Traumatic brain injury (TBI) is one of the most stubborn and long-lasting problems produced by 10 years of war, but there is progress in its treatment.

“The brain is a wonderful thing, and it is plastic,” said Dr. Andrew Ritcheson, senior consulting psychologist and program manager at contractor DRC. “It develops and it can grow and it can also be tremendously injured. What we need to do is to work on rehabilitation and bringing people back to health.”

Ritcheson spoke the Federal Drive with Tom Temin and Emily Kopp Thursday from AFCEA Health IT Day. Hosted by AFCEA Bethesda, the annual event invites federal senior executives and IT professionals to share lessons learned around IT program management, acquisition and the budget process.

“DRC is involved in trying to bring innovations and solutions to challenging problems within this space,” Ritcheson said. A lot of these solutions involve health care and health challenges within the Military Health System and the departments of Defense and Veterans Affairs.

According to Ritcheson, both VA and DoD have become more proficient at treating TBI. “We’ve had a lot of years at war and we’ve had a lot of experience trying to develop new ways to approach these challenges, a lot of them above the neck, a lot of them below the neck as well, he said.

The protective body armor and the armored vehicles employed in Iraq and Afghanistan have boosted the survivability rate among war fighters. This has led to a corresponding advancement in the treatment for injuries like TBI for patients, who, in previous conflicts, may not have survived with those injuries.

“The survivability rates have increased markedly,” Ritcheson said. “But along with that, the nature of the injuries have changed as well. We simply haven’t seen these sorts of injuries before.

One of the most pernicious combinations of injuries medical workers are seeing is around TBI and post traumatic stress disorder (PTSD).

“These often occur at the same time,” Ritcheson said. “They’re called ‘comorbid,’ and they bring with it a whole lot of symptoms that we don’t really well understand currently, and we don’t understand how it’s going to progress over time. As we go along, we’re adding to the science, but we also have a current need to care. So, we can’t be patient. We have to give them treatment now.”

The challenge in treating a patient with TBI is that caregivers must deal with both the physical and psychological aspects of the injury.

“There’s no one-size-fits-all,” Ritcheson said. “Both of these things, both physical and psychological are happening against sort of a social tapestry as well. It’s a complicated thing to unpick, which to do first and what’s causing what?”

One thing that has improved, according to Ritcheson, is TBI patients are receiving a much better diagnosis than in the past. Also, treatments unfold much more rapidly because of what doctors have learned about the nature of these injuries.

“Part of the exciting new sciences is around imaging and the way of diagnosing and treating these injuries, that’s on the horizon as well,” he said.

Some of the most recent clinical developments involve putting the people in place who are able to make those developments stick in the places they need to happen.

“So, if you can put people between IT, health technology and all of those exciting developments and the actual need on the ground or in the clinics, and having people championing that and acting as change agents, that’s one of the most important clinical developments and it is the least clinical,” Ritcheson said.

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