Today, there is a growing critical need to assess and treat Traumatic Brain Injuries (TBI) and although DOD, the VA, and rehabilitation hospitals are trying to address the problem, there can be shortages of TBI specialists at any one location. At this point, telemedicine technologies have the opportunity and the need to step in and play an important role in TBI patient care.
Several of the challenges involved in managing TBI require the cooperation of many disciplines. First of all, severe TBI frequently occurs with other traumatic injuries that can complicate emergency treatment, recovery, and rehabilitation. Secondly, mild and moderate TBI particularly for those patients where the head is not penetrated may not immediately know that they have TBI. Thirdly, if symptoms are subtle and occur in isolation as in a remote region, the patient may not be aware of any brain problems.
There are several ways that telemedicine can be used to help patients with TBI and can be used to:
- Identify concussion and mild TBI by using electronic cognitive assessment systems
- Provide information so that clinical teams are able to collaborate on TBI care
- Provide teletherapy and encouragement for patients with TBI receiving long term rehabilitation services
- Provide real-time video visits with family members
- Provide video nursing supervision of patients with TBI in their home
- Manage medication and provide for an online response system
- Provide cognitive therapy, speech, and physical therapy in distance or rural areas
- Provide interactive video programs and web courses to train medics, physician assistants, nurses, and other providers in civilian and military settings
According to the newsletter “Brainwaves” published by the Defense and Veterans Brain Injury Center (DVBIC) located at the Walter Reed Medical Center, a telemedicine program has been established to help healthcare providers assess and treat TBI in deployed settings or in remote locations. The program includes specialty experts in a variety of disciplines such as neurologists, neuropsychologists, occupational and physical therapists, and others who are able to offer expert advice related to TBI.
The DVBIC telemedicine program specialists make recommendations on when and how to screen for TBI, strategies for symptom management, return to duty considerations, and provide advice in areas where neurological and psychological health concerns overlap. The specialists are able to work with 16 other specialty groups such as dermatologists, ophthalmologists to help thousands of patients each year by making specialty email consultations available in remote locations. Questions generated in theater are expedited through an email network which allows expert clinical responses to be given within five hours.
One of the problems in treating TBI concerns the limited time and resources available at forward medical commands. To deal with this problem, DVBIC’s remote cognitive assessment system identifies TBI using a web-based program containing evaluation questionnaires and brief cognitive screening tests. It has been found that computerized cognitive assessment becomes even more useful when baseline test data is available.
Also, the Biomedical Technology Defense Program is helping with TBI by developing PC or web-based video game applications to improve cognitive, motor, and sensory performance. A portable system has been used on the battlefield to monitor TBI, along with a virtual reality based assessment tool to determine return to duty status of patients.
The Veterans Health Administration is also very involved in helping patients with TBI. Currently, the Polytrauma Telehealth Network using state-of-the-art video conferencing connects clinicians at Polytrauma Centers and VA medical centers across the country to help coordinate national trauma rehabilitation and educational services and to provide for direct patient evaluations.
Recently, the National Rehabilitation Hospital (NRH) in Washington tested a web-based system for assessing cognitive and emotional functions on a group of patients with TBI who were receiving outpatient rehabilitation services at NRH. The patients participating in the study took a series of cognitive tests through an intranet connection. All communication with the examiner was conducted via video conferencing.