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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)
Post Brain Injury Problems
Physical Symptoms
Psychological Symptoms
Social Symptoms
Physical Symptoms
Visual Disturbances
Chronic Pain
Impaired Cognition
Neurogenic Bladder
Neurogenic Bowel
Spasticity and Dystonias
Psychological Symptoms
Personality Changes
Mood Disorders
• Depression
• Mania
• Anxiety
• Substance Abuse
Social Symptoms
Relationship Difficulties
Vocational Concerns
Sexuality Issues
Driving Safety
Health Maintenance Needs
USPSTF Preventive healthcare and health
General recommendations based on age and gender
- Counseling
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
Immunization: pneumovax, influenza, hep b, TD,
Chemoprophylaxis: asa, vit d, calcium, bisphosphonates
Secondary Prevention Measures: injury, skin integrity,
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
• Focus on a Few Chronic Problems
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
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