More than 2,000 people each year are seen in Aspen Valley Hospital’s emergency room and clinics with concerns about brain injuries. And every year nearly 250 of those patients are referred for follow-up care through the Hospital’s specialized Traumatic Brain Injury (TBI) Program.
As one of the most comprehensive and highly-regarded programs of its kind on the Western Slope, Aspen’s TBI Program provides hope for those dealing with all levels and types of brain injuries. Since 2014, it has helped approximately 900 people recover and reclaim their lives.
The Program’s most senior member and original founding member is Krista Fox, an occupational therapist. The newest addition to the team is Kelsey Sanders, a physical therapist whose specialty is the vestibular system—the inner ear apparatus that is critical to our balance and motion through space.
March is Brain Injury Awareness Month, so Krista and Kelsey agreed to discuss the work they do to help those with TBIs recover and thrive.
What are the various specialties offered through the Hospital’s Traumatic Brain Injury Program?
Krista: Our brains control everything, so regaining a high level of integration is needed to get all of the body and the mind’s systems working together. We have a full complement of specialties to support recovery, including:
- Speech and language pathology, which helps with a patient’s cognitive functions;
- Occupational therapy, which assists patients in regaining their ability to return to their daily activities;
- Physical therapy to help with strength and range of motion and balance;
- Vestibular therapy, which involves the inner ear and the body’s place in space;
- Ocular motor therapy, which is how your eyes move and work together.
The Hospital also offers specialists in pediatrics, neurology, cognitive function, psychosocial function, and cervical treatment which focuses on the spine and neck. The trauma and emergency departments know to look for brain injuries, and we’ve been able to treat a lot of patients who we otherwise wouldn’t have known about.
How do you initially assess a patient’s rehabilitation needs when they are referred to your department?
Kelsey: Everyone on the team is knowledgeable and can identify various impairments. We start with a comprehensive assessment to get an understanding of where the patient’s primary impairments are. We’re looking at their sensory systems, including their ocular motor system, their somatosensory system, which is their body system; and the vestibular system. We’re also paying attention to their emotional and cognitive responses, which can influence their care.
Krista: Our work is very evidence-based and up-to-date on the newest research, so we’re able to evaluate and treat our patients at the same level as other large care centers.
What are some ways people sustain brain injuries?
Krista: We see a lot of workplace injuries, people falling off ladders for instance. Falling objects, explosions, car accidents or something that seems as innocuous is slipping and falling on ice can also cause brain injury. You don’t even have to hit your head. There can be enough force from a hard landing on your hip to cause a brain injury.
Are concussions the primary traumatic brain injury that your team treats?
Krista: Yes, they are the most common injury we treat. And though concussion is generally considered a “mild” injury, they can cause life-changing and lifelong impairments.
But not all brain injuries are concussions. Anoxic brain injuries occur if you’re not getting enough oxygen to your brain, which can happen during a heart attack, from carbon monoxide poisoning, or as a result of substance use and abuse. There are blast injuries and penetrating injuries as well. There are also acquired brain injuries which are a result of a stroke that causes bleeding in the brain, or from a clot that causes part of the brain to die.
If someone’s having symptoms, should they go to the emergency room, or to their primary care doctor?
Krista: Some red flags for people are nausea, vomiting, a really intense headache, or feeling dizzy or very confused. If you’re experiencing those symptoms, you need to go to the emergency room right away. If you’re just feeling a little foggy, a little bit off, typically your primary care physician can manage that. Research shows that therapy within the first week of a head injury can reduce the projected time of recovery.
Kelsey: If you continue to feel bad or if you feel like your symptoms are getting progressively worse, it’s important to seek care. When in doubt, you can always come to our emergency department.
What technologies does the Program use for both assessment and treatment of a traumatic brain injury?
Krista: One technology we use is the Bioness Integrated Therapeutic System. It includes a large interactive screen that helps us evaluate some of the common areas where people have impairments after a head injury. We recently added some balance components that will help people re-learn that high level of balance and other demands needed for dynamic sports such as skiing and mountain biking. This technology helps our patients integrate their systems back together again. Potentially, one reason people end up with multiple concussions is their systems aren’t fully re-integrated.
Please elaborate on the importance of having fully integrated sensory systems.
Krista: In order to spin, to ski, to run and cut on a field, you need awareness of where you are in space, your vestibular system, and the sensations coming from your muscles in your body. Your eyes need to be scanning and knowing what’s going on around you. Your body and mind need to be able to figure out and respond to gravity, especially if you’re spinning and doing those sorts of activities. If one of those systems is off, it causes impairments in other systems and increases the risk of additional injury.
Kelsey: In this valley we see young athletes who are at a very high level. Being aware of some of the changes that might happen with youth concussion and making sure that they’re supported to maximally return to their level of function is a critical role we play in traumatic brain injury rehab.
How do brain injuries and treatment differ for children and young adults?
Krista: Our brains develop and integrate into our early 20s, so there can be lifelong developmental changes if a traumatic brain injury occurs when a young person’s brain is going through a period of super-specialized connectivity.
Kelsey: One challenge is with children who may have never experienced dizziness or other symptoms, so they don’t actually have the words to describe what they are feeling. That’s why it’s important to have a professional who can identify some of these impairments. Understanding what’s happening, reducing their fear and appropriately reintegrating them to activities and school can be very successful and done in a manner that allows them to succeed.
How do you collaborate with professionals outside the Hospital to help your patients recover?
Krista: We collaborate with social workers and counselors for the psychosocial and emotional needs of patients. A local counselor has a counseling group called Brain Buddies, where people with brain injuries meet each other and get the support they need to understand they’re not alone in this. Primary care physicians are important as well. Many of them do a great job understanding their patients’ needs and help us manage their rehabilitation.
Anytime we have a young person with a with brain injury, we try to collaborate with teachers and school counselors. The goal is to figure out how can we get them back to learning first. If they are looking at going back to a sport, we work with their coaches and trainers as well.
Can you share some success stories that are particularly inspiring?
Krista: When I see a former patient at their work, caring for their family members, out skiing or enjoying the activities they love, it gives me the greatest joy you can imagine.
Kelsey: We have both worked with very high level amateur and professional athletes. To see them return to their level of play is so rewarding. I am proud of what that person has accomplished, the hard work they go through in physical therapy and the other emotional work they need to do to return to their sport.
If you or a loved one would benefit from a consultation by one of our Certified Traumatic Brain Injury specialists, please call Rehabilitation Services at Aspen Valley Hospital at 970.544.1177 to make an appointment.