disabilities: perceptions from consumer and provider focus groups. Family Medicine,
40(9)645-651.
Orff, H, Ayalon, L., & Drummond, S. (2009). Traumatic brain injury and sleep
disturbance: a review of current research. Journal of Head Trauma Rehabilitation,
24(3): 155-65.
Radice-Neumann D, Zupan B, Tomita M, Willer B (2009). Training emotional processing
in persons with brain injury. Journal of Head Trauma and Rehabilitation, 24(5): 313–
323.
Slomine, B., McCarthy, M., Ding, R., MacKenzie, E., Jaffe, K., Aitken, M., Durbin, D.,
Christensen, J., Dorsch, A., and Paidas, C.(2006). Health care utilization and needs
after pediatric traumatic brain injury. Pediatrics, 117(4)663-674.
Sutton, J., and DeJong, G. (1998). Managed care and people with disabilities. Archives
of Physical Medicine and Rehabilitation, 79: 1312-1316.
US Department of Health and Human Services (2010). Agency for Heath Care
Research and Quality. The guide to clinical preventive services 2010-2011. Electronic
Publication of the US Preventive Ser
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