Interdisciplinary Team Provides Support after Traumatic Brain Injury

A joyful gathering of friends turned suddenly frightening in the moment a swing-dancing move went wrong. Madison Denton's partner tried to flip her, but she hit her head on the concrete floor and began to bleed from her ear. She was taken to the local emergency department and quickly life-flighted to The University of Kansas Health System.

In Kansas City, Madison, a student pursuing a degree in early childhood education, was diagnosed with a traumatic brain injury (TBI). After several days of monitoring her neurological status and medications to control her nausea and dizziness, she was able to return home with her parents.

The immediate danger had passed, but Madison wasn't yet herself.

"I couldn't do anything without pain," she says. "I got a lot of headaches and slept all the time."

Kelly Patton, RN, clinical nurse coordinator, helped Madison continue her care. Patton had met the Denton family during Madison's hospitalization and provided educational information, defining TBI and outlining the recovery process. She recommended Madison obtain follow-up care in the health system's TBI clinic, where Patton provides continuing education and support and coordinates care across disciplines including trauma, rehabilitation, neurosurgery, physiatry, psychiatry, orthopedics, vestibular therapy and case management.

"Our goals are to get TBI patients back into their communities and taking control of their own lives again," Patton explains. "We also want to provide education to patients and families as well as to staff and communities in order to promote understanding and acceptance of this type of injury."

The TBI clinic provides comprehensive, convenient, ongoing support for patients recovering from brain injuries.

"On the outside, she looked normal, but there were a number of things we tend to take for granted that she couldn't do," says Judy Denton, Madison's mom. "The extensive testing done in the TBI clinic was very helpful. It provided some explanation for those things Madi was still struggling with."

Madison's care in the clinic began with an examination by neurosurgery physician Tanya Filardi, MD. She is often the first physician a patient sees when beginning follow-up care in the TBI clinic.

"Frequently, our patients don't remember much about receiving the injuries that brought them to the hospital, and clarity is an important step in the neurosurgical journey," Dr. Filardi says. "I'll spend time with the patient and their family reviewing their scans with them and providing anatomical explanations of their injuries. It helps to fill in those gaps. When the picture becomes clearer, the patient often feels less frightened and more at ease."

Dr. Filardi collaborated with a neuropsychologist, neurophysiatrist and physical therapist to develop a plan for Madison's care.

"We bring perspectives from each of our specialties to develop the care plan," she says. "That is the value we bring, looking at the patient's experience from all angles and planning care together with a global view."

The clinic staff tested Madison's ability to walk and balance. They evaluated her speech, memory and language skills.

"There was a lot of testing," Madison recalls. "I answered questions, recited numbers and added numbers up in my head. I put numbers in order on paper. I closed my eyes and walked in a line, and that didn't go well at all. My balance was off, too."

She began vestibular therapy to improve her strength and balance. She also spent time retraining and strengthening her eyes, looking up and down and side to side, to help improve her injured brain's ability to receive and comprehend information.

Neurophysiatrist Alexandra Nielsen Arickx, MD, continued Madison's follow-up care in the TBI clinic.

"The interdisciplinary TBI clinic is an efficient way for patients to receive the comrephensive follow-up care they need after spending time hospitalized for a brain injury," Dr. Arickx says. "We bring the relevant specialties together in a single location to support patients on their path to full recovery and to help them become confident about returning to school, work and life."

"We support all aspects of brain care after patients leave the hospital," she adds.

"Dr. Arickx was so nice and helpful," Madison says. "I could always contact her with any issue I had and know that she would have an answer or advice."

Dr. Arickx spent time just talking to Madison," Judy adds. "She reassured her that someone was listening, someone who understood what she was going through and who was paying attention. She let us know what to expect and what to be aware of. She was very supportive."

Madison's injury occurred during her school's winter break. It was another 6 weeks after the end of the break before Madison returned to school. Reading, writing and typing were slow going for her. Her teachers made helpful accommodations, such as dimming the classroom lighting and working with her verbally on assignments typically turned in on paper. She continues to take a bit more time on tasks she used to complete quickly, but is refocused on her studies and continuing her education.

"Madison was extremely fortunate in that most of what she needed for recovery was time," Judy says. "Still it was hard for her to be patient and take things slowly and wait. Dr. Arickx reminded Madi and all of us that this was just a very small portion of her life and she didn't have to rush things."

That gentle reassurance was as important to Madison as the rehabilitation care itself.

"It reminded me not to get frustrated at the beginning and to take my time with the little things," she says. "That really helped me improve, and today I'm feeling so much better."

Recently, months after her accident, Madison returned to the TBI clinic for additional in-depth testing to assess her readiness to apply for educational licensing and determine whether any accommodations for test-taking were necessary.

"That's another advantage we offer," Dr. Arickx says. "Even months later, even when everything has seemed fine, we're right here if a patient needs us. Madison was easily able to reconnect with us for an in-depth assessment. We are committed to that ongoing follow-up."