A brain injury takes only seconds. An elderly individual falls down a flight of steps. A weary driver drifts off the highway. A carotid artery, narrowing gradually over the years, finally closes off completely, triggering a massive stroke. An aneurysm ruptures, and a river of blood flows to the base of the brain.
Potentially catastrophic, the damage is immediate. But for those who survive a brain injury, recovery can take months, years or even a lifetime.
As the Brain Injury Association of America leads the nation in observing Brain Injury Awareness Month — #NotAloneinBrainInjury — UC Health is stepping up its comprehensive, multidisciplinary effort to provide brain injury survivors with a continuum of care that extends long beyond the initial crisis.
Silke Bernert, MD, one of the physicians leading this initiative, is a physical medicine and rehabilitation specialist who was recruited to UC Health from the University of Kentucky. Bernert, who played a major role in the development of UK’s brain injury continuum, hopes to duplicate that effort here.
“There is great opportunity and a vast availability of resources at UC to build a superb continuous brain injury care program,” Bernert says. “I will be able to follow patients and be available for brain injury care across the continuum. We have really good people here, and more are coming in and are building this program on many levels.”
Bernert, who has subspecialty certification in brain injury medicine, is the primary physician on the acute rehabilitation unit for brain injury unit at HealthSouth, a 60-bed facility at the Drake Center for Post-Acute Care. She envisions a continuum of care in which patients transition seamlessly from their hospitalization at UC Medical Center, a Level 1 trauma center, to the next phases of recovery.
Those phases can involve further inpatient care at different levels, depending on the individual’s injury severity and medical and rehabilitation needs. Acute rehabilitation, sub-acute rehabilitation, and long-term acute care are provided at Drake Center. After a patient goes home, care continues with outpatient or in-home physical, occupational and speech therapy, psychological care and other services.
The UC Health multidisciplinary brain injury team includes:
• Physical medicine & rehabilitation (PM&R) specialists (physiatrists)
• Neurocritical care specialists
• Psychologists and neuropsychologists
• Physical, occupational and speech therapists
• Rehabilitation nurses
• Ophthalmologists and an optometrist
• Case managers and social workers
The brain injury team also includes members of UC’s athletic department and serves patients, including athletes, who have suffered a mild traumatic brain injury, or concussion.
Multiple specialists are needed, Bernert says, because brain injury is a multidisciplinary disease process. “Brain injury affects the whole body, the whole being of a person,” she says. “It affects the patient physically, medically, emotionally and cognitively. As such, a specialist will be involved for almost any issues he or she might have.”
Opeolu Adoeye, MD, a neurocritical care specialist, says a sufficiently severe brain injury will bring new realities. “A hard fact is that people will not be their former selves,” he says. “It is difficult when patients and/or families have a protractedly difficult time accepting the new person.”
Mental health specialists are integral to the process of recovery. “Forty to 60 percent of patients who suffer brain injury will develop depression or anxiety,” Bernert says. “Depression can develop almost immediately after the injury, or it can develop 6 months to a year later. There is also the potential for onset of other major psychiatric disorders, such as schizophrenia.”
According to the Brain Injury Association of America, an estimated 2.4 million children and adults in the United States sustain a traumatic brain injury (TBI), and another 795,000 individuals sustain an acquired brain injury from non-traumatic causes (such as stroke) each year. The association reports that more than 5.3 million children and American adults live with a lifelong disability as a result of TBI and an estimated 1.1 million have a disability caused by stroke.
The most common cause of TBI is a fall, typically in an elderly individual or child, Bernert says. Other causes of TBI include motor vehicle accidents, ATV accidents, motorcycle accidents, gunshot wounds, assault, and domestic or child abuse.
The UC Medical Center admitted 692 neurotrauma patients in the fiscal year 2016. UC’s Stroke Team, meanwhile, in a typical year provides immediate consultation for more than 3,000 acute stroke patients from regional hospitals and emergency diagnostic centers in Ohio, Kentucky and Indiana. Of those consults, several dozen are performed via the UC Health Telestroke Network, which extends the Stroke Team’s excellence to underserved and rural areas.
Physicians agree that people who suffer brain injury today are better off than those who were injured 10 to 20 years ago.
“We know now that with aggressive medical and surgical therapy, good outcomes are indeed possible,” Adeoye says. “As such, we continue to push the bounds of clinical care in order to give patients a chance at a meaningful recovery.”
“The hospital care has changed,” Bernert says. “Although we still need more research, we are continuously improving brain injury care and medical management of brain injury. In addition, rehabilitation begins earlier in the process, and we have abandoned the use of a certain drugs that were previously thought to be helpful but we now know could be detrimental or prolong recovery.”
START Program for Stroke Survivors
For people who have survived a stroke but continue to have difficulty thinking or remembering, UC Health offers the Stroke Team Assessment and Recovery Treatment (START) Program at Drake Center. Candidates for the START program include those who suffered a stroke at least six months ago and are seeking a fuller recovery. For more information, please contact Lucretia White, MBA, BSN, RN, at (513) 418-2549 or Lucretia.White@UCHealth.com.