traumatic brain injury

[indytravl]

can anyone help with info or practical clinical resources for pharmaceutical management of cognitive (attention, concentration, distractibility) & behaviorial/psych(restlessness or dec'd fatigue, initiation, irritability) symptoms in young adult MILD tbi patients (grade 1-3 concussion types).

not all patients c/o of all these symptoms or even if they do, they'll note that some of these predominate & be the most impairing. often there are psychiatric, insomnia, & pain components that compound the presentation. pt's are relatively young & don't want to be on regular meds.

is there any article, book, or other resource that can give some guidance for the psychotropics that would be helpful & not impair neuro recovery?

also, when is cognitive rehab with slp not a realistic option lilkely to show gains? one year post-injury? five years?

what type of cognitive rehab does occupational therapy do? how does it differ from slp? what about neuropsycholgy's role in rehab? any resource for details on what neuropsych testing can help evaluate? what's different from speech's cognitive eval/testing? how & what to order neuropsych exam without getting biledl for several days of testing & thousands of dollars?

what actually does physical therapy do in vestibular evaluation & rehab?

any thoughts regarding hippotherapy?

thanks!

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[PMR 4 MSK]

In my training, we always sent these patients to speech Tx. Where I am now, speech path's don't want the patient's, so they go to neuropsych, who tests the living crap out of them, literally hours of intensive testing, prepares 10 -20 page reports, then has their counselors work with the patients. I see most improvement in first 2 years. Most of the TBI's I see are work-related.

Not sure about hippotherapy. Hippo's are rather dangerous semi-aquatic animals, as I understand it. Not very therapeutic...

 

[Ludicolo]

The recent March study guide in Archives deals with brain injury. Haven't read it closely so I'm not sure if it will answer your questions regarding mild TBI. Might be a place to start though.

Did you mean "hypnotherapy"? Because a hippo falling on your head would probably make a mild TBI worse.

 

[ampaphb]

http://www.americanequestrian.com/hippotherapy.htm

 

[axm397]

hippo therapy = therapy with horses, no? haven't seen it much with TBI - used much more commonly with pediatrics - helps with core strength, stability, etc. Not sure how practical it would be to enroll adult TBI patients in hippo therapy - there's usually a wait list for the kids.

For a good reference on TBI - try The Rehabilitation of People with Traumatic Brain Injury by Woo and Nesathurai. Not sure if this is in print anymore but we get photocopies during our rotation. Can also try the TBI section of pocketpedia, braddom/delisa, or cuccurullo.

indytravl, - are you a practicing physiatrist? A lot of these things you should have been exposed to in residency - did you have a dedicated TBI unit at your residency? It seems that different TBI attendings have different arsenals of meds that help with cognition/behavior/attention/etc. And it's tough to suggest meds without knowing the patient or the specific issues. A lot of issues can be solved without meds - environmental cues, etc.

 

[Shalom77]

Another book to consider looking at is Brain Injury Medicine (Zasler, Katz, Zafonte) They have a whole section on neuropsychopharmacology and alternative treatments.

Nothing about hippotherapy though.

 

[Ludicolo]

http://www.americanequestrian.com/hippotherapy.htm

Thanks! Learned a new word today.

 

[ShrikeMD]

can anyone help with info or practical clinical resources for pharmaceutical management of cognitive (attention, concentration, distractibility) & behaviorial/psych(restlessness or dec'd fatigue, initiation, irritability) symptoms in young adult MILD tbi patients (grade 1-3 concussion types).

not all patients c/o of all these symptoms or even if they do, they'll note that some of these predominate & be the most impairing. often there are psychiatric, insomnia, & pain components that compound the presentation. pt's are relatively young & don't want to be on regular meds.

is there any article, book, or other resource that can give some guidance for the psychotropics that would be helpful & not impair neuro recovery?

also, when is cognitive rehab with slp not a realistic option lilkely to show gains? one year post-injury? five years?

what type of cognitive rehab does occupational therapy do? how does it differ from slp? what about neuropsycholgy's role in rehab? any resource for details on what neuropsych testing can help evaluate? what's different from speech's cognitive eval/testing? how & what to order neuropsych exam without getting biledl for several days of testing & thousands of dollars?

what actually does physical therapy do in vestibular evaluation & rehab?

any thoughts regarding hippotherapy?

thanks!

Get the Brain Injury Medicine book (Zasler/Katz/Zafonte) cited earlier. It isn't perfect, but it is the best single source of neuromedical mgt on the TBI-related issues you inquired about above (except hippotherapy.)

Regarding the use of pharmacological agents to enhance cognitive/behavioral performance after tbi, these practices vary considerably across the country. There are few studies that provide empiric data to guide clinical decision-making; most of the literature is comprised of case-reports/case series.

Finally, the Archives Study Guide Supplements are much too sparse to be a useful resource for your questions. It is a limited overview, and not a good one at that. Its coverage of neuromedical complications of acquired brain injury is unacceptably poor. (e.g. I don't think posttraumatic seizures are discussed. Then again, the word count constraints imposed upon authors of the Study Guides are formidable.)