Interdisciplinary Management of Traumatic Brain Injury

Introduction

Team-Based Care – Professionals from different disciplines work together to provide comprehensive care that meets as many patients’ needs as possible. This can be delivered by a range of professionals as a team or by professionals under the umbrella of an organisation. A unique team comes together from a range of organisations, including private practice. As the patient’s condition continues to change, the composition of the team may change to reflect the patient’s changing clinical and psychosocial needs. ” [1]

The complexity of traumatic brain injury sequelae is so large and dynamic that no health or social care professional can address this diverse burden in isolation. Therefore, teamwork is one of the most fundamental and essential elements in traumatic brain injury rehabilitation Comprehensive patient care and improved patient outcomes, including better survival. [2] During the neurorehabilitation process, a multispecialty team is usually led by a rehabilitation medicine consultant with appropriate knowledge and skills, with mutual trust and respect A willingness to share knowledge and expertise and speak openly has proven to be the best condition for caring for patients with complex needs. [2]

A study published in 2021 found that an interdisciplinary model of care that combines traditional rehabilitation with integrative medicine significantly improved symptoms in patients with mild combat-related TBI. [3]

Most importantly, we must never forget that people with brain injuries and their families are the most important members of the treatment team. [4]

Team Members

People with traumatic brain injuries often present with a mix of medical, physical, sensory, cognitive, communication, behavioral and social problems that require the expert opinion of a wide range of medical and allied health professionals, including:

Medical Specialists

Rehabilitation Medicine Physician Neurologist Geriatrician Orthopedic Surgeon Neurosurgeon Neuropsychiatrist Endocrinologist Anesthesiologist and Intensive Care Pain Management Doctor Ophthalmologist and others depending on individual needs.

Rehabilitation Trained Nurse/Nurse Professional

Provides a foundation for neurorehabilitation by implementing multidisciplinary team/interdisciplinary team (MDT/IDT) strategies and plans, attending to patients with medical needs such as skin vitality epilepsy while working with the treatment team on 24-hour postural management Program splint mechanism, etc.

Physiotherapist

Physiotherapists promote motor reeducation mobility and balance retraining verticalize general fitness and a person’s tolerance for physical challenges; advise on physical activity, including participation in recreational activities such as gyms, swimming, golf games, etc., to prevent other Comorbidities and support for the management of inactivity fatigue mood and other traumatic brain injury related issues.

Occupational Therapist

Occupational therapists promote independence in activities of daily living (ADLs) such as dressing, washing, cooking, budgeting and planning for leisure activities; support home remodeling and environmental organization; promote higher cognitive and executive function retrain driving skills Vocational training and return to work; helps with fatigue management

Speech and Language Therapist

Speech and language therapists facilitate re-education of communication skills, including understanding and expressing written and spoken language and improving speech intelligibility; help identify any communication support strategies for effective communication in school work social networks; assess Dysphagia (dysphagia) and provides guidance for safe swallowing management, ie: type of diet, fluid thickening, environmental organization, etc.

Neuropsychologist

Neuropsychologists assess and treat behavioral emotional and cognitive problems after traumatic brain injury; can advise on minimally conscious behavior Challenging behavioral strategies How to cope with deficits such as memory loss or cope with emotions such as low mood or depression anger

Vocational Therapist

Occupational therapists who facilitate return to work can be occupational psychologists or occupational therapists (by background)

Therapy Assistant

Therapeutic assistants support individual therapy, i.e.: Occupational Therapy Assistant or Physical Therapy Assistant

Social Work

Social workers give practical advice on family welfare, housing, transport support and wider aspects or personal welfare and wellbeing

Case Manager

The case manager oversees the overall care of the traumatic brain injury patient; develops an individualized care plan or treatment plan to meet the individual’s specific health social and emotional needs, and is often based on assessments by other clinicians and professionals; comes From different professional backgrounds, such as social work, occupational therapy or nursing, are often available through private referrals and provide interim compensation for clients seeking legal claims Traumatic Brain Injury Nursing.

Family & Friends

Family members and friends can achieve better outcomes when they act as advocates in the community for rehabilitation programs and strategies based on their knowledge of the traumatic brain injury patient. [5]

Others

Depending on individual needs, a range of other health and wellbeing professionals may also be involved, including orthotists, audiologists, rehabilitation engineers, orthopedic therapists, recreational therapists, peer mentors, spiritual health facilitators such as Imam rabbis, and others.

Large teams require clearly appointed leaders with strong leadership skills. Improve team effectiveness through multidisciplinary/interdisciplinary training. Ensure effective coordination and communication within the team and between patients and the team Or the case manager should determine. The key worker/case manager role is described in Recommendation G20 of the Guidelines for RCP Rehabilitation after Acquired Brain Injury:[6]

G20 Designated team members (e.g. “key staff”) should be responsible for overseeing and coordinating the patient’s program and serving as a point of communication between the team and the patient/family. [6]

Models of Team Based Care

Both multidisciplinary and interdisciplinary models of care provide greater knowledge and experience in neurorehabilitation of patients and employ a more patient-centred approach to care than disciplines operating in isolation. In some publications or among some clinicians, multidisciplinary Interdisciplinary rehabilitation and integrative rehabilitation are used interchangeably.

