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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)
cdc.gov/traumaticbraininjury/tbi_report_to_congress.html#6
health.state.mn.us/injury/midas/ub92/index.cfm
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Post Brain Injury Problems
Physical Symptoms
Psychological Symptoms
Social Symptoms
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Physical Symptoms
Headache
Dizziness
Tinnitus
Visual Disturbances
Insomnia
Fatigue
Chronic Pain
Impaired Cognition
Neurogenic Bladder
Neurogenic Bowel
Spasticity and Dystonias
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Psychological Symptoms
Personality Changes
Mood Disorders
• Depression
• Mania
• Anxiety
• Substance Abuse
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Social Symptoms
Relationship Difficulties
Vocational Concerns
Sexuality Issues
Driving Safety
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Health Maintenance Needs
USPSTF Preventive healthcare and health
maintenance
General recommendations based on age and gender
for
-Screening,
-Immunization
- Counseling
-Chemoprophylaxis
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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,
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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
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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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References
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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.
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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,
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Radice-Neumann D, Zupan B, Tomita M, Willer B (2009). Training emotional processing
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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
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