Telerehab for TBI Shows Promise, Comorbid PTSD Remains Problematic

by U.S. Medicine

January 22, 2011

BETHESDA, MD—There is a pressing need to understand what the rehabilitation trajectories are going to be for those servicemembers returning with mild and moderate TBI, according to Kris Siddharthan, PhD, a health services researcher at the James A Haley Veterans’ Hospital in Tampa, FL. In a presentation at the 3rd Annual Trauma SpectrumConference last month, Siddharthan cited that “When the war first started, we misunderstood very much what the complications were going to be for this group.”

VA is discovering that, while most mild and moderate TBI symptoms are acute, there are some patients who continue to have persistent symptoms, for which they need life-long monitoring and therapy. Further complicating treatment is the fact that frequent treks to the nearest VA medical center can be a considerable burden for most veterans.

In 2008, Siddharthan and his fellow researchers began recruiting 75 OEF/OIF veterans with mild to moderate TBI to test out a telerehabilitative intervention for TBI. The intervention emphasizes care coordination, with a group of physicians, including a primary care physician, psychiatrist, psychologist, and rehab specialists, working together to determine the patient’s course of treatment.

Patients have to communicate at least once weekly with a full-time interventionist—an advanced registered nurse practitioner (ARNP)—over the Internet. “We did not come up with [pre-planned] dialogues,” Siddharthan explained. “This is a very complex group of people. When we started this intervention, we had no idea what type of dialogue to use. We decided to go free format. This has worked very well. There are as many dialogues as there are veterans to follow. Each veteran is unique.”

The interventionist, backed by the care team, coordinates the patient’s therapy, including scheduling appointments, pain management, drug therapy, substance abuse treatment, and behavioral modification. The group also started a drug-tapering program, since patients going from acute care to home care frequently have problems due to addiction to long-term pain killer use.

The group also keeps a regular account of the veteran’s health status over time.

Those directing the intervention have found that veterans end up, either because of the regular contact or the informal nature of the contact, telling the ARNP things they never told their primary care provider. “One veteran told the ARNP that he [couldn’t reply] to her chat because he had a seizure,” Siddharthan said. “It was a symptomatology that was not listed in his health record.”

Siddharthan and his team are conducting a longitudinal study as part of the overall study, looking at changes in patients’ ability to self-care, as well as their mobility, locomotion, communication skills, adjustment, and cognitive function. Early results show that patients with just TBI show a fairly stable course from baseline out to 18 months. However, those with comorbid PTSD show a more erratic course. “They go way up and are stable for a long time, then come crashing down,” Siddharthan said. “How do we deal with this? There are no models for this.”

back to January articles

Comments are closed here.

Related Articles

After 40 Years, VA Study Finds Antipsychotics No Help for Delirium

For more than 40 years, haloperidol and ziprasidone have been given to critically ill patients who develop delirium in hospital intensive care units.

Program Helps Reduce Domestic Violence Involving Returning Servicemembers

While intimate partner violence in the military population has been found to occur at about the same rate as the civilian population, servicemembers and veterans face unique challenges: a lack of separation between home and work life, long separations from family and repeated exposure to combat and other traumatic situations.

U.S. Medicine Recommends

More From department of veterans affairs

Department of Veterans Affairs (VA)

Senate VA Committee Chair Vows to Pass 'Blue Water' Navy Benefits

Senate Committee on Veterans' Affairs Chairman Sen. Johnny Isakson (R-GA) vowed that addressing benefits for Blue Water Navy Veterans “is no longer going to be a question,” but that “how we do it is the only question.”

Department of Veterans Affairs (VA)

VHA Makes Progress in Improving Safety of Opioid Prescribing

VHA medical facilities should ensure that its providers are following three key opioid risk mitigation strategies, including conducting urine drug screening, a recent report recommended.

Department of Veterans Affairs (VA)

VA faces healthcare staffing shortages, barriers to hiring facility leaders

A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.

Department of Veterans Affairs (VA)

Veteran nephrologist labors to improve ESRD treatment at VA

When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.

Department of Veterans Affairs (VA)

Committee approves bill to provide agent orange benefits to ‘blue water’ vets

A long sought-after bill that would make it easier for Blue Water Navy veterans to receive Agent Orange benefits has been passed by a key House of Representatives committee.

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up