NNMC Practices Innovative TBI Approach

Story Number: NNS100812-04Release Date: 8/12/2010 1:31:00 PM
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By Mass Communication Specialist 3rd Class Timothy Wilson, National Naval Medical Center Public Affairs

BETHESDA, Md. (NNS) -- National Naval Medical Center behavioral health providers have using an innovative approach to meet the needs of service members who face a long road to recovery.

Traumatic brain injury (TBI) patients often have multiple problems, including a wide array of physical wounds coupled with mental health issues, that need to be addressed simultaneously.

"Our mission is to screen every incoming casualty for the presence of TBI and other psychological or psychiatric complications of combat," said Dr. David Williamson, NNMC Inpatient Psychological Health/Trau-matic Brain Injury (PH/TBI) program medical director.

Williamson said when a patient arrives to NNMC with a head injury; they first receive lifesaving care to stabilize their condition. In addition, every patient meets with a psychiatrist upon their arrival, regardless of injury type. The PH/TBI team practices a revolutionary policy of not waiting until people have trouble.

"We want behavioral health providers involved the minute the patient arrives at Bethesda," said Williamson. "Alongside the trauma surgeons, our team is going in to evaluate the injuries and we are trying to predict and plan ahead what types of problems the patient will have from their brain injuries, so we can put services in place ahead of time."

This approach has evolved after many years of developing the best practices to help the patients on their road to recovery. The inpatient unit officially began using this method of having an open line of communication between the behavioral health providers and medical doctors in April 2009.

"We will take a look at your pain, your wound, all the physical medicine rehab and psychological [aspects] all at the same time," said Williamson. "You need balance and having everyone working together is the model that really has made the difference."

The team also opens and maintains lines of communication with the patient's family, teaching them how to adjust to life after injury.

"Sometimes family members need some special treatment or a referral for some special support," said Williamson. "We do education, teaching about TBI and the other psychological health [issues] that we treat."

Williamson said this is important because TBI symptoms may not be obvious for years. More than 50 percent of the patients the PH/TBI treats are outpatients years after their initial injury.

Brain injuries can create difficult medical problems to solve, said Williamson. The repercussions resulting from a TBI may include difficulties with balance and coordination, hearing and understanding speech, limb movement difficulties and loss of vision.

"[Post Traumatic Stress Disorder] PTSD isn't the only psychological consequence of combat," said Williamson. "We are interested in the higher brain functions as well [such as] memory, the ability to organize and multi-task, what controls personality and emotional regulation."

Different areas of the brain control different functions of the body. The location of the injury will determine how the body is affected. This immediate evaluation will allow the behavioral health doctors to determine the best treatment options, he added.

"We are looking at what does the brain injury mean for this person, what things are affected, [and] what do we need to do to help them succeed in their rehabilitation," said Williamson.

Brain injuries are a life-long condition because the brain tissue cannot regenerate, unlike a broken fracture or a skin wound, said Williamson.

"It's not that we fix the injuries so the patient can perform the way they did before the injury, we change people's expectations," said Williamson. "Changing their ways of thinking can make a huge difference for the [patient] and their families."

The PH/TBI staff consists of more than 80 specialists and support staff. At least twice a week, they will meet with a patient's medical doctors to assess the status of the patient. This is to ensure that one treatment plan or medication from one doctor will not interfere with that of another.

"This multidisciplinary model of treatment with psychiatrists and psychologists in the same team as surgeons and rehab doctors is new and not practiced anywhere else in the world," said Williamson.

This approach has drawn national media attention to the PH/TBI clinic at NNMC due to the success of the program.

For more news from National Naval Medical Center, visit www.navy.mil/local/nnmc/.

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