The Marcus Institute for Brain Health: an integrated practice unit for the care of traumatic brain injury in military veterans.

PRIMARY OBJECTIVE: Traumatic brain injury (TBI) is a signature wound of recent Unites States military conflicts. The National Intrepid Center of Excellence (NICoE) has demonstrated that interdisciplinary care is effective for active-duty military personnel with TBI and related psychological health conditions. This paper details how the Marcus Institute for Brain Health (MIBH), established in 2017 as an Integrated Practice Unit (IPU), is founded on the NICoE model and is dedicated to interdisciplinary care for Veterans with persistent symptoms due to TBI and psychological comorbidities. RESEARCH DESIGN: A highly integrated group of clinicians from diverse disciplines combine their expertise to offer comprehensive evaluation, intensive outpatient treatment, and program outcomes evaluation. METHODS AND PROCEDURES: The role of each discipline in the provision of care, and the regular interaction of all clinicians, are delineated. A strong connection to academic medicine is maintained so that clinical research and education complement patient care. MAIN OUTCOMES AND RESULTS: Over three hundred veterans and family members have received treatment at the MIBH. Program evaluation is underway. CONCLUSIONS: As the understanding of TBI and related psychological conditions continues its rapid evolution, the expert interdisciplinary care at the MIBH has great promise as a Veteran counterpart of the NICoE.

Met and unmet rehabilitative needs among pediatric patients with moderate to severe TBI.

OBJECTIVE: Estimate the probability of met and unmet post-acute rehabilitative needs among pediatric patients with moderate to severe traumatic brain injury (TBI). PARTICIPANTS: One hundred and thirty children who received acute and post-acute rehabilitative services at a hospital for children. METHODS: Prospective, observational study. Recommended service needs (1. Medical, 2. Psychological, 3. Cognitive/Educational, 4. Medically Based Therapies, 5. Community/Caregiver/Family Support) were collected at discharge and 1, 6, 12, and 18 months post-injury. Probabilities were estimated using nonlinear logistic regression models. The impact of age at discharge was also assessed. RESULTS: Over time, the estimated probability of need for Medical, Medically Based Therapies, and Cognitive/Educational services were consistently high. Whereas unmet need for Medical and Medically Based Therapies were low, unmet need for Cognitive/Educational services were relatively high. Need for Psychological and Community/Caregiver/Family Support services increased in the months post-discharge, as did the probability of unmet need. Older age at discharge was associated with need for Psychological and Community/Caregiver Family Support services. CONCLUSIONS: Findings support the long-term monitoring of need for Psychological and Community/Caregiver/Family Support services among children with moderate to severe TBI. Future research to explore the etiology of unmet needs is warranted.