Mild to moderate traumatic brain injury clinic
About the clinic
The Traumatic Brain Injury Clinic is comprised of an interdisciplinary team which includes a psychiatrist with knowledge and clinical skills in adult neuropsychiatry, a youth psychiatrist, a physical medicine and rehabilitation physician (also known as a physiatrist), and a clinic coordinator with a clinical background in occupational therapy. The clinic also has a well-recognized research component, and our extended team includes research coordinators.
The clinic provides specialized and targeted neuropsychiatric evaluations and follow-up for individuals who are 14-64 years of age and who have acquired a mild to moderate traumatic brain injury.
We are dedicated to the provision of person-centred care and strive to provide an evidenced-based approach for the early assessment, diagnosis and management of the physical, emotional, behavioural, cognitive, psychological and psychiatric symptoms following mild to moderate traumatic brain injury.
What to expect during your visit to the clinic
You will initially meet with the occupational therapist/clinic coordinator and the clinic physician (a psychiatrist with knowledge and clinical skills in neuropsychiatry). They will collect background information; ask you about your present symptoms; and assess for any possible difficulties in social, occupational, interpersonal and leisure life that you may be having after your injury. Given that concurrent or pre-existing medical or psychological difficulties could impact recovery, questions will also be asked about any prior medical, psychiatric or psychological issues you may have. The clinic doctor will make a diagnostic assessment and will provide recommendations for treatment and rehabilitation of your traumatic brain injury symptoms.
You will be given education about traumatic brain injury and its associated symptoms, expected time of recovery, and possible risk factors that may contribute to persistent symptom. You will also be provided with suggestions and strategies on how to cope with your symptoms, help your recovery and return to daily activities including work, school or leisure activities.
A plan of care will be mutually developed with you and your health care and rehabilitation providers.
Your plan of care may include:
- additional medical/diagnostics tests
- referrals for consultation with other specialists or medical services
- coordinating appropriate treatment/therapy, rehabilitation and other community services (OHIP funded and third party funded services)
Additional appointments in the Traumatic Brain Injury Clinic will be scheduled based on:
- your needs
- an evidence-based framework that is based on expected recovery
- evolution of symptoms and the availability of the clinic
Typically, patients undergo an initial assessment, followed by reassessments that occur every three months, up to a maximum of one year from the time of their target injury.
We are situated in an acute care hospital and service one of the biggest and busiest tertiary trauma centres in Canada. As such, we can only see, manage and treat patients on an acute basis with time-limited follow-up that cannot extend beyond one year.
How to get referred to the clinic
All new patients must be referred by physicians only
Referrals must be made within three months of the target injury.
If you are a patient that was seen in the Emergency Department at Sunnybrook, or if you were admitted to Sunnybrook for your brain injury, your treating or assessing doctor may make a direct referral to the clinic. Patients can be referred internally for post-discharge follow up or by their family doctor by faxing a referral letter to 416-480-4613.
All community referrals (patients who have not seen a doctor at Sunnybrook for their injury) must be made through the Acquired Brain Injury (ABI) Network which oversees referrals for all ABI services within the GTA. Admission criteria for the Traumatic Brain Injury Clinic are outlined on the ABI Network website.
Our office will call the patient with information about the first appointment. Our office will also contact the referring doctor with the appointment date and time.
The clinic’s preference is that external referrals are received directly from the patient’s family doctor. At a minimum, the family doctor must be informed and in agreement with the referral by the referring physician. Our clinic works with family doctors in a collaborative model of care, in order to ensure coordination of care, and to optimize the chances for recovery.
Patients who do not have a family doctor at the time of the referral should be counseled by the referring physician about how to obtain access to a family doctor or family health care team.
To avoid duplication, patients who are referred to inpatient brain injury rehabilitation units, and/or patients who are referred to other brain injury clinics, will not be seen in the Traumatic Brain Injury Clinic. Patients with individual symptoms that can be served by single services will also not be seen in the Traumatic Brain Injury Clinic.
About our research
The Traumatic Brain Injury Clinic has a large database of imaging findings from structural high-resolution magnetic resonance imaging (MRI), including diffusion tensor imaging sequences, and functional resting neuroimaging (single photon emission computerized tomography or SPECT). These scans contain a wealth of information that enables carrying out longitudinal studies exploring the relationship between neuroimaging findings, clinical and neuropsychological findings, treatment and rehabilitation and prognosis and outcome.
So far, research on TBI has provided novel insights into the trajectory of symptoms, outcome and prognosis, and response to treatment or rehabilitation. It has provided novel data about:
- prevalence of mood disorders in mild TBI
- predictors of poor outcome in mild TBI
- link between mood and cognition
- link between sleep disorders and TBI outcome
- link between classifying parameters for the severity of TBI and the development of post-traumatic stress disorder symptoms
- role of litigation in modulating outcome
- early functional neuroimaging changes in TBI with associated mood symptoms
Scientists are now trying to create new therapies and rehabilitation methods to improve the outcomes of patients with mild to moderate TBI and develop markers for predicting and quantifying response.
If you require more information or have clinical queries, please email Elke McLellan, at Elke.McLellan@sunnybrook.ca, or call 416-480-4095.
Location and Contact
Mild to Moderate Traumatic Brain Injury Clinic
Sunnybrook Health Sciences Centre
2075 Bayview Avenue
F-wing, ground floor, room 52
Toronto, ON M4N 3M5