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
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, MD, is associate chief of staff for Rehab Services at the Washington DC VA Medical Center. Dr. Scholten also works in VA Central Office within the PM&R Program Office as the national director of Special Projects. His research interests include traumatic brain injury, polytrauma, and pain.
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