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  Governor’s Task Force Governor’s Task Force

on Brain Injuryon Brain InjuryNovember 6, 2013November 6, 2013

Bryan Andresen MDEugene-Springfield, OR

Sacred Heart Med Center, Eugene-SpringfieldTrauma ServicesInpatient neurology unitIn-patient rehab unit: Oregon Rehabilitation Center

Community Rehabilitation Services of Oregon

Agenda--TBIAgenda--TBI

Level 2 trauma center Calendar yr 2012

◦140 patients admitted with TBI as Dx◦Disposition 45% Home 17% rehab 16% exp. 11% SNF 6% Home health

Sacred Heart Med Ctr Trauma Sacred Heart Med Ctr Trauma ServicesServices

Advanced Primary Stroke Center◦Neurohospitalist◦Endovascular surgery◦600-700 stroke patients/year

SHMC-NeurologySHMC-Neurology

Oregon Rehabilitation Center◦ Eugene-University District◦ 18 beds◦ 275-300 admissions/year◦ Started 1976◦ Full rehab team

Rehabilitation physician Rehab nurse Physical/Occupational/Speech and Language therapy Neuropsychology Social worker/Care manager

SHMC Inpatient SHMC Inpatient RehabilitationRehabilitation

Program Objectives individualized treatment plan with the patient and

their family. We work with patients on: Cognitive and functional abilities to facilitate the

return to home or other community setting Mobility and self-care skills Neuropsychological testing Behavioral programs for acute stages of recovery Language and communication skills Community mobility, resources and re-entry Assessment of adaptive equipment needs Supportive counseling for adjustment issues

Oregon Rehab Ctr--TBIOregon Rehab Ctr--TBI

Number Served 51 Age    Average Age 53    Age Range 18 to 84

Male/Female Ratio: 66%/34% Average Length of Stay, Days 13.4

ORC-TBI Outcomes 2012ORC-TBI Outcomes 2012

Discharge setting:◦Home Setting (Percent) 42 (82.%)   

◦Long Term Care 6%    ◦Sub-Acute & Rehab 4%    ◦Acute 8%

ORC-TBIORC-TBI

Physical therapy◦ Mobility/balance/vestibular◦ Seating and wheelchair

Occupational therapy◦ Self care◦ Cognition

Speech therapy◦ Cognition◦ Language◦ Swallowing

Neuropsychology

SHMC—outpatient rehabSHMC—outpatient rehab

Founded 1992. Outpatient program Who served: ages 13-64 Mild/moderate ABI Medical and vocational programs Assessments

◦ Cognitive screening◦ Neuropsychological ◦ AD/HD◦ Community based situational assessment◦ Psychological◦ Job site

Community Rehabilitation Community Rehabilitation Services of Oregon (CRSO)Services of Oregon (CRSO)

Med Rehab◦Cognitive rehabilitation◦Case management◦Psychotherapy◦Support Group-monthly

Vocational Rehab◦Situational assessments◦Job retention/work placement coordination

Community Rehab Services of Community Rehab Services of OregonOregon

Private medical insuranceAutomobile insuranceWorker’s compVocational rehab

◦ Caseworker typically performs intake interviews at CRSO

Funding sourcesFunding sources

1. Medical rehab 2. Vocational Assessment 3. Neuropsychological Assessment 4. Team meeting 5. Situational assessment 6. Team meeting 7. Job Search 8. Job placement 9. Follow-along

J Head Trauma Rehab, 2003. data collected by grant through Dept of Ed and OVRS

Ideal process (rare!)Ideal process (rare!)