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Dr. Joel Scholten on Developing Individualized TBI Treatment Plans

Dr. Joel Scholten on Developing Individualized TBI Treatment Plans

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Every individual with a traumatic brain injury is different. They can present with a variety of different symptoms, and the challenge often is that those symptoms--there's no symptom [Joel Scholten, MD, Washington DC VA Medical Center] that's completely specific for a brain injury; so it may be due to a mental health issue, it may be a pain issue that's kind of driving that symptom. The real key then in the rehabilitative process is to look at the individual and see how those symptoms are affecting their functioning, and then-- then you can try to help work with the veteran to develop a treatment plan that's going to-- that's going to take into account their individualized needs and what they really would like to focus on, and how it affects their function. So for instance if its really, really a cognitive issue or a memory issue that they're the most concerned about then we'll try to kind of focus our efforts on that, and that may include a short course of speech therapy-- to see the speech therapist for cognitive therapy. It may be, when talking with the individual, they may not be able to concentrate because they may also have post traumatic stress, and they're hyper-vigilant and not able to, you know, focus their attention because they're too worried about what's, you know, what's happening outside the room or what was that noise outside the door. So it really is very, very individualized as far as how to kind of develop that treatment plan. Some of the treatments though are the same. You know if it--and it doesn't really depend so much on the actual diagnosis. So if it's an attention issue, we can work on cognitive-- some cognitive therapy to focus on improving attention. We can provide techniques as well as you know technology. So some of the techniques may be, you know, using a post-it note to remind an individual to--of an appointment, or it may include using a smart phone to schedule your appointments to remember how to-- what you need to do during the day or during the week. So it really is very individualized. It's also important to talk to the individual and see, of all their symptoms, what might--where you might get the biggest bang for your buck in regards to treatment. So for instance sleep issues are very common, and certainly if you can help to improve sleep then you're likely going to improve memory and concentration, likely to improve, you know, overall pain or at least tolerance of pain, and overall function and mood certainly. So that will impact not only the individual but their functioning and how they interact with their family.

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Helping improve function and mood for patients post-TBI involves getting the whole picture of a person, his symptoms, and how they are affecting his life.

See more of Dr. Sholten's videos here.


Produced by Ashley Gilleland and Victoria Tilney McDonough, BrainLine.

Joel Scholten, MDJoel Scholten, MD is associate chief of staff for Rehab Services at the Washington, DC VA Medical Center. He also works in VA Central Office within the PM&R Program Office as the national director of Special Projects.

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