Soldiers with Occult Traumatic Brain Injury

Lew, Henry L.; Poole, John H.; Alvarez, Stéphanie; Moore, William P.

doi:10.1097/01.phm.0000163703.91647.a7

Cited by 52 publications

(44 citation statements)

References 18 publications

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“…The following elements are essential to the sequential assessment and treatment of postconcussion symptoms: (1) complete description of altered consciousness and history of functioning from immediately after potential injury events to the present, (2) counseling that targets postconcussion symptoms as early as possible by instilling coping and adaptive strategies, (3) psychotherapy and medical treatments to address any continuing conditions that affect cognitive functions and are potentially reversible (emotional disorders; vision, hearing, and vestibular impairments; orthopedic needs), and (4) comprehensive neuropsychological evaluation to guide further rehabilitation if cognitive difficulties continue despite these interventions or are atypical of known comorbidities. Thus, in serving this initial cohort of PNS patients, we developed invaluable collaborations with numerous professionals in the healthcare system, including the National Center for PTSD, and primary care and mental health clinicians in VA centers throughout the Palo Alto VA's catchment area.…”

Section: Discussionmentioning

confidence: 99%

“…However, the steady influx of new patients presents a challenge to the system. This challenge arises not only from the increased demand for clinical services but also from returning soldiers' complex combat-related injuries, which were not typically seen in prior wars [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…As a result of major advances in body armor technology and battlefield medicine, many military personnel are now surviving injuries that would have been fatal in previous wars [1][2]. In particular, the conflicts in Iraq and Afghanistan have resulted in a new generation of combat survivors who frequently have complex physical injuries and emotional trauma [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Military and VA telemedicine systems for patients with traumatic brain injury

Lew

Poole²,

Vanderploeg³

et al. 2007

JRRD

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143

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Abstract-The conflicts in Iraq andAfghanistan have resulted in a new generation of combat survivors with complex physical injuries and emotional trauma. This article reports the initial implementation of the Polytrauma Network Site (PNS) clinic, which is a key component of the Department of Veterans Affairs (VA) Polytrauma System of Care and serves military personnel returning from combat. The PNS clinic in Palo Alto, California, is described to demonstrate the VA healthcare system's evolving effort to meet the clinical needs of this population. We summarize the following features of this interdisciplinary program: (1) sequential assessment, from initial traumatic brain injury screening throughout our catchment area to evaluation by the PNS clinic team, and (2) clinical evaluation results for the first 62 clinic patients. In summary, this population shows a high prevalence of postconcussion symptoms, posttraumatic stress, poor cognitive performance, head and back pain, auditory and visual symptoms, and problems with dizziness or balance. An anonymous patient feedback survey, which we used to fine-tune the clinic process, reflected high satisfaction with this new program. We hope that the lessons learned at one site will enhance the identification and treatment of veterans with polytrauma across the country.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Military and VA telemedicine systems for patients with traumatic brain injury

Lew

Poole²,

Vanderploeg³

et al. 2007

JRRD

Self Cite

143

View full text Add to dashboard Cite

show abstract

“…As of May 2010, over 31,800 U.S. servicemembers have been wounded in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) [6]. Injuries caused by IEDs are associated with the unusually high prevalence of traumatic brain injury (TBI) [7] and PTSD among the injured [8][9], conditions that are likely to present substantial challenges in reintegrating into community roles. Data suggests that OIF/OEF service will negatively affect a far greater number of persons beyond those counted in the combat casualty statistics, with upwards of 790,000 veterans expected to seek disability benefits for service-related health problems [10].…”

Section: Introductionmentioning

confidence: 99%

Measurement of community reintegration in sample of severely wounded servicemembers

Resnik¹,

Gray²,

Borgia³

2011

JRRD

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Abstract-The Community Reintegration of Servicemembers (CRIS) is a new measure of community reintegration. The purpose of this study was to test the CRIS with seriously injured combat veterans. Subjects were 68 patients at the Center for the Intrepid. Each patient completed three CRIS subscales, the 36-Item Short Form Health Survey for Veterans (SF-36V), the Quality of Life Scale (QOLS), and two Craig Handicap Assessment and Reporting Technique subscales at visit 1 and the 3-month follow-up. Of the patients, 11 also completed the measures within 2 weeks of visit 1. We abstracted diagnoses and activities of daily living from the medical record. We evaluated test-retest reliability using intraclass correlation coefficients (ICCs). We evaluated concurrent validity with Pearson product moment correlations. We used multivariate analyses of variance to compare scores for subjects with and without posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and depression. Responsiveness analyses evaluated floor and ceiling effects, percent achieving minimal detectable change (MDC), effect size (ES), and the standardized response mean (SRM). CRIS subscale ICCs were 0.90 to 0.91. All subscales were moderately or strongly correlated with QOLS and SF-36V subscales. CRIS subscale scores were lower in PTSD and TBI groups (p < 0.05). CRIS Extent of Participation and Satisfaction with Participation subscales were lower for subjects with depression (p < 0.05). Of the sample, 17.4% to 23.2% had change greater than MDC. The ES ranged from 0.227 to 0.273 (SRM = 0.277-0.370), showing a small effect between visit 1 and the 3-month follow-up. Results suggest that the CRIS is a psychometrically sound choice for community reintegration measurement in severely wounded servicemembers.

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“…Now and for the coming decades, larger proportions of veterans will be from racial/ethnic minority groups and more likely to return with an ABI from war-torn countries like Iraq and Afghanistan. However, equally important to recognize is that military personnel in both combat and noncombat posts are at high risk for sustaining an ABI [34][35][36]. One study, for example, found that 23 percent of noncombat, Active Duty soldiers at Fort Bragg (n = 2,276) sustained an ABI during their military service [37].…”

Section: Minority Issues and Veteransmentioning

confidence: 99%

Community integration: Current issues in cognitive and vocational rehabilitation for individuals with ABI

Wehman¹,

Gentry²,

West³

et al. 2009

JRRD

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Abstract-In this article, we examine cognitive and vocational rehabilitation and the issues related to minority veterans with acquired brain injury (ABI). As more servicemembers are returning from conflict, ways to help them repair their lives, not only physically but also socially and economically, are increasingly needed. The challenges of ABI are multifactorial; that is, the problems are not just cognitive or emotional but spill over into community living and vocational issues. Individuals from racial/ethnic minority backgrounds often face even more difficulties. Therefore, we review the nature of cognitive and vocational rehabilitation and suggest areas for additional research.

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Soldiers with Occult Traumatic Brain Injury

Abstract: Lew HL, Poole JH, Alvarez S, Moore W: Soldiers with occult traumatic brain injury. Am J Phys Med Rehabil 2005;84:393-398.

Cited by 52 publications

References 18 publications

Military and VA telemedicine systems for patients with traumatic brain injury

Military and VA telemedicine systems for patients with traumatic brain injury

Measurement of community reintegration in sample of severely wounded servicemembers

Community integration: Current issues in cognitive and vocational rehabilitation for individuals with ABI

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