Speaker: Patricia Garcia
This presentation focused on adult patients will provide an explanation of the different mechanisms of injury, how severity is classified, ICU management of moderate/severe TBIs, tools for tracking recovery, and neuropsychological sequelae as it applies to cognitive and personality/behavioral domains. Neuroanatomical correlates will be highlighted when discussing the most commonly seen neurocognitive deficits.
Patricia Garcia, PsyD, HSPP is a Clinical Neuropsychologist and Assistant Professor of Clinical Neurology and Physical Medicine and Rehabilitation who specializes in the neurocognitive and psychiatric assessment of adult populations. Clinically, Dr.
Garcia evaluates a variety of adult patients with acquired and neurodegenerative diseases affecting cognition and personality. Her research interests include cognitive aging after a brain injury, neuropsychiatric sequelae following brain lesions, and cultural adaptations of psychological/behavioral interventions addressing neuropsychiatric symptoms. She graduated from Albizu University in Miami FL with a concentration in neuropsychology, and went on to complete internship and fellowship training in neuropsychology at the University of Miami Leonard M. Miller School of Medicine and Jackson Memorial Hospital where she received extensive training on the neurocognitive assessment of trauma populations, including brain injury and stroke, both at acute/inpatient settings at the nation-renowned Ryder Trauma Center, and outpatient clinics. Dr. Garcia is past chair of Culture and Diversity Task Force in Traumatic Brain Injury from the American Congress of Rehabilitation Medicine and is current faculty with the Outreach Recruitment and Engagement (OREC) core of the Indiana Alzheimer’s Disease Research Center (IADRC).
Program: Traumatic Brain Injury: Classification, Management, and Sequelae
Speaker: Patricia Garcia, PsyD, HSPP, Clinical Neuropsychologist and Assistant Professor of Clinical Neurology and Physical Medicine and Rehabilitation, IUSM and more
Introduced By: Bill Halsema for Jeff Rasley
Attendance: NESC: 97, Zoom: 28
Guest(s): Billy Blythe, Barbara Eden, Sherie Kendall, Al Northrop, Amanda Wanlass
Scribe: Bill Dick
Editor: Carl Warner
Talk’s Zoom recording found at: https://www.scientechclubvideos.org/zoom/04272026.mp4
Brain injuries may be penetrating or closed. Penetrating ones are worse. Gunshots are the leading cause. They have a mortality rate six times worse than closed head injuries, and they more often have seizures. Closed head injuries are more common and have a more generalized brain injury.
The primary neurological sequelae can be skull fracture, brain tissue injury and bleeding or hematomas, and axonal injury. Prevention is the key to avoid injury – helmets, use of walkers and seatbelts. There can be secondary neurological sequelae such as edema, inflammation, and hypoxia. The goal in ICU management is to minimize those sequelae. The term neurostorming relates to complications, which can include kidney, liver or lung complications, or neurological decline.
CT scans help detect bleeding or skull fractures. In addition, CT scans help in the determination of when to operate. MRI scans are used later in the treatment course. They help assess soft tissue and are better at assessing the extent of bleeding or brain damage. Other medical sequelae are infection or abscess, hydrocephalus, and coma.
Clinical indicators of prognosis are measured in time to follow commands and posttraumatic amnesia. The time to follow commands is predictive of global outcome and helps predict injury severity. Post traumatic amnesia ranges from mild to severe. Factors predicting prolonged amnesia are coma duration, age, and anti-seizure medication. The Rancho Los Amigos scale has been developed to predict outcome. Medical intervention is handled by the medical team. It is best to prevent agitation.
General guidelines for severe TBI are to avoid noise, overstimulation, irritability, and fatigue. Dr. Garcia reviewed management of acute hospitalization, and impatient and outpatient care. A review of frontal lobe problems was given. Mainly they center around emotional issues. Cognitive effects involve attention and concentration, processing speed, and cognitive communication. There are social effects of TBI. They include lower insight and social isolation. Most people do not return to a normal level.
Emotional effects of TBI are anxiety and depression, PTSD, substance abuse disorders, and psychosis. There is a risk of suicide with TBI. Multiple risk factors include difficulty with impulse control, rapid mood changes, and seizures. TBI morbidity increases with age. Falls must be prevented. Complications such as bleeding are more common. Past medical history can show risk factors. The worse prognosis in older people involves a history of cardiovascular disease, substance abuse, and prior head trauma.
The risks of suicide are loneliness, loss of independence, chronic pain and illnesses; and cognitive deterioration. Here is no known association between Alzheimer’s disease and TBI.
Patricia Garcia
