Director of Safe Headspace-I have a patient who might benefit from some of the interventions for TBI and PTSD you recently studied

Patient Profiles

From: Janie Poole

To: Alexander 

Good morning!

At last week’s conference I spoke with Alicia Balewa, Director of Safe Headspace. They’re a relatively new nonprofit working on improving outcomes for TBI patients, and I immediately thought of Mr. Nowak. At his last biannual cholesterol screening he mentioned having trouble with his balance. This may be related to his hypertension, but he believes it’s related to the time he was hospitalized many years ago after falling out of a tree, and expressed distress that this might be the beginning of a rapid decline.

Ms. Balewa will be on premises next week, and I’d like to set aside some time for you to talk.

— Janie

Director of Safe Headspace-I have a patient who might benefit from some of the interventions for TBI and PTSD you recently studied. What populations did your public health improvement initiative study?

My father came home from Vietnam with a kaleidoscope of mental health problems. That was the 1970s, when treatment options for things like PTSD, TBI, and even depression were very different. Since then there has been a lot of investment in treatment and recovery for combat veterans. That’s excellent news for veterans in treatment now, but they’re not looking at my dad, and how his TBI and PTSD have affected him through mid–life and now as a senior. That’s why I started Safe Headspace: to focus on older patients who are years or decades past their trauma, and find ways to help them.

Which treatments showed the strongest improvement?

Exercise. We were able to persuade about half of our participants — that’s around 400 people, mostly men ages 45–80 — to follow the CDC’s recommendations for moderate aerobic exercise. Almost everyone showed improvement in mood, memory, and muscle control after four weeks. After that a lot of participants dropped out, which is disappointing. But of the 75 who stuck with it for another three months, muscle control improved 15%, mood improved 22%, and short–to–medium term memory improved 61%. We didn’t specify what kind of exercise, but we did ask them to record what they did every week, so that data is available.

Second was medication and therapy. Most of our participants didn’t receive any kind of psychotherapy in the years immediately following their trauma, so we had everyone assessed by a team of psychotherapists. As a result of those assessments, 40% of participants started on anti–depressant medication and 9% started taking anti–psychotics. Those who started taking medications now have regular contact with a therapist to manage that care. With some help at home to stick to the regimen, all but a few have successfully followed their treatment plans. They’ve reported a 26% improvement in mood over six months, and a 6% improvement in memory.

The third treatment I want to mention is meditation. We only had a small group interested in trying it, but the results were dramatic. We prescribed daily meditation at home, just 10 to 15 minutes, with a weekly hour–long guided group meditation for all 23 participants. After three weeks we lost two to disinterest, but the other 21 showed improvements of over 70% in mood and memory, and 32% in muscle control.

Have you tried anything that hasn’t worked?

Sure. There are memory exercises for patients in elderly care, and things like Sudoku and crossword puzzles. We didn’t see any gains with those. Some of our participants preferred strength training to aerobic exercise, and the only improvement we saw in that group was in muscle control, but only 4%, which is significantly less than the aerobic group.

I should also say that we were working with a willing group of participants. They knew they needed help, and were motivated to get it. One of the hurdles we see with veterans, especially in older generations, is an unwillingness to acknowledge that they have a problem. We haven’t had to wrestle with that because everyone who volunteers to participate wants to be there.

Your organization is intervening with people who have TBI and PTSD simultaneously. We have a patient with moderate TBI suffered almost 40 years ago, but no history of PTSD. Have you separated your population and studied each separately?

We haven’t, no. In some cases we could, for those who come in with previous diagnoses and medical records. But we have participants who either weren’t diagnosed, were under–diagnosed at the time, or don’t have records to show us.

 Assessment Case Study: Traumatic Brain Injury Care Report My Questions 

Question: What were the outcomes of the PHII? 

Answer: I was able to gather information enough to know how to care for my patient. 

Question: How could they have been improved? 

Answer: I would have asked some more questions. 

Question: How do the results of the PHII relate to Mr. Nowak’s case?

 Answer: They give me enough information to be able to help the Dr’s better develop a plan of care. 

Grading Rubric: 

1.  Evaluate the outcomes of a population health improvement initiative based on demographic, environmental, and epidemiological data. 

Passing Grade:  Evaluates the outcomes of a population health improvement initiative based on demographic, environmental, and epidemiological data. Identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the evaluation). 

2.  Propose a strategy for improving the outcomes of a population health improvement initiative, or for ensuring that all outcomes are being addressed, based on the best available evidence. 

Passing Grade:  Proposes a strategy for improving the outcomes of a population health improvement initiative, or for ensuring that all outcomes are being addressed, based on the best available evidence. Acknowledges challenges in the proposed strategy. 

3.  Develop a personalized patient care plan that incorporates lessons learned from a population health improvement initiative. 

Passing Grade:  Develops a personalized care plan that incorporates lessons learned from a population health improvement initiative, and identifies assumptions on which the approach is based. 

4.  Identify the value and relevance of evidence used to support a personalized patient care plan. 

Passing Grade:  Identifies the value and relevance of evidence used to support a personalized patient care plan. Identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve a personalized patient care plan). 

5.  Propose an evaluation strategy to assess the outcomes of a personalized care approach. 

Passing Grade:  Proposes an evaluation strategy to assess the outcomes of a personalized care approach. Identifies aspects of the approach that could be challenging, with solutions. 

6.  Determine aspects of the personalized approach that could be applied to similar situations and patients. 

Passing Grade:  Determines aspects of the personalized approach that could be applied to similar situations and patients. Exhibits insight into the broader application of the approach for the community. 

7.  Write clearly and logically, with correct grammar and mechanics. 

Passing Grade:  Writes clearly, logically, and persuasively; grammar and mechanics are error-free. 

8.  Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

Passing Grade:  Integrates relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style. Citations are error-free.