Article

Program development and defining characteristics of returning military in a VA Polytrauma Network Site.

Physical Medicine and Rehabilitation Service, Department of Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, B117, Palo Alto, CA 94304, USA.
The Journal of Rehabilitation Research and Development (Impact Factor: 1.69). 02/2007; 44(7):1027-34.
Source: PubMed

ABSTRACT The conflicts in Iraq and Afghanistan 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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    • "One of the most common co morbidities of TBI is the disruption of normal sleep (Zeitzer et al., 2009). Sleep disturbances, such as insomnia, are very common following traumatic brain injury and have been reported in frequencies from 40% (Bushnik et al., 2008) to as high as 84% (Lew et al., 2007). Sleep disruption can be related to the TBI itself but may also be secondary to neuropsychiatric (e.g., insomnia, anxiety) or neuromuscular (e.g., pain) conditions associated with TBI or to the pharmacological management of the injury and its consequences. "
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    ABSTRACT: Study of insomnia and associated factors in Traumatic Brain Injury Objectives This study is designed to investigate prevalence and risk factors of insomnia in TBI. This study has also tried to explore the connection between insomnia with neuroanatomical localization of TBI as well as depression Design Prospective study Material and Method All eligible participants were evaluated initially after two week interval for first 4 weeks and monthly interval subsequently till one year. Demographic and injury characteristics of the participants were assessed on a self designed semi structured performa. Interviews focused on assessment of severity of TBI, insomnia and depression using GCS, ISI and PHQ-9 respectively. Results Total 204 patients were included, mean age was 33.34 years. 40.2% participants were found to have insomnia. None of the demographic variables were associated with insomnia except severity and duration of TBI. Moderate TBI patient (70.73%) had significantly higher occurrence of insomnia than the mild cases (19.67%) (P = 0.000, df 1). First three month after TBI witnessed more than half (63.41%) of those patient who had insomnia. This was found statistically significant (P < 0.017). Neuroanatomical localization was also correlated with insomnia. Cerebral contusion was the most common (40.24%) site of impact. Almost half (42.42%) of the patients with insomnia had multiple contusions. 32.84% of the study population had depression. No significant correlation could be established between depression and insomnia. Conclusion Insomnia is a prevalent condition after TBI requiring more clinical and scientific attention as it may have important repercussions on rehabilitation.
    Asian Journal of Psychiatry 04/2014; 8(1). DOI:10.1016/j.ajp.2013.12.017
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    • "). Lew et al. (2007) "
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    ABSTRACT: The nature of combat in Iraq and Afghanistan has resulted in high rates of comorbidity among chronic pain, posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI) in Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Although separate evidence-based psychological treatments have been developed for chronic pain and PTSD, far less is known about how to approach treatment when these conditions co-occur, and especially when they co-occur with mTBI. To provide the best care possible for OEF/OIF Veterans, clinicians need to have a clearer understanding of how to identify these conditions, ways in which these conditions may interact with one another, and ways in which existing evidence-based treatments can be modified to meet the needs of individuals with mTBI. The purpose of the present paper is to review the comorbidity of pain, PTSD, and mTBI in OEF/OIF Veterans, and provide recommendations to clinicians who provide care to Veterans with these conditions. First, we will begin with an overview of the presentation, symptomatology, and treatment of chronic pain and PTSD. The challenges associated with mTBI in OEF/OIF Veterans will be reported and data will be presented on the comorbidity among all three of these conditions in OEF/OIF Veterans. Second, we will present recommendations for providing psychological treatment for chronic pain and PTSD when comorbid with mTBI. Finally, the paper concludes with a discussion of the need for a multidisciplinary treatment approach, as well as a call for continued research to further refine existing treatments for these conditions.
    Journal of Clinical Psychology in Medical Settings 06/2011; 18(2):145-54. DOI:10.1007/s10880-011-9239-2 · 1.49 Impact Factor
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    • "Importantly, pain was the second most frequently reported impairment after cognitive deficits for both groups (Sayer et al., 2008). Lew et al. (2007) found that 97% of a sample of 62 outpatients with polytrauma identified pain as a presenting problem. For most individuals who suffer a TBI, headaches are the primary pain condition (Nicholson & Martelli, 2004), and they are typically accompanied by the other common symptoms of persistent postconcussive syndrome (i.e., fatigue, sensory disturbances, photophobia, phonophobia, sensitivity, memory and executive functioning deficits, attention/concentration deficits, and emotional distress). "
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    ABSTRACT: Chronic pain conditions are common sequelae of traumatic brain injury (TBI). Unfortunately, the incidence of TBI among personnel deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) is significant, and there is growing evidence that ongoing pain, particularly headaches, will be a primary concern for these individuals. This article synthesizes empirical data from civilian and veteran populations and clinical experience with OEF/OIF personnel with polytrauma to provide recommendations for the assessment and treatment of chronic pain among those with TBI. The available data signal the need for the incorporation of early and aggressive pain management strategies into existing treatment models. Challenges to providing effective pain management for OEF/OIF veterans are numerous and include comorbid cognitive, medical, and emotional impairments that complicate readjustment to civilian life. It is likely that the problem of polytrauma pain and associated comorbid conditions such as posttraumatic stress disorder and postconcussive syndrome will require the development of integrated approaches to clinical care which bridge traditional subspecialty divisions. A proposed model of treatment is presented.
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