Multidisciplinary Team Model (MDT)

The multidisciplinary model draws on the skills and experience of clinicians from different disciplines, but professionals work while clarifying roles. MDT is characterized by a hierarchical model, with the physician having a clear lead role in coordinating individual patient care. Multidisciplinary teams allow for a high degree of autonomy, with each clinical specialty setting its own goals and treatment plans. Patient discovery goals and issues related to treatment planning are communicated and discussed in case conferences where the patient is not necessarily present.

Interdisciplinary Team Model (IDT)

Interdisciplinary models demonstrate a more integrated approach that works together to achieve jointly set goals. Significantly closer interdisciplinary teams, joint patient histories for assessment, diagnosis and management, shared goal setting involving Various clinician patients and their families.

All major decision-making meetings of the G21 eg. Evaluation Goals Planning Case Conference Discharge planning should be undertaken by relevant members of the interdisciplinary team together with the patient and their family/carers as appropriate and should be documented in the case notes. [6]

Communication is effective when an interdisciplinary individual patient record system is in place and all members of the IDT enter the same case. Team hierarchies are less prominent; communication is closer and collaboration is greater. interdisciplinary team Often demonstrated a stronger teamwork culture, increased productivity and job satisfaction.

It turns out that specialist neurorehabilitation of patients with traumatic brain injury is a long-term and ongoing process that should involve a variety of expert opinions over time to address traumatic brain injury sequelae and prevent secondary complications. question Specialist neurorehabilitation should be managed using a 24-hour interdisciplinary program that may include:

24-hour contracture prevention and spasticity management Postural management program for tissue vitality and respiratory management with input from nursing staff and physiotherapists including positioning in various posture groups, vertical and seated using splints and Orthotic mobilization procedures, manual chest clearing techniques, etc.
Spasticity management strategies consider concurrent guidelines such as “Splitting for the Prevention and Correction of Contractures in Neurologically Impaired Adults” or “Spasticity in Adults: Management with Botulinum Toxin.” IDT should create Triggers for increased muscle tone such as infection pain Poor postural management Constipation Consent for use of devices such as splints and pharmaceutical antispasmodics, including use of Botox, and provide education to relatives and patients of all professionals. (G60-G62 of RCP rehabilitation Acquired Brain Injury Guidelines)[6]
The tracheostomy care weaning and extubation program was developed jointly by an interdisciplinary tracheostomy team including nurse physiotherapists and speech and language therapists. (Guidelines G43-G47 for RCP Rehabilitation After Acquired Brain Injury)[6]
A swallowing disorder management plan developed by speech and language therapists, physical therapists, nurses, occupational therapists, with advice on swallowing positioning and appropriate equipment to ensure safe and successful delivery of effective assessments. (G49 rehabilitated by post-RCP Brain Injury Guidelines)[6]
The IDT protocol for use of botulinum toxin is recommended to be agreed by the interdisciplinary team prior to injection and to physically manage splint positioning and pain management using a target assessment tool.
Early recognition and optimal treatment of heterotrophic ossification IDT regimens limit secondary range of motion loss and painful symptoms and should involve a medical professional nurse, physical therapist, and wheelchair/seating engineer.
IDT seating clinics should ensure that the optimal wheelchair and alternative sitting positions are available to meet the individual patient’s posture needs. Standing aids should be evaluated by the IDT to establish weight bearing and opportunities to experience a vertical position. splint orthotics and Walking aids should also be evaluated to facilitate improvements in stabilizing tissue vitality and sensorimotor feedback. (G10 4-G105 of RCP Rehabilitation after Acquired Brain Injury Guidelines)[6]
Neglect management, due to its complex nature, requires IDT involvement to identify the type of assessment (visual auditory tactile-kinesthetic neglect) and implement strategies through a 24-hour management protocol. (RCP Guidelines for Rehabilitation after Acquired Brain Injury G110)[6]
The ADL Recreational and Occupational Engagement Program promotes independence, uses a variety of modalities and available therapeutic techniques and approaches, is led by an occupational therapist, and employs a paramedic physiotherapist in a meaningful setting, including the patient’s native family Community. (G 141-G144 of RCP Rehabilitation after Acquired Brain Injury Guidelines)[6]
Challenging behavior management protocols are suggested by neuropsychologists using pharmacological agents prescribed by rehabilitation medicine physicians or psychiatrists and are followed by all members of the interdisciplinary team to facilitate a consistent approach through agreed strategies.
An epilepsy protocol recommended by the IDT with the recognition of triggering epilepsy symptoms and the management of rescue medications, along with physician and nursing advice and training for other team members and family members.