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has occurred. At this time, not all of the data needed
to model the three case studies had been provided.
Qualitatively, all three case studies appear to be
successful. However, we looked forward to a more
in-depth analysis based on tradeoffs (COI). While
too early to judge whether this combination will
eventually be successful, our companion study of
promoting online web-based metrics for MDRCs
has been successful beyond all of our expectations
as the modest system that we proposed has been
picked up by DOD for all of its IRBs (Wood et
al., 2008; 2009; and Tung et al., 2008; 2009).
COI predicts that fragmentation will significantly
reduce organizational performance and outcomes.
Although at this time we cannot identify systemic
problems and make recommended changes to en-
hance MCG's programs, that is our ultimate aim.
walk, and to think functionally. Some patients with
mild TBI recover completely, but others require
life-long therapy.
While patients with mild traumatic brain in-
jury may fully recover from their impairments,
for others, chronic treatment for TBI will be
life-long. In many cases, the type and intensity
of treatment will decrease over-time as the TBI
treatments advance, and as the TBI patient and
his or her family learn more about how to care for
and cope with traumatic brain injury.
While behavioral TBI symptoms are generally
observable, physiological correlations may also
be detected such as, for example, changes in pulse
rate, blood pressure, and abnormal respiratory
rates. Even levels of patient activity throughout
the day, or the quality of nightly sleep might pro-
vide insightful. Remote monitoring (e-health) to
detect these changes could offer an improved and
cost-effective means for monitoring and treating
TBI sufferers.
In addition, many symptoms attributable to
TBI, including neuro-psychiatric symptoms, can
be mimicked or modified by abnormal circulating
hormone levels. Modulation of peripheral endo-
crine gland hormone secretion is under the control
of the anterior pituitary gland, which in turn, is
under the control of neuro-hormones secreted by
a portion of the brain - the hypothalamus. The
hypothalamus and pituitary gland are connected
by a fine stalk, permeated by fragile portal blood
vessels through which neuro-hormones travel
from the hypothalamus to the pituitary. Thus, there
are three sites, individually or in combination,
at which TBI could result in abnormal pituitary
hormone secretion: hypothalamus (brain), stalk,
or anterior pituitary gland itself.
Finally, while initial treatment and stabiliza-
tion of the TBI patient will likely occur in the
controlled setting of the hospital, the true test of
success will be the patient's ability to re-insert him/
herself into their pre-injury lives. These long-term
efforts will occur at home and in communities that
may be distant from institutions staffed with the
new Work
Traumatic Brain Injury (TBI) is the “signature
wound” of soldiers returning from Iraq and Af-
ghanistan theaters of conflict. Due to the increased
use of explosive devices, although improved body
armor and helmets save lives, facial exposure
during combat results in symptoms of TBI in
soldiers who live through trauma that would have
otherwise been fatal.
Initial TBI treatment TBI aims to sustain life
and prevent further injury. Chronic care requires
re-habilitation and use of assistive technologies
that will enable victims to live as independently
as possible after they have returned to their homes
and communities.
TBI victims experience a range of chronic
symptoms that may include confusion, headache,
fatigue, trouble sleeping, irritability, anger, depres-
sion, withdrawal, altered response, and reduced
cognition. While the aim of chronic care and
rehabilitation is recovery and independent living,
short-term achievements that facilitate these out-
comes include the ability to socialize, restoration of
self-esteem, amelioration of depression and other
emotional issues, re-learning to communicate, to
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