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Dr. Joel Scholten: Biggest Changes and Improvements in DoD and VA TBI Care

Biggest Changes and Improvements in DoD and VA TBI Care

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When we talk about care for traumatic brain injury and the changes that have occurred in the last few years, I would say the biggest change, certainly, in the VA and the Department of Defense is the overall awareness of traumatic brain injury and the very comprehensive screening and evaluation programs that have been put in place by both agencies. It is still a challenge to develop a treatment plan because, again, it should be very individualized to meet the patient's needs. There are advances in research in regard to imaging. There's been a lot of work on biomarkers, but currently there's no one or two objective clinical findings that definitely diagnose the history of concussion or mild traumatic brain injury. So that remains a challenge, and I think it's also a challenge as you're talking to patients and families to kind of balance that out because sometimes the research hits the headlines and then the patient and family will ask for that potential intervention or particular test, which may kind of be in a research phase yet. So I think that's a large challenge, but in regard to treatment, it's still--for traumatic brain injury still the focus should still be an individualized rehabilitation plan of care, and really the focus should be on non-pharmacologic interventions because they are going to probably provide the greatest benefit because this is going to be long-term. The traumatic brain injury was a historical event, but the symptoms can persist and so we want to equip veterans and service members with the tools to deal with that over the long range. And certainly if we can avoid medications, that's probably the best thing we can do for our service members and veterans.

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Increased awareness of the short- and long-term issues of TBI has helped improve programs for comprehensive TBI screenings and evaluations. But many treatments are still in the research phase.

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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