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Dr. Joel Scholten: Asking the Right Questions with Patients with Brain Injury

Asking the Right Questions with Patients with TBI

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So when I treat an individual with traumatic brain injury, I think it's again important to look at overall function and what might be affecting their life. It's a challenge because oftentimes there are so many symptoms that an individual will focus on that you have to prioritize because you may not be able to address 20 things appropriately in your treatment session or in your clinic session. However, I do think it's important for a clinician or a team member to keep in the back of their mind the habits, possibly, that may be affecting someone's function. When I think of--when I talk about that I mean like alcohol use or other substance use because oftentimes an individual's not just going to volunteer that they're maybe drinking every night just to fall asleep. So I think it's important for the clinician to address that. I also think--and, similarly, caffeine use can become, certainly, a barrier and can affect function as well. Other things that patients won't often bring up are sexual functioning or intimacy problems, so it's important for the provider to kind of keep that in the back of their mind and kind of ask about that because it can be caused from a variety of different things, sometimes from the traumatic brain injury itself, probably more often from some of the medications that we may prescribe. So it's, again, important to look at medications and the whole treatment effect and are there adverse effects that we're not aware of? The one other thing that I would encourage providers to keep in the back of their mind at all times is the risk of suicide. Mood issues occur very frequently after traumatic brain injury. Certainly with military personnel we tend to think of post-traumatic stress disorder right away, but actually depression in the general population is more common after traumatic brain injury, and so when we think of depression we also need to think about risk of suicide. And that certainly has been a topic in the news and under discussion, and so providers should just keep that in the back of their mind and potentially ask the patient and also the family member about mood and any changes and be aware of those potential warning signs or red flags, because that's an important assessment that should be done at, really, every clinic intervention.

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When looking at the full-picture treatment for people with TBI, clinicians need to ask leading questions about issues including alcohol and caffeine use, intimacy or sexual issues, and suicide risk.

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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