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TBI Screening. All OEF/OIF patients are screened for possible TBI Conducted within three VA clinic visits Done by various providers Identifies soldiers who may have sustained a concussion while deployed Positive screens are referred for an in-depth evaluation. Mild TBI .
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TBI Screening • All OEF/OIF patients are screened for possible TBI • Conducted within three VA clinic visits • Done by various providers • Identifies soldiers who may have sustained a concussion while deployed • Positive screens are referred for an in-depth evaluation
Mild TBI • Mild TBI accounts for 85-90% of all military related brain injuries • The vast majority of people with mild TBI recover without intervention • Belanger et al., 2005; McCrea, 2008; Ivins et al., 2009 • A small percentage have persistent difficulties • Risk factors
Co-Morbidity • mTBI in the military population rarely occurs in isolation • Complex web of anxiety, depression, pain, substance use • Treatment of co-occuring conditions ; utilize an interdisciplinary approach • Addressing sleep is especially important
Medications • “Studies to date have yielded minimal positive evidence for enhancing function, memory and behavior after TBI.” Chew and Zafonte 2009 • Medication can be a major contributor to symptoms • DoD/VA TBI Clinical Practice Guidelines, 2009
TBI and Suicide • Risk Factors • Cognitive issues • Social factors • Post injury psychiatric issues • Treatment considerations • Ongoing risk assessment • Enhance protective factors • Expectations verses capability
Current Data: VA Wide • 426,413 total screened • 84,008 (19.7%) referred for further evaluation • 31,980 TBI positive (7.5% of total screened) • 12, 583 previously diagnosed • Military reports: • 428 penetrating • 271 severe • 3,389 moderate
Local Statistics • Over 3000 OEF/OIF patients screened • 928 seen for secondary evaluation • 262 diagnosed with ongoing TBI related symptoms • 252 mild traumatic brain injuries • 8 moderate TBIs • 2 severe TBIs
Summary • Recovery takes a lot of hard work • Research • Regeneration • Hyperbaric treatment • Altitude • Biomarkers • Imaging • Neurotrauma/blast injury