Clinical Practice and Research on TBI Now and Going Forward
Ron Broughton, chief clinical officer of Brookhaven Hospital, talks about measuring outcome, the importance of looking at the person as a whole and not as an injury, and erasing the stigma of TBI.
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Measuring outcome is kind of a fluid everyday thing. You can talk about the outcomes daily, do you want to talk about who's measuring the outcome. Engaging the family and the individual and partner of each individual outcome on a small scale, on a grand scale, whether you're talking about one individual or a group of individuals. From my perspective I think it's very important to talk about the individuals and single case studies and things that work for individuals and then somehow put that together statistically to be able to call that actually a group study. Because in the levels of research the single case study is not thought of as some wonderful panacea for intervention to be used in the future for everyone unless you have randomized controlled trials and some of the things that everyone talks about that are the ideal, then the worth of the research appears to be limited. I think with brain injury, though, that's not the case. When you're talking about those individuals it could be something of the moment of having a good day, especially someone who's severe and is able to get up today, shower themselves, and not attack anyone. You talk about moderate, it's just they have a good two or three weeks going on and then, of course, at discharge to a lower level of care is also considered a success of an outcome. So, again I think the research community has a large task before them in trying to pull all this together and succinctly put it in ways that we can all understand it and work towards it via best practices. I think there's going to be a lot of medical advancements, or have been a lot of medical advancements over the years when you talk about the wars in Iraq and Afghanistan. First,and foremost, a lot of the medical procedures that probably have come out of that are going to be moving to some of our emergency rooms as common practice, so you have the medical side to look at first. Progressing from there, I think looking at the person as a whole and being able to remove some of the barriers is also a major step forward, and working towards erasing the stigma like with any disability or any ostracized group, sometimes it seems in our country that someone out there, and I haven't figured out who the group of people are yet who are making all these judgment calls about individuals with disability or who are obese or whatever. It's very confusing to me sometimes. But removing that stigma, I think is very, very important, and I think we've come a long ways. There's a long way to go.
Posted on BrainLine November 6, 2012. Reviewed December 25, 2017.
Ron Broughton, MEd, LPC,CBIST is the chief clinical officer at Brookhaven Hospital as well as chairman of the Ethics and Performance Improvement Committees.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.