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Summer 2013

Creating a Clinical Home for Mild Traumatic Brain Injury

In both the medical community and the general public, there is widespread recognition that concussions and mild traumatic brain injury (MTBI) can cause lasting neurological damage. Despite this knowledge, there are few places nationwide where community physicians can refer worried patients and families for a comprehensive diagnosis and expert care.

Dr. Geoffrey Manley

Dr. Geoffrey Manley

"That's why we've set up a clinical infrastructure where patients can get in front of a team of physicians who understand traumatic brain injury," says neurosurgeon Geoffrey Manley, M.D., of the Bay Area Concussion and Brain Injury Program at UCSF.

Located at the new Mission Bay campus, the program includes a multidisciplinary team of nationally recognized experts in sports medicine, physical medicine and rehabilitation, neuropsychology, neuroradiology, neurology and neurosurgery.

Meeting a Previously Unmet Need

"MTBI is one of the major underserved public health issues in this country," Manley says. According to the Centers for Disease Control and Prevention, at least 1.7 million Americans seek medical help every year for the condition, and if you include unreported injuries, the condition might affect considerably more. While many of these individuals do not suffer lasting damage, far more do than was previously believed. Part of the reason is that clinicians tend to treat MTBI as one event, rather than a process or condition that demands ongoing follow-up.

"If someone showed up in the ER with a blood glucose of 400, we'd put them in a chronic disease management program, but here we have something that is cognitively and socially disabling people, and because the medical community isn't informed, these patients often don't get the care they need," he says.

To provide that care, the Bay Area Concussion and Brain Injury Program builds on the UCSF Department of Orthopaedic Surgery's PlaySafe program, which works with school districts across the San Francisco Bay Area to treat and raise awareness about concussion and brain injury. Athletes at participating schools receive:

  • Comprehensive evaluation by a sports medicine physician trained in management of concussion injuries
  • A detailed, step-by-step return to play progression program
  • Consultation and communication with the school's certified athletic trainer or official

Dr. Benjamin Ma

Dr. Benjamin Ma

"Now we can draw on expertise that exists across UCSF to work with the entire continuum of brain injury patients, from mild to complex," says Benjamin Ma, M.D., chief of Sports Medicine at the UCSF Orthopaedic Institute.

One Comprehensive Center

In the new program, sports medicine experts and leading-edge imaging are available five days a week to evaluate and triage most concussions. In addition, there is a monthly multidisciplinary clinic for patients who need more extensive evaluation.

Dr. Mitchel Berger

Dr. Mitchel Berger

"It's a program for the entire Bay Area where we can rigorously describe the severity of the problem and make recommendations about return to activity, " says neurosurgeon Mitchel Berger, M.D., chair of Neurological Surgery at UCSF Medical Center, who is on the National Football League's Head, Neck and Spine Medical Committee.

In some cases, this just means providing accurate education, advice and reassurance. "But if people have more complicated problems, for example, we have specialists on-site, including pediatric rehab specialists and neuropsychologists," says Manley. While there are no proven treatments yet, patients can still benefit from clinicians who understand the pathology, help treat the symptoms and can recommend adaptive strategies as needed.

Dr. Claude Hemphill

Dr. Claude Hemphill

"One of the questions we look at is why the accident happened," says UCSF neurointensivist Claude Hemphill, M.D. "You help people decide on when to return and how they might alter their approach to the activity.… A lot of it is symptomatic treatment of persistent postconcussive symptoms and evaluation for cause that can help with prevention."

When to Refer

Consider referring your patient to the Bay Area Concussion and Brain Injury Program if he or she has suffered a blow to the head, neck or body and is experiencing one or more of the following:

  • Confusion
  • Difficulty concentrating or remembering things
  • Dizziness or problems with balance or coordination
  • Headaches
  • Insomnia or excessive sleepiness
  • Nausea
  • Problems with balance and coordination

For more information, call the Bay Area Concussion and Brain Injury Program at (415) 353-1915.

     

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