 |
Treating Traumatic Brain Injury
|
An increasing number of active duty service members are returning from the Middle East exhibiting symptoms of traumatic brain injury (TBI), which is commonly caused by falls, motor vehicle accidents, assaults/blows and explosive blasts. The long-term effects of even a “mild” TBI with only a brief alteration in consciousness can be serious. Early recognition and treatment are critical to improving patient outcomes.
Immediate TBI symptoms may include mental confusion, loss of memory and/or loss of consciousness.
Delayed symptoms may include headaches; pain; seizures; insomnia; dizziness; fatigue; spasticity and hydrocephalus; cognitive or emotional complaints of irritability; lability; disinhibition; impaired judgment; slowed thinking; aggression; substance abuse; impulsivity and/or inability to focus.
It is important to evaluate and treat patients who present somatic complaints early. This provides the opportunity to document baseline neurological findings, including cognitive and emotional state. It also allows you to assess the ability of the patient to return to everyday activities.
When treating TBI it is important to:
-
Review pain medications to determine those which can cause dependence or rebound headache.
-
Educate about the importance of avoiding substances—such as alcohol, caffeine and cold medications—that can worsen symptoms.
-
Consider short-term utilization of stimulant therapy (e.g., Ritalin®).
-
Avoid medications—such as benzodiazepines, anticholinergic and antidopaminergic agents—that can impair cognition, cause oversedation or diminish neuronal recovery.
-
Systematically wean anxiolytics and, instead, employ SSRI anti-depressants.
-
Use pharmacological assistance to re-establish sleep patterns on a short-term basis.
-
Evaluate complaints of parathesias or radiculopathy via MRI imaging of the spine.
-
Manage headaches by evaluating potential etiologies such as sinusitis, TMJ dysfunction or cervical strain/sprain.
-
Steer clear of medications for dizziness, such as Antivert®.
-
Make physical therapy referrals to increase flexibility, strength, cardiorespiratory endurance, muscular endurance and range of motion; to decrease pain; and to treat vestibular hypersensitivity.
-
Undertake neuro-ophthalmologic evaluation for complaints of visual blurring, double vision, difficulty reading, etc.
-
Gradually progress to a goal of no long-term medications.
Providers can improve outcomes by implementing early treatment when mild TBI is suspected or diagnosed. Refer patients, as appropriate, when physical, emotional or cognitive symptoms interfere with normal routines and relationships.
Back to Top
|
