TRIPLER ARMY MEDICAL CENTER, Hawaii – March is designated as National Brain Injury Awareness Month where raising the awareness of traumatic brain injury throughout the nation is practiced by organizations, such as the Brain Injury Association of America.
Dr. Sarah Miyahira, Pacific Regional Traumatic Brain Injury Program director, answers questions about the traumatic brain injury program here that is designed to provide a comprehensive continuum of care for TBI patients from the point of injury, to their return to active duty, or if need be to get patients to the highest level of functioning if they are separating from their branch of service.
Q: What is the purpose of the Tripler Army Medical Center Traumatic Brain Injury Center and why was it created?
A: The center was created back in 2008 as part of the larger U.S. Army’s action plan to establish a traumatic brain injury program at all of the strategic medical facilities in order to be able to meet the demand for the soldiers coming back with traumatic brain injuries. There are about 1.7 million Americans who suffer from a traumatic brain injury every year and of that there are 5.3 million Americans cumulatively who are suffering from a long-term disability as a result.
From 2002 to 2013 more than 294,000 military service members have suffered from traumatic brain injury. So the Army, recognizing that this is a really serious military health concern, wanted to establish a program that would customize, systematize and standardize a kind of care that service members could expect from military treatment facilities. In 2008 the Army established an action plan to do so and Tripler was one of the facilities that was targeted for setting up a TBI program.
Q: Can you describe the types of treatment provided at the TAMC TBI Center?
A: The program at Tripler really consists of two major parts. One is the traumatic brain injury concussion clinic, which is really Tripler’s main point of entry for TBI care. The other part is our specialty providers, who are embedded in specialty clinics throughout the hospital.
When someone comes into the program either from referrals from their provider, self-referring, or by referrals initiated by loved ones, they can contact the concussion clinic.
Our main purpose here is to do an assessment and evaluation as to whether or not a TBI occurred, when it occurred, how severe it is and what the symptoms that the patient is experiencing are, particularly those that really interfere with their daily living. Then we will do a further assessment if needed through our specialty providers as well as come up with a treatment plan that our nurse case managers will manage and coordinate care with these other providers.
Q: Who do these providers treat and what is the treatment’s range?
A: [Patients] don’t need to come in with a diagnosis of TBI. We can do that. We can make the diagnosis. If they have symptoms that look like TBI like the dizziness, headaches, and nausea, we will look at that patient as being someone who should come in and should get checked out. In addition to [service members] we will also treat family members who might have a concussion or injury.
After an injury, if you see stars, have a little loss of memory, or you have sustained symptoms after the event, you should really get checked out. We would rather err on the side of caution than to miss something, because TBI is not a visible injury. It often tends to be undetected and untreated, and the untreated TBI may in fact progress to something that is much more significant. It’s only through being checked out and having some sense in knowing what the symptoms are.
Q: Is there anything people should know about the TAMC TBI Center regarding its purpose and treatment methods?
A: First we need to assess whether or not [a patient] has had a traumatic brain injury. We try to get the specific event that might have triggered all of these symptoms. If we are not able to do that then what we try to do is get a history of how these symptoms occur, over what period of time, and are they exasperating or are they resolving. If we can get a spouse, a roommate or whoever the service member lives with to be able to cooperate or give us additional information about their functioning. We then will look check if there are cognitive deficits. We might call upon our neuropsychologist to do a cognitive assessment. The neuropsychologist will conduct an interview and will administer some performance tests. [The neuropsychologist] might ask that person to repeat a sequence of numbers for example or draw a certain picture based upon some instructions that are given.
In addition to our neuropsychologist helping with rehabilitation we will go to our occupational therapist, physical therapist, speech pathology, and audiologist to also do their evaluations and to come up with recommendations or results that might give us an idea on what kind of treatment plan we really want to pull together for a particular patient. That’s really important that each of these treatment plans are very customized to the individual. It’s not one size fits all.
For more information on traumatic brain injuries and Brain Injury Awareness Month visit the U.S. Department of Defense official website at www.defense.gov.