The Patient Centered Team: How an Interdisciplinary Approach Can Be Used in Treatment of mTBI For Service Members

LCDR Joann Shen, MS CCC-SLP & LTJG Megan Kelly, OTR/L MS, MSC, USN

DISCLAIMER We do not have any financial or

nonfinancial relationships relevant to the

content of the proposals to disclose.The views expressed in this

presentation are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the

U.S. Government.

Objective: This session will provide an overview of some of the cognitive and visual

domains that can be addressed with service members with traumatic brain

injury (TBI) in interdisciplinary therapy sessions with SLP and OT. We

will discuss the process of clinical collaboration and how we treat

cognition and visual symptoms in mTBI through an interdisciplinary

approach.

At the end of the session, participants will be able to:

1. Explain what is an interdisciplinary model for the rehabilitation of mTBI2. Describe how to treat cognition and visual symptoms through collaboration3. Summarize how an interdisciplinary approach can be used in treatment of mTBI

WHERE DID WE START

- 5 staff members in TBI trailer- Multiple sites across base- Specialized care (multidisciplinary)- Traditional medical, including pharmacologic treatments, allied health therapy

WHERE DID WE START

WHERE ARE WE NOW

Services available for concussion therapy:Traditional medical therapy, including pharmacologic treatments, allied health treatments with physical and occupational therapy, speech and language therapy. Complementary and alternative medicine (sleep hygiene, art therapy, acupuncture, mindfulness, yoga, etc.)

- Holistic- Integrative

- Patient and family centered

Cognitive Rehab

Vestibular

Rehab

Vision therapy

Rehabilitation Model

Physical Therapy

Vestibular Rehabilitation Physical accommodation Physical health management

Vision Therapy and Visual Perceptual Training

Stress Management Anxiety Management Sleep Hygiene Strategies Skill integration for

holistic function

Occupational Therapy

Speech Therapy

Cognitive Communication Rehabilitation

Group treatment to reinforce compensatory strategies and social communication

Assistive/accommodations technology training (CAP, smart phone, apps, etc.)

Speech Therapy

WHERE ARE WE HEADED

- Multiple pathways to recovery (Return to Duty vs. Return to Community)

- Identify & participate in research to contribute to scientific TBI body of knowledge (outcome measures/ validate best practice models)

Interdisciplinary

Collaborative Therapy Outcomes

Improved Preparation for Return to Community

Improved Preparation for Return to Duty

Goal setting and discharge as a team Improved Goal Setting and

Achievement for Providers and Service Members

Collaborative Therapy Outcomes

CHALLENGES:

- Logistics (admin barrier, provider schedules, unstaffed teams)- Medical vs. Rehab model- Provider’s willingness to participate and collaborate- Redundancy of services

CHALLENGES:

SOLUTIONS:

Define the leadership roles, program parameters, hiring staff, and developing an interdisciplinary team approach.

Questions??

References:

Parrish, C., Roth, C., Roberts, B., Davie, G. (2009). Assessment of cognitive-communicative disorders of mild traumatic brain injury sustained in combat. Perspect Neurophysiol Neurogenic Speech Language Disorders, 19(2), 47-57.

Leape, L., Berwick, D., Clancy., Gluck, P., Guest, J., Lawerence, D., Morath, J., et.al. (2009). Transforming healthcare: A safety imperative. Quality and Safety Healthcare, 18(6), 424-428.

Mashima, P. (2013). Rehabilitating post-deployment cognitive symptoms: Empowering change [PowerPoint slides]. TBI Grand Rounds, San Antonio Military Medical Center.

Radomski, M., Davidson, L., Voydetich, D., Erickson, M. (2009). Occupational therapy for service members with mild traumatic brain injury. American Journal of Occupational Therapy, 63(5), 646–655.

Riesthal, M. (2009). Treatment of cognitive-communicative disorders following blast injury. Perspect Neurophysiol Neurogenic Speech Language Disorders, 19(2), 58-64.

Scherer, M., Weightman, M., Radomski, M., Davidson, L., McCulloch, K. (2013). Returning service members to duty following mild traumatic brain injury: Exploring the use of dual-task and multitask assessment methods. Physical Therapy, 93, 1254-1267.

Schneider, S. , Haack, L., Owens, J., Herrington, D., Zelek, A.; An Interdisciplinary treatment approach for soldiers with TBI/PTSD: issues and outcomes. Perspect Neurophysiol Neurogenic Speech Language Disorders 2009; 19(2):36-46.

Solomon, P. (2010). Inter-professional collaboration: Passing fad or way of the future? Physiotherapy Canada, 62(1), 47-55.