Cell Phones: Answering the Call for TBI Patients

Could cell phones play a key role in treating traumatic brain injury' A robust group of clinical, technology, and research experts working out of the Telemedicine and Advanced Technology Research Center (TATRC) would argue yes. The concept, created by Col. Ron Poropatich, M.D., involves upgrading personal cell phones with unique software that would enable case managers and staff in care facilities to send targeted reminder messages to individuals regarding their specialized treatment plans.

The system is simple yet has the potential to create lasting change in warrior care. Right now, the plan targets community-based warrior transition units (CBWTUs), which provide outpatient care to Army National Guard and Reserve members with TBI after they are released from inpatient medical facilities. To date, eight CBWTUs exist, located in the North Atlantic and Southeast regions of the U.S. This study is being conducted through three CBWTUs located in Rock Island, Ill., Virginia Beach, Va., and Concord, Mass. Additional CBWTUs will be added as the project progresses.

"A formal communications structure was set up well in advance to ensure smooth transfer of information and coordination between the oversight team and the CBWTUs," says project manager Holly Pavliscsak. Medical directors, platoon sergeants, case managers and project liaisons in each of the CBWTUs are all involved in managing the Web-faced portal, which serves as a database for message distribution and monitoring.

Through the program, every eligible soldier that comes into one of the designated CBWTUs will have his or her personal cell phone upgraded with the mCare application. Once upgraded, the phones will receive SMS text messages announcing new treatment and program information, when available, and appointment reminders, when applicable. Even with the special software, cell users must open the secure application by entering a password before being able to access the appointment reminders, as well as important health and medical information related specifically to their treatment plan.

A Phased Release

The project is set to roll out in four different phases. The first phase, performance improvement, began on February 27. It will implement the application on the cell phones of soldiers at the three community-based warrior transition units; principally measure appointment no-show rates; and evaluate if appointment notifications sent to cell phones increases the likelihood that service members keep their appointments.

Phase II involves a formal research study, headed by research team leader James Tong, and consists of full spectrum messaging and expansion of the program to two additional CBWTUs in Florida and Arkansas.

Depending on the success of Phases I and II, Phases III and IV involve an expansion of the program to the remaining three CBWTUs, as well as additional warrior-treatment facilities. Additional upgrades to the cell phone application will be made at this time based on lessons learned in Phases I and II, as well as recommendations for program improvement from Army and DoD personnel.

For TBI patients, who frequently experience treatment disruption because of cognitive and functional impairments, this may be just the solution. In addition to memory loss related to TBI, "patients seen at CBWTUs suffer from a wide variety of functional limitations; headache, sensitivity to light, ringing in ears, nausea, blurred vision, trouble reading, balance problems, trouble with sleep, nightmares, depression, mood swings," according to Technical Team Leader and Contracting Officers Representative Jeanette Rasche. These limitations interfere greatly with their ability to manage their care and remember their appointment schedule.

By sending reminders and updates via cell phone, patients will be less likely to forget critical steps in their treatment and more likely to stay on track. Furthermore, Rasche says, "if a soldier responds to certain questions related to his health and how he is feeling negatively, when he speaks with his case manager, instead of [the case manager] having to ask those questions all over again, the case manager can immediately move into why he is feeling the way he is. It is about empowering the quality of those interactions."

For the time being, minimizing impediments to treatment programs and care for patients is of utmost concern. Rasche says, "Even if they don't have a formal diagnosis [of TBI], just the fact that they are a warrior in transition means they can benefit from mCare."