Polytrauma/Traumatic Brain Injury (TBI) - VAMC Manchester, New Hampshire
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VAMC Manchester, New Hampshire


Polytrauma/Traumatic Brain Injury (TBI)

Offers assessment and treatment by staff Physiatrist, Neurologist, and Neuropsychologist. Also on staff is a full-time Social Worker to assess and assist with psycho-social issues and a full Rehab team to assess and treat for physical injury and/or functional loss.

Polytrauma Support Clinic Teams (PSCT) provide interdisciplinary outpatient rehabilitation services in their catchment areas for Veterans and Service Members with mild and/or stable impairments from polytrauma and TBI. Services include comprehensive TBI evaluations, outpatient therapy services, management of stable rehabilitation plans referred from Polytrauma Rehabilitation Centers (PRC) and Polytrauma Network Sites (PNS), coordinating access to VA and non-VA services, and follow-up care and case management for ongoing rehabilitation needs.

Traumatic Brain Injury (TBI) may happen from a blow or jolt to the head or an object penetrating the brain. When the brain is injured, the person can experience a change in consciousness that can range from becoming disoriented and confused to slipping into a coma. The person might also have a loss of memory for the time immediately before or after the event that caused the injury. Not all injuries to the head result in a TBI.

Polytrauma occurs when individuals have sustained TBI (traumatic brain injury) and other physical injuries, such as hearing or vision loss, or spine and limb injuries. These injuries can cause physical, cognitive (thinking and memory), emotional, and social problems that affect individual’s daily lives.

Our clinic is comprised of Neurologists, Neuropsychologist, Speech Language Pathologist, Nurse and Social Worker Case Managers.

The purpose of TBI/Polytrauma Clinic is to better understand any physical, cognitive, and emotional problems you may be having, to assess whether these symptoms are related to TBI, and to make recommendations for appropriate treatment needs.

If you are interested in admission to our Polytrauma Network Site or want to schedule an evaluation, please contact your VA primary care provider, or our clinic for further information. We can be reached at 603-624-4366 ext. 1960 or ext. 6455.

Understanding Traumatic Brain Injury

What is TBI?

Traumatic Brain Injury (TBI) may happen from a blow or jolt to the head or an object penetrating the brain. When the brain is injured, the person can experience a change in consciousness that can range from becoming disoriented and confused to slipping into a coma. The person might also have a loss of memory for the time immediately before or after the event that caused the injury.  Not all injuries to the head result in a TBI. 

How Does TBI Happen?

TBI can come from:

  • The head being struck by an object, such as a bat or a fist during a fight
  • The head striking an object, such as the dashboard in a car accident or the ground in a fall, or
  • The head being affected by a nearby blast or explosion.

How severe is a TBI?

Severity of the TBI is determined at the time of the injury and is based on:

  • Length of the loss of consciousness
  • Length of memory loss or disorientation
  • How responsive the individual was after the injury, for example, whether they were able to follow commands

The severity of the injury ranges from mild (a brief disorientation or loss of consciousness) to severe (an extended loss of consciousness or a penetrating brain injury, like a gunshot wound to the head).  Mild TBI is also known as concussion.

Severity of TBI is a continuum and the particular classification used to designate a person as having mild, moderate or severe injury can be somewhat arbitrary.  The severity level has prognostic value, in the sense that persons with more severe TBI tend to have more difficulty making complete recovery. However, it does not necessarily define the person's likelihood of recovery.  

What are the consequences of TBI?

TBI can cause a number of difficulties for the person who is injured. This can include physical changes, changes in the person’s behavior, or problems with their thinking skills. After an injury, a number of symptoms might be noted including headaches, dizziness/problems walking, fatigue, irritability, memory problems and problems paying attention. These changes are often related to how severe the brain injury was at the time of injury.

Where can I get care for TBI?

The Veterans Health Administration has a Polytrauma System of Care to treat and care for Veterans with TBI alone or in combination with other injuries and health conditions.  Depending on their health care needs, Veterans with TBI can receive treatment at one of the specialized rehabilitation programs in the Polytrauma System of Care, or they can seek treatment through their local VA Medical Center or community healthcare providers. 

Treatments for TBI focus on the symptoms that cause most problems seen in everyday life. These can include:

  • Medications specific to symptoms
  • Learning strategies to deal with health, cognitive, and behavioral problems
  • Rehabilitation therapies (such as physical therapy, occupational therapy, speech-language therapy)
  • Assistive devices and technologies     
  • Case management for re-integration and/or psycho-social factors

Recovery and Rehabilitation

After TBI and polytrauma, the body begins a remarkable repair process. Recovery tends to follow an accelerating curve, which is most rapid in the first three months to a year after the injury, but continues at a slower pace for years later. There is, however, considerable individual variability in the recovery curve, so that it is difficult to predict the pattern, time course or ultimate extent of recovery in a given individual.

Here, at the Manchester VA, teams of rehabilitation specialists with expertise in TBI and polytrauma are available to complete comprehensive assessments and develop Plans of Care focused on community re-integration needs.

Our outpatient TBI and polytrauma clinic emphasizes improvement of symptoms (such as managing headaches, pain, sleep) and training in using strategies and assistive technology devices to manage difficulties in performing activities of daily living. In addition to rehabilitation services, veterans and service members recovering from TBI and polytrauma also receive treatments through other clinical services including: primary care, mental health, social work, driver's rehabilitation, vocational counseling, and others, as appropriate.

Additionally, case managers are assigned to veterans and service members participating in rehabilitation care to assist with coordination of services and resources and to ensure effective communication among service providers and veterans, service members, and their families or caregivers

For more information on other rehabilitation options, click here: https://www.polytrauma.va.gov/about/Treatment_Settings_and_Services.asp 

Caregiving Tips – Traumatic Brain Injury

What is Traumatic Brain Injury?

Traumatic brain injury (TBI) happens when something hits the head hard or makes it move quickly. Injuries may be due to blasts in combat, or as a result of motor vehicle accidents, falls, falling or flying objects, or assaults. TBI is called “mild,” and may also be referred to as a concussion, when there is a brief change in awareness or consciousness at the time the injury occurs. It is called “moderate” or “severe” when there is a longer period of unconsciousness or amnesia, which means memory loss. The initial injury does not necessarily predict what long-term symptoms an individual may have.

  • Treatment may include: rehabilitation therapies, exercise and other activities, medication, education and support.

Physical and Mental Changes to Expect:

There are some common physical and thinking changes that can occur with TBI depending on the type and severity of the injury. Some symptoms may be present immediately, while others may appear later. The Veteran’s symptoms and course of recovery may differ from others with a similar type of injury. One individual may recover with little remaining problems, while others experience symptoms that can last for days, weeks, or sometimes longer. In general, recovery from TBI is slower for older individuals, and for those who have had a previous brain injury. For individuals with a more severe TBI, there may be lifelong changes to or problems with physical, emotional or cognitive (thinking) functioning.

  • Physical changes may include: problems with vision, weakness and coordination, as well as headaches, dizziness, fatigue, pain, and sleep disturbances.
  • Thinking changes may include: memory and learning problems, decreased concentration, problems with judgment, and slower thinking.
  • Emotional changes may include: irritability, problems managing anger or frustration, depression, anxiety, adjustment difficulties, and problems with social functioning.

What Does This Mean for Me?

Family Caregivers play an important role in recovery. In fact, many people who work with TBI patients believe that having a Family Caregiver is one of the most important aids to recovery. You can offer support, encouragement and guidance to your injured family member, and help ensure the treatment plan established by the medical professionals caring for the Veteran is followed.

At times, you may feel overwhelmed, angry or scared. You may also feel alone, or feel worn out by caregiving responsibilities. These reactions are normal and typically come and go. If you feel like there is just too much to deal with, seek help either by confiding in a friend, participating in a support group or consulting a professional mental health practitioner.

Caregiving Tips

  • It is often difficult for an individual with TBI to multitask, so give one instruction at a time. Try using lists and memory notebooks. A calendar is also a helpful tool to organize daily tasks.
  • Be sensitive to the issue of fatigue. If your family member seems tired or overwhelmed, suggest they take a break.
  • Establish a routine in which your family member pre-plans activities for the day. Scheduling the most important activities for the morning is a good idea, because energy levels tend to decline over the course of the day. Remember that your loved one will have good days and bad days, both emotionally and physically. This is a normal part of recovery.
  • Know what resources are available and reach out to friends, family, and professionals. VA can help you learn about available resources at www.caregiver.va.gov.
  • Attend visits to the medical provider with your family member and provide detailed information about the Veteran’s progress and challenges. Ask questions and take notes.
  • Be supportive and patient, but also remember to take care of yourself. If you find yourself completely overwhelmed or you feel yourself “losing it,” take a moment and call someone — a friend, a family member, or VA’s Caregiver Support Line (1-855-260-3274) are all good places to start. Support groups may also be available in your community or at your local VA.
  • Visit your doctor regularly, and get plenty of rest so you can stay strong. Remember, you are doing the best you can and you are making a difference in your loved one's life.

Need Help?

Caregiver Support Coordinator

Your Manchester VA Caregiver Support Coordinator is a licensed professional who can support you by matching you with services for which you are eligible, and providing you with valuable information about resources that can help you stay smart, strong and organized as you care for the Veteran you love. At the Manchester VA, our Caregiver Support Coordinator is Polly Bernard; she can be reached at 603-624-4366 ext. 2524.

Caregiver Support Line

With VA's Caregiver Support Line – 1-855-260-3274 – assistance is just a quick phone call away. If you're just getting started with VA, calling the Caregiver Support Line is a great first step to take to learn more about the support that's available to you.*Link will take you outside of the Dept. of Veterans Affairs (VA) Website. VA does not endorse and is not responsible for the content of the linked websites.

There are various resources that can assist with TBI/Polytrauma

Concussion Coach

Concussion Coach is a mobile phone application for Veterans, Servicemembers, and others who have experienced a mild to moderate concussion. It provides portable tools to assess symptoms and to facilitate use of coping strategies.

Find more information here: Concussion Coach Mobile App 

A Head for the Future: A Defense and Veterans Brain Injury Center (DVBIC) Initiative

A Head for the Future provides resources to help the military community prevent, recognize and recover from traumatic brain injury (TBI). Learn about TBI, and watch the videos of service members and veterans who recognized TBI symptoms and got help: http://dvbic.dcoe.mil/aheadforthefuture

Brain Injury Association of New Hampshire

The Brain Injury Association of New Hampshire is the only state-wide organization in New Hampshire dedicated to brain injury and stroke support, prevention, education, and advocacy for survivors and caregivers.

For more information, check out their website at http://www.bianh.org/ They can also be reached at their direct line @ 603-225-8400.

 Krempels Center: New Life After Brain Injury

Krempels Center is a nonprofit organization dedicated to improving the lives of people living with brain injury from trauma, tumor or stroke. In partnership with universities and community volunteers, they offer programs that engage our members in meaningful and productive experiences and provide ongoing support and resources to survivors and their families.

More information can be found on their website: https://www.krempelscenter.org/

Northeast Passage

The mission of Northeast Passage is to create an environment where individuals with disabilities can enjoy recreation with the same freedom of choice, quality of life, and independence as their non-disabled peers. We strive to create an open and welcoming environment for Veterans in all of our programs and Veterans from all eras and with any disability are encouraged to participate in this program. Most options are provided at no cost to Veterans & Members of the Armed Forces through funding from the United States Department of Veterans Affairs, the Bob Woodruff Foundation and Operation Hat Trick. To find out schedules and notices of upcoming events – join our Veteran Email List. Find their website here.

Veterans Crisis Information

Mental Health Support/Veterans Crisis Line

Many Veterans with Polytrauma injuries also need mental health support. If you or someone you know is having trouble readjusting to civilian life, is having trouble sleeping, or is experiencing mood swings, depression, or other signs of extreme stress, we can offer free or low-cost assistance and care.

Veterans Crisis Line:

For immediate help, call the National Veterans Crisis Line at 1-800-273-TALK (8255). Your call is confidential and can also be anonymous. Or, you may have a confidential online conversation with a professional on the National Veterans Crisis Line Web Chat site.


The goal of the homeless recovery program is to assist homeless Veterans in accomplishing meaningful goals for housing, employment, recovery (both mental health and substance abuse) and independent living. The program integrates both VA-based and/or community based programs and services, according to each Veteran's needs and preferences.

Contact information is below:

Website: Homeless Veterans

Phone Number: 603-624-4366 X6883

*They also have Homeless Walk-In Hours Monday thru Friday from 1300-1400 located on the 5th floor.