What should providers consider when developing an individualized treatment plan for a patient with TBI and/or PTSD?
[Lt. Col. Jeffrey Yarvis] When you're talking about individualized plan,
the word individualized is very, very critical.
And one of the most difficult aspects of traumatic brain injury and PTS
is that you and another warrior can be in the same exact incident
and have two very different presentations.
So the word individualized is key.
That if your predominant complaint is about sleep disturbance,
that will be a driver in where we target their care.
Now if we know there's a physical njury, there will be a parallel
full assessment process of their brain functioning
from what we call neurocognitive testing.
There will be MRIs perhaps ordered of their brain.
If we know there has been some reported concussive injury—
and we'll take their word for it even if there's not a documented event.
If they're talking about anger management,
then sometimes we can match the present symptoms to the actual injury.
If they said they hit the front of their head
and they're also having some emotional dysregulation,
I think there is going to be concern that there
has been an impact on the frontal lobe.
But we're going to target that person's individual plans
because one of the first things we want to do is make them confident in the process
and instill some hope.
And also address some of their low-hanging fruit symptom problems.
And so if it's sleep, we are going to target that
because the other thing is sometimes we'll think it's one thing,
and then after three or four days of good solid rest,
the person's presentation may be very different.
If the anxiety comes way down as a result of getting some solid sleep,
then we might be able to decipher is it really psychological in nature
and not because the anxiety has come way down.
But there's still this sort of point where the tires meet the road,
and they're not functioning quite the way they used to be.
Maybe they're still irritable, and they're still not able to concentrate,
they're just not anxious now, which tells us maybe we're
teetering a little bit towards traumatic brain injury.
And so that would then take on the focus—
when I say the focus, that doesn't mean the other disorders are neglected.
Usually what I would say is, where there's smoke, there's fire.
So if you have some symptoms, we want providers thinking about the other things.
Are there pain management that suits both physical and psychological?
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Lt. Col. Jeffrey Yarvis, PhD is the first integrated service chief of the Fort Belvoir Community Hospital. He is an assistant professor of Family Medicine and director of Social Work at the Uniformed Services University of the Health Sciences.
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