No images? Click here October 2020 Mild Traumatic Brain InjuryBy Mary K. Voegeli, FNP-BC, APNP, CRRN, CBIS A Mild Traumatic Brain Injury (mTBI) is an injury to the head with either brief loss of consciousness ( less than 30 minutes) or no loss of consciousness with a Glasgow Coma Score between 13-15. Post Traumatic Amnesia (PTA) is determined by the duration of time from the point of injury until the patient has continuous memory of ongoing events. < 24 hours PTA is deemed mTBI. Risk factors for mTBI include: involvement in combat, physical abuse, history of previous concussion, lack of helmet use, lack of seatbelt use, alcohol abuse, substance abuse, falls, participating in sports, motor vehicle crashes, biking accidents, pedestrian accidents. 90% of all traumatic brain injuries are mild. 75% of hospital admissions are mTBls. CTOH is not always positive. Symptoms of mTBI: headache, confusion, amnesia surrounding event, delayed response to questions, dizziness, tinnitus, nausea, vomiting, fatigue. Symptoms usually resolve over time. Concussion Management: Extended brain rest is no longer recommended past the first 2-3 days of injury contrary to prior approach of isolating the patient from all physical, cognitive activities for weeks on end. Most patients report that their symptoms are gone in 3-4 days. Most concussed individuals will recover completely in 7-10 days. Most of these patients are managed by Primary Care Provider. Patient may require a referral to a Mild Traumatic Brain Injury Clinic if symptoms persist > 2 weeks. Clinic is staffed by Physical Medicine and Rehabilitation Providers and a Neuropsychologist. Pre COVID-19, these visits were done jointly, but now due to restrictions, visits are separate. We are hoping as time passes that the multidisciplinary approach will be put back into place. Team members: Mark A. Klingbeil, MD; Mary Voegeli, APNP; Julie Janecek, PhD; Mike McCrea, PhD; Lindsay Nelson, PhD; Sara Swanson, PhD; Laura Umfleet, PsyD; and Neuropsychology Fellows. The patient undergoes an interview with a physical exam that is neurologic in nature. The patient undergoes abbreviated cognitive testing to assess memory, processing speed and comprehension. The team addresses return to work, school, driving, recreational sports, recommended treatment and follow up care. Feedback is provided to the patient and family. Goals of care across the board is to establish a uniform approach in the community as this paradigm shifts to a more active approach in the treatment and recovery of the Mild TBI patient PREVENTION IS THE ONLY CURE FOR BRAIN INJURY!
Dr. Braza Dr. Kotsonis
PM&R Diversity and Inclusiveness Initiatives
The 2020 United Way of Great Milwaukee and Waukesha County Giving Campaign runs from October 5 through October 23, 2020. Dr. John Raymond, our MCW President, is a Co-Chair of this year's campaign. Beatriz Envila will be the Champion for the PM&R Department. Please consider participating to support our community in such an unprecedented time we are living through. Look up for emails coming from the United Way team and Bea Envila, which will include some fun activities. The Twitter account is gaining followers! 106 accounts have already followed our official department account. If you don’t have a Twitter account of your own, consider starting one and follow @MCW_PMR. "Fall into Wellness" Have news to share with your PM&R colleagues? We would love to hear from you for our next issue, so please email any recent publications, awards, presentations, shout-outs, etc. to Beatriz Envila at benvila@mcw.edu. Medical College of Wisconsin | 8701 Watertown Plank Road | Milwaukee, WI 53226 Connect to MCW on Social |