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October 2020
Mild Traumatic Brain Injury
By 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!
- Congratulations to Mary Elizabeth Nelson, DNP, for appointment as assistant professor, PM&R, effective 7/1/2020. Dr. Nelson is the first APNP in PM&R to be appointed to faculty status.
- Congratulations to Dr. Ken Lee and to Dr. Michael Harper for being awarded with the second grant to support the development and publication of the handbook on concussion in adaptive sports.
- Kudos to the Froedtert Rehab Medicine Clinic Providers for outstanding CG-CAHPS scores. The clinic is at the 99 percentile for 12-month rolling overall provider score and at 98th percentile for provider communication.
- Congratulations to Dr. Diane Braza for25 years of service and to Dr. Ken Lee for 20 years of service to MCW, as recognized at the MCW Convocation on September 24, 2020.
- Congratulations to the following physicians for being named Best Doctors. The list keeps growing every year. We could not be more proud:
Dr. Braza Dr. Kotsonis
Dr. deDianous Dr. McGuire
Dr. Del Toro Dr. Nelson
Dr. Ketchum Dr. Waring
Dr. Klingbeil Dr. Zvara
Dr. Kosasih
- Spinal Cord Injury Medicine fellowship recruitment is in full swing virtually this year. Using Zoom, Dr. Chris White and Sue Abrahms interviewed very highly qualified candidates. Rank order lists are due October 14, and we look forward to finding out who we match with on October 28!
Required flu vaccinations available NOW until November 13, 2020. Appointments need to be scheduled this year by accessing the Occupational Health's Influenza Vaccination Online Scheduler.
After 41 years with the Medical College of Wisconsin and Curative Care Network, Dr. Muni Reddy announced he is retiring on December 31, 2020.
After 22 years of service, Dr. Bill Waring has announced his retirement effective December 31, 2020.
PM&R Diversity and Inclusiveness Initiatives
- MCW Common Read, How to be an Antiracist by Ibram X. Kendi.
- PM&R Common Read, So you Want to Talk about Race. Will be postponed to early winter.
- The AAMC has partnered with Cook Ross, Inc., a leading consulting firm, to create training focused on the science behind unconscious bias to help academic medical staff and faculty mitigate disparities. Seven members of DOP team have earned a certification as unconscious bias trainers through Cook Ross. These trainers have translated what they’ve learned into a two-hour training for our faculty and staff. By learning how to identify and confront unconscious bias, it is possible to mitigate the impact and promote respect for all groups.
- Our PM&R Residency Leadership team has discussed Unconscious Bias training for PM&R faculty and chief residents involved in resident recruitment interviews Lead by Dr. Michael Levas from Department of Pediatrics aiming to cascade to all faculty, residents and staff during the year.
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"
Kathy Strupp, RN, Linda Yoon, RN, and Bea Envila, AA
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.
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