Military and VA Telemedicine Systems for Patients with Traumatic Brain Injury

Journal of Rehabilitation Research & Development 2007:44(7); 1017-26

Philip Girard, MS
Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center, Washington, DC; Manchester Department of Veterans Affairs Medical Center, Manchester, NH

Abstract: Telemedicine plays a critical role within the Department of Veterans Affairs (VA) Veterans Health Administration by allowing the surveillance and care of patients who are isolated by geography, poverty, and disability. In military settings, telemedicine is being widely used to identify injury and illness and aid in the treatment, rehabilitation, and recovery of combat-wounded soldiers in theater. Rapid advances in both domains are transforming the way clinicians provide care, education, and support to patients with traumatic brain injury (TBI) and their families. This article discusses the military and VA telemedicine capabilities that are supporting the care of service members and veterans with TBI. These capabilities include new technologies that enhance the identification of TBI, management of symptoms in theater, and application of proven technologies (interactive video, Internet, and World Wide Web) to improve overall care coordination throughout military and VA systems. The impact of distance learning, teleconsultation, telerehabilitation, and home telehealth programs is also described within this context.

Excerpt: The goal of the DVBIC research is to test the technical feasibility of remote cognitive assessment systems that could (1) allow medics to identify TBI and postconcussion syndrome (PCS) in the field and (2) give VA and community healthcare providers the ability to identify TBI remotely. The TBI assessment system is a Web-based program that contains evaluation questionnaires and brief cognitive screening tests, including:

1. The PCS Checklist and Scale, which assess the most common symptoms experienced after TBI.
2. The State-Trait Anxiety Inventory and the Automated Neuropsychological Assessment Metrics (ANAM) Mood and Sleep Scales, which provide focused assessment of mood and anxiety disturbance.
3. The DVBIC clinical tracking form, which documents injury characteristics such as severity and cause.
4. The ANAM Simple Reaction Time and Continuous Performance subtests, which objectively measure cognitive functioning.
5. Together these tests help clinicians identify the areas of the brain that may have been affected by the injury. Step-by-step instructions are provided as the patient works through the test. Areas of concern can be flagged for easy reference by physician’s assistants (PAs) onsite, and full reports can be gathered by a neuropsychologist at different intervals or reviewed by specialists and returned with recommendations. Various technical, security, and logistical issues are involved in the delivery of such testing; however, limited deployment with a laptop computer with high-speed Internet access has been successful.