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: 1.43). 02/2007; 44(7):1027-34.
Source: PubMed


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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    • "Jenewein et al. (2009) have referred to this combination of traumatic physical and psychological injuries as " polytrauma " . Lew et al. (2007) found that 97% of a sample of outpatients with polytrauma identified pain as a presenting problem. Most of the time with traumatic brain injury (TBI), this is headache, often accompanied by other symptoms. "

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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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    • "Now, with the wars in Afghanistan and Iraq, among other conflicts , those numbers have appeared to change and the needs seem much more clear. There are likely over 100,000 veterans who are currently in the United States who have an injury from wars from 2001 to 2011 (Frain, Tschopp, Lee, & Rolland, 2012; Kang, Natelson, Mahan, Lee, & Murphy, 2003; Lew et al., 2007). But even that number is dwarfed in comparison to some other disabilities, over a million people are living with HIV in the United States, and over 3 million individuals are diagnosed with autism. "
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    ABSTRACT: Veterans with disabilities have gained national attention in recent years because of the wars in Iraq and Afghanistan. This study examined certified rehabilitation counselors' (CRCs) knowledge and preparation for working with veterans with disabilities on their rehabilitation. Results indicate that CRCs report low levels of preparation in some of the areas deemed important by veterans and professionals. However, CRCs report high knowledge in many important areas to work effectively with veterans with disabilities.
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