Military Traumatic Brain Injury.

Traumatic brain injury (TBI) in the military can involve distinct injury mechanisms, diagnostic challenges, treatments, and course of recovery. TBI has played a prominent role in recent conflicts, causing significant morbidity and mortality. Blast-related TBI in combat settings is often accompanied by other physical injuries. Military TBIs of all severities can lead to prolonged recoveries and persistent sequelae. The complex interplay between TBI, pain, and mental health conditions can significantly complicate diagnosis and recovery. Military and veteran health settings and programs provide comprehensive care along the continuum of TBI recovery rehabilitation with the goal of optimizing recovery and function.

Virtual Reality Game Selection for Traumatic Brain Injury Rehabilitation: A Therapist's Wish List for Game Developers.

This project explored the selection process of commercially available virtual reality (VR) games for traumatic brain injury rehabilitation. Occupational therapy practitioners (OTPs) developed a classification framework that they used to evaluate VR games. The classification framework focused on movements required to effectively play the game, cognitive demand, position for game play, ease in menu navigation, and perceived therapeutic applications. OTPs used the ratings to aid in game selection and identified relevant game examples that allowed customizable settings and basic navigation with a game focus on functional activities. The OTPs and the research team identified the need for further work on accessibility and adaptability of game features (e.g., difficulty and limb usage) allowing for more individualization to optimize outcomes of VR-enhanced rehabilitation. The classification framework was useful in evaluating the potential therapeutic benefit of commercially available VR games. However, trial of the game by clinicians prior to use was still warranted.

Alteration of Smell Sensation: Brief Review With Implications for Nursing Care During the COVID-19 Pandemic.

ABSTRACT: BACKGROUND: Alteration in olfaction, the sense of smell, can lead to a surprisingly high level of functional disability. Effects can range from mild changes in nutrient intake to a significant decrease in quality of life. Olfactory dysfunction can follow clinical problems such as trauma to the brain and nose. During recent months, in the setting of the current worldwide pandemic of coronavirus disease 2019 (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2, it has become clear that olfaction can also be damaged by viruses that enter the body through the nose. METHODS: To learn more about this important clinical problem, we reviewed the current literature about smell sensation and the contextual application of altered olfaction in the setting of COVID-19. Knowledge about this topic, along with other clinical aspects of COVID-19, is expanding quickly. CONCLUSION: Nurses perform assessments, assist with implementing treatment interventions, and provide vital education to patients and their families. These interventions help patients with olfactory dysfunction achieve the best possible functional outcome.

Department of Veterans Affairs Polytrauma Rehabilitation Centers: Inpatient Rehabilitation Management of Combat-Related Polytrauma.

Traumatic brain injury (TBI) is one of the signature injuries of Operation Iraqi Freedom and Operation Enduring Freedom. To ensure that rehabilitation care needs of veterans and active duty servicemembers with TBI and polytrauma injuries were met, the Department of Veterans Affairs (VA) established the Polytrauma System of Care (PSC) in 2005. The 5 VA Polytrauma Rehabilitation Centers provide tertiary, acute inpatient rehabilitation for the PSC. Interdisciplinary treatment teams of multiple rehabilitation disciplines provide the complex, patient-centered care to achieve maximum benefit. After discharge, veterans and servicemembers with TBI and polytrauma receive lifelong support and care through the PSC.

Agitation in Patients Recovering From Traumatic Brain Injury: Nursing Management.

This article reviews clinical and research literature regarding the nursing management of agitation after severe traumatic brain injury. Neuroscience nurses in acute rehabilitation settings use an evidence-based approach to perform multifaceted assessments and implement effective individualized plans of care. These essential efforts minimize the effects of agitation and help patients achieve optimal outcomes.

Deleterious cognitive and motoric effects of haloperidol in an adolescent with cerebral palsy: a case report.

This case report describes a 15-year-old male patient with spastic diplegic cerebral palsy, Gross Motor Function Classification System Level III, who developed severe new cognitive and motoric impairments after the administration of haloperidol. He received this dopamine antagonist and typical antipsychotic medication for an acute postoperative episode of agitation. He improved when he received the dopamine agonists amantadine and carbidopa/levodopa. This case suggests that dopamine blockade may be deleterious for individuals with cerebral palsy. Potential explanations for the events observed in this case are also presented.

Clinical case study: a 4-year-old boy with posterior fossa syndrome after resection of a medulloblastoma.

Posterior fossa syndrome can occur after neurosurgical resections of childhood posterior fossa tumors, such as medulloblastomas. Posterior fossa syndrome is characterized by transient mutism, emotional lability, cognitive deficits, weakness, ataxia, and cranial nerve dysfunction. Symptoms generally appear 1 to 3 days after surgery and persist for months to years. Neuroscience nurses play an integral role in helping affected children and their families through the diagnosis, treatment, and sequelae of this frightening syndrome.

Administering hypertonic saline to patients with severe traumatic brain injury.

Hypertonic saline (HTS) is an osmotic agent that can help patients in the acute phase of severe traumatic brain injury. HTS extracts fluid from swollen cerebral tissue to both control intracranial pressure and diminish the deleterious effects of secondary brain injury. Neuroscience nurses in intensive care and acute care units, who may administer HTS as resuscitation fluid, continuous infusion, or bolus dose, need to be familiar with physiologic actions, potential side effects, and appropriate HTS administration techniques. Neuroscience nurses collaborate with other members of the interdisciplinary team to ensure that HTS is administered safely